Even light smokers could be addicted

"Lighter smoking is correctly perceived as less harmful than heavy smoking, but it still carries significant health risks," Jason Oliver says. (Credit: ian dooley/Unsplash)

Many light smokers, those who smoke one to four cigarettes per day or fewer, meet the criteria for nicotine addiction and should be considered for treatment, researchers report.

“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,” says Jonathan Foulds, professor of public health sciences and psychiatry and behavioral health at Penn State.

“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.”

When assessing nicotine addiction—clinically referred to as “tobacco use disorder”— clinicians are encouraged to fully assess the 11 criteria listed in the fifth edition of the Diagnostic and Statistical Manual (DSM-5), says Jason Oliver, assistant professor of psychiatry and behavioral sciences at Duke University. As a shortcut, clinicians more typically ask smokers how many cigarettes they smoke per day.

“Lighter smoking is correctly perceived as less harmful than heavy smoking, but it still carries significant health risks,” Oliver says. “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 examined an existing data set from the National Institutes of Health, including more than 6,700 smokers who had been fully assessed to find out if they met the DSM-5 criteria for tobacco use disorder. They found that 85% of the daily cigarette smokers were addicted to some extent—either mild, moderate, or 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,” Foulds says.

The researchers found that the severity of cigarette addiction, as indicated by the number of criteria met, increased with the frequency of smoking, with 35% of those smoking one-to-four cigarettes per day and 74% of those smoking 21 cigarettes or more per day being moderately or severely addicted.

“This was the first time that severity of cigarette addiction has been described across the full range of cigarette use frequency,” says Foulds, a Penn State Cancer Institute researcher.

The study highlights the high prevalence of tobacco use disorder even among those considered to be light smokers and provides a basis from which treatment can begin to target this population, Oliver says.

“Previous research has found that non-daily smokers are more likely than daily smokers to make a quit attempt,” he says. “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 findings appear in the American Journal of Preventive Medicine.

The National Institute on Drug Abuse supported the research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Foulds has done paid consulting for pharmaceutical companies involved in manufacturing smoking-cessation medications (e.g., GlaxoSmithKline, Johnson & Johnson) and has acted as a deposed and compensated expert witness on behalf of plaintiffs suing cigarette manufacturers.

Source: Penn State