According to a new study from Penn State, most light smokers meet the criteria for nicotine addiction and should be considered for treatment. The researchers report that people who smoke as little as one to four cigarettes a day are likely addicted to nicotine.
“In the past, some considered that only patients who smoke around 10 cigarettes per day or more were addicted, and I still hear that sometimes,” said study lead author Professor Jonathan Foulds. “But this study demonstrates that many lighter smokers, even those who do not smoke every day, can be addicted to cigarettes. It also suggests that we need to be more precise when we ask about cigarette smoking frequency.”
Duke Professor Jason Oliver said that when assessing nicotine addiction, also known as tobacco use disorder, clinicians are encouraged to fully assess the 11 criteria listed in the 5th edition of the Diagnostic and Statistical Manual (DSM-5). As a shortcut, clinicians usually just ask smokers how many cigarettes they smoke per day, he explained.
“Lighter smoking is correctly perceived as less harmful than heavy smoking, but it still carries significant health risks. Medical providers sometimes perceive lighter smokers as not addicted and, therefore, not in need of treatment, but this study suggests many of them may have significant difficulty quitting without assistance.”
The researchers analyzed data from the National Institutes of Health, including the assessments of more than 6,700 smokers, to determine whether they met the DSM-5 criteria for tobacco use disorder. The study revealed that 85 percent of daily cigarette smokers were addicted to some extent, ranging from mild to moderate to severe addiction.
“Surprisingly, almost two thirds of those smoking only one to four cigarettes per day were addicted, and around a quarter of those smoking less than weekly were addicted,” said Professor Foulds.
The researchers found that the severity of cigarette addiction increased with the frequency of smoking. For example, 35 percent of light smokers and 74 percent of heavy smokers were moderately or severely addicted.
Professor Foulds said that this is the first time that the severity of cigarette addiction has been described across the full range of cigarette use frequency.
Professor Oliver noted that the study sheds light the high prevalence of tobacco use disorder even among those considered to be light smokers and provides a foundation for treating this population.
“Previous research has found that non-daily smokers are more likely than daily smokers to make a quit attempt,” said Professor Oliver. “Clinicians should ask about all smoking behavior, including non-daily smoking, as such smokers may still require treatment to successfully quit smoking. Yet, it is unclear the extent to which existing interventions are effective for light smokers. Continued efforts to identify optimal cessation approaches for this population remain an important direction for future research.”
The study is published in the American Journal of Preventive Medicine.