The absence of DSM-IV nicotine dependence in moderate-to-heavy daily smokers

Background: Current theoretical models of nicotine dependence assume a close relationship between use and dependence; however, previous data suggest that many daily smokers fail to develop nicotine dependence. Objectives: To determine what percentage of daily smokers fail to meet DSM-IV criteria for nicotine dependence within their lifetime, how non-dependence relates to duration and quantity of cigarette use, and whether other tobacco use and/or specific dependence criteria differentiate never-dependent and dependent smokers. Methods: Cross-sectional data collected via personal interview from a nationally representative sample of 8213 past year daily smokers were analyzed. Results: Approximately 39.4% of daily smokers never reached nicotine dependence. While the probability of remaining non-dependent decreased with smoking quantity and duration since the onset of daily smoking, a substantial portion of individuals (37.7%) who reported smoking >= 10 cigarettes per day and began smoking daily >= 10 years prior, remained never nicotine dependent. Conclusions: The absence of nicotine dependence in heavy daily smokers may result from limitations in the measurement of dependence and/or nicotine exposure. Alternatively, some individuals may be relatively resistant to becoming nicotine dependent despite extensive use. The latter explanation would have important implications for understanding the nature of nicotine dependence. (c) 2007 Elsevier Ireland Ltd. All rights reserved.