Unifying Concepts

DSM-5 Criteria for Tobacco Use Disorder

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), provides criteria for the diagnosis of tobacco use disorder, which falls under the category of substance-related and addictive disorders.

The DSM-5 outlines the following criteria for diagnosing tobacco use disorder:

A problematic pattern of tobacco use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

  1. Tobacco is often taken in larger amounts or over a longer period than was intended.
  2. There is a persistent desire or unsuccessful efforts to cut down or control tobacco use.
  3. A great deal of time is spent in activities necessary to obtain, use, or recover from the effects of tobacco.
  4. Craving, or a strong desire or urge to use tobacco.
  5. Recurrent tobacco use resulting in a failure to fulfill major role obligations at work, school, or home.
  6. Continued tobacco use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of tobacco.
  7. Important social, occupational, or recreational activities are given up or reduced because of tobacco use.
  8. Recurrent tobacco use in situations in which it is physically hazardous.
  9. Tobacco use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by tobacco.
  10. Tolerance, as defined by either a need for markedly increased amounts of tobacco to achieve intoxication or the desired effect or a markedly diminished effect with continued use of the same amount of tobacco.
  11. Withdrawal, as manifested by either the characteristic withdrawal syndrome for tobacco or the use of tobacco (or a closely related substance) to relieve or avoid withdrawal symptoms.

The severity of tobacco use disorder can be classified as mild, moderate, or severe depending on the number of criteria that are met. It is important to note that the diagnosis should be made by a qualified healthcare professional, such as a psychiatrist or psychologist, after a comprehensive assessment. Treatment for tobacco use disorder often involves a combination of behavioral therapies, pharmacological interventions, and support services.



  1. Shmulewitz D, Greenstein E, Stohl M, Fink DS, Roncone S, Walsh C, Aharonovich E, Hasin DS. Validity of the DSM-5 tobacco use disorder diagnostics in adults with problematic substance use. Drug Alcohol Depend. 2022 May 1;234:109411. [Medline]
  2. Baker TB, Breslau N, Covey L, Shiffman S. DSM criteria for tobacco use disorder and tobacco withdrawal: a critique and proposed revisions for DSM-5. Addiction. 2012 Feb;107(2):263-75. [Medline]


Created Oct 27, 2023.


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