Strength of the relationship between tobacco smoking, nicotine dependence and the severity of alcohol dependence syndrome criteria in a population-based sample

Aims: Little is known about the relationship between current and past smoking behaviour and the severity of alcohol dependence. The purpose was to explore the strength of this relationship. Methods: A random population sample of 18 to 64 year-olds from northern Germany was used (n = 4075; participation rate: 70%). It included 761 cigarette smokers fulfilling at least one alcohol-dependence criterion. The severity of alcohol dependence according to the alcohol-dependence syndrome criteria frequency (ASF) was estimated by a standardized questionnaire based on diagnostic instruments of the alcohol dependence syndrome and which included five response categories, from 'never' to 'daily'. Nicotine dependence was diagnosed according to the Diagnostic and Statistical Manual of mental disorders (DSM-IV) with the Composite International Diagnostic Interview (CIDI). As a second measure, the Fagerström Test of Nicotine Dependence (FTND) was used. Results: The number of cigarettes and years of daily smoking, nicotine dependence, and the number of nicotine dependence symptoms each showed a relationship with the ASF. Effect size (w) were 0.17-0.21 for chi-squared (X²) tests. In a general linear regression model with the ASF as the dependent variable (R² = 0.17), number of years of daily smoking, age at onset of smoking, number of attempts to reduce or quit, the number of nicotine-dependence symptoms according to DSM-IV and the FTND sum score were retained as independent variables. Conclusions: Long-term smoking, a large number of nicotine-dependence symptoms according to DSM and a strong urge to smoke according to the FTND are related with a high ASF.