Abstract
Rationale
With physical addiction to tobacco, abstinence triggers a desire to smoke. As physical addiction advances, the desire to smoke changes in quality and intensity from wanting, to craving, to needing. A prior study in adolescents suggested that this progression signifies increasing addiction.
Objective
We sought to determine if the sequential appearance of wanting, craving and needing provides an indication of the intensity of other markers of tobacco addiction including psychological and behavioral indicators.
Methods
A web-based survey was completed by 422 smokers ages 18–78 years. Subjects were assigned to one of four qualitatively distinct stages of physical addiction based on their most advanced symptom: 1—none, 2—wanting, 3—craving, or 4—needing. Using linear Chi square and ANOVA, we determined if higher stages were associated with higher levels of tobacco addiction on more than a dozen measures.
Results
16.8% of subjects were in stage 1, 26.1% in stage 2, 17.1% in stage 3 and 40.0% in stage 4. Each step up in stage was associated with higher levels of addiction as measured by the Fagerström Test for Nicotine Dependence, the Hooked on Nicotine Checklist, the Autonomy over Tobacco Scale, and higher levels of psychological dependence, duration of tobacco use, frequency of tobacco use, daily cigarette consumption, and 10 additional measures.
Conclusions
In this cross-sectional study, each sequential stage of physical addiction was associated with higher levels of every indicator of addiction. The data suggest that the stages of progression of physical addiction provide a global indication of the severity of tobacco addiction.
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References
Contreras G, O’Loughlin J, Rodriguez D, Wellman R, DiFranza J (2010) Measures of nicotine dependence in adolescents: an update of the evidence 2000–2010. Journal of Pediatric Biochemistry 1:143–163
DiFranza J, Ursprung W (2008) The latency to the onset of nicotine withdrawal: a test of the sensitization–homeostasis theory. Addict Behav 33:1148–1153
DiFranza JR, Wellman RJ (2005) A sensitization–homeostasis model of nicotine craving, withdrawal, and tolerance: integrating the clinical and basic science literature. Nicotine Tob Res 7:9–26
DiFranza J, Wellman R (2007) The hooked on nicotine checklist: a measure of diminished autonomy over tobacco. In: Goldfarb P (ed) Psychological tests and testing research trends. Nova Science, Hauppauge, pp 191–209
DiFranza J, Wellman R, Ursprung S, Sabiston C (2009) The autonomy over smoking scale. Psychol Addict Behav 23:656–665
DiFranza J, Ursprung W, Carlson A (2010) New insights into the compulsion to use tobacco from a case series. J Adolesc 33:209–214
DiFranza J, Sweet M, Savageau J, Ursprung W (2011) An evaluation of a clinical approach to staging tobacco addiction. J Pediatr: In press
Fernando W, Wellman R, DiFranza J (2006) The relationship between level of cigarette consumption and latency to the onset of retrospectively reported withdrawal symptoms. Psychopharmacology (Berl) 188:335–342
Heatherton T, Kozlowski L, Frecker R, Fagerström K (1991) The Fagerström test for nicotine dependence: a revision of the Fagerström tolerance questionnaire. Br J Addict 86:1119–1127
Hughes JR (2007) Effects of abstinence from tobacco: valid symptoms and time course. Nicotine Tob Res 9:315–27
MacPherson L, Strong D, Myers M (2008) Using an item response model to examine the nicotine dependence construct as characterized by the HONC and the mFTQ among adolescent smokers. Addict Behav 33:880–894
Moolchan ET, Radzius A, Epstein DH, Uhl G, Gorelick DA, Cadet JL, Henningfield JE (2002) The Fagerström test for nicotine dependence and the diagnostic interview schedule: do they diagnose the same smokers? Addict Behav 27:101–13
Morello P, Gershenson B, DiFranza J (2011) The retest reliability of nicotine dependence measures. Addiction Research and Theory: In press
PASW Statistics Version 17. SPSS Inc, Chicago
Rose JS, Dierker LC (2010) An item response theory analysis of nicotine dependence symptoms in recent onset adolescent smokers. Drug Alcohol Depend 110:70–9
Russell M (1971a) Cigarette dependence: I—nature and classification. Br Med J 2:330–331
Russell M (1971b) Cigarette smoking: natural history of a dependence disorder. Br J Med Psychol 44:1–16
Shiffman S, Sayette M (2005) Validation of the nicotine dependence syndrome scale (NDSS): a criterion-group design contrasting chippers and regular smokers. Drug Alcohol Depend 79:45–52
Strong D, Kahler CW, Colby S, Griesler P, Kandel D (2009) Linking measures of adolescent nicotine dependence to a common latent continuum. Drug Alcohol Depend 99:296–308
Ursprung S, Morello P, Gershenson B, DiFranza J (2010) Development of a measure of the latency to needing a cigarette. J Adolesc Health 48:348–343
Wellman R, DiFranza J, Savageau J, Godiwala S, Friedman K, Hazelton J (2005) Measuring adults' loss of autonomy over nicotine use: the hooked on nicotine checklist. Nicotine Tob Res 7:157–161
Wellman R, Savageau J, Godiwala S, Savageau N, Friedman K, Hazelton J, DiFranza J (2006) A comparison of the hooked on nicotine checklist and the Fagerström test of nicotine dependence in adult smokers. Nicotine Tob Res 8:575–580
Wellman R, McMillen R, DiFranza J (2008) Assessing college students' autonomy over smoking with the hooked on nicotine checklist. J Am Coll Health 56:549–553
Willis G, Caspar R, Lessler J (1999) Cognitive interviewing: a “how to” guide, Accessed June 22, 2011, http://appliedresearch.cancer.gov/areas/cognitive/interview.pdf. Research Triangle Institute
Acknowledgements
The authors wish to acknowledge the help of the administration of Fitchburg State University and Mississippi State University.
This work was supported by the University of Massachusetts Medical School.
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Funding was provided by the University of Massachusetts Medical School. The authors have no conflicts of interest to report.
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DiFranza, J.R., Wellman, R.J. & Savageau, J.A. Does progression through the stages of physical addiction indicate increasing overall addiction to tobacco?. Psychopharmacology 219, 815–822 (2012). https://doi.org/10.1007/s00213-011-2411-4
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DOI: https://doi.org/10.1007/s00213-011-2411-4