This paper highlights the complexities of the dependence concept as if relates to tobacco and nicotine. With cigarette smoking, the integrated complexity between the dependenceproducing drug (nicotine) and nonnicotine components have been discussed. These two different components are almost impossible to disentangle, and therefore, it is suggested that diagnosing and assessing degree of dependence is best accomplished with product-specific instruments. We acknowledge that arguing for product-specific assessment instruments also has downsides. Besides the need to keep track of different scales, the comparability would be lost if instruments were created separately for each product. If a continuum of dependence is a reality, it would be of great interest to have instruments, where the score independent of product would reflect degree of dependence, that is, comparability. We acknowledge that with product-specific instruments, comparability across products may be difficult. The other suggestion made is that when the totality of the dependence is measured, different forms of tobacco/nicotine products probably have different potential for dependence development. There might be a continuum of dependence where in one end, we find the cigarette and in the other end, NR products and particularly the patch formulation. If a particular product is far from cigarettes and close to NR on the continuum of harm and at the same time closer to cigarettes than NR on the continuum of dependence, this product may have considerable success in reducing the public health costs associated with cigarette use.
Citation
Fagerstrom. “Dependence on Tobacco and Nicotine Products: A Case for Product-Specific Assessment.” Nicotine & Tobacco Research 14, no. 11 (2012).
