How can we most usefully characterise nicotine and tobacco addiction?

The term ‘addiction’ has multiple meanings relating to an acquired ‘need’ for something. In some cases, it refers to a clinical syndrome characterised by a set of signs and symptoms including subjective, behavioural and physical phenomena. In other cases, it refers to a dimension of need that people can experience to varying degrees. The term ‘dependence’ is sometimes used synonymously with ‘addiction’ and sometimes differentiated from it, with addiction referring to a psychological need and dependence referring to a physiological need. These meanings serve different purposes and it is vital to be clear about which meaning one is referring to and to match that meaning to the purpose in hand.
When it comes to nicotine and tobacco addiction, the most important use is to understand and predict the success of quit attempts. Here, the evidence indicates that construing addiction as a dimension of psychological need is the most successful approach, assessed by measures such as the Fagerstrom Test for Cigarette Dependence (FTCD) and the Strength of Urges to Smoke Scale (SUSS). The physiological clinical syndrome approach, as assessed for example by DSM-V tobacco dependence criteria, performs poorly when predicting success of quit attempts. Evidence also indicates that it is crucial to distinguish between different nicotine and tobacco products and the context in terms of societal and population characteristics. It follows from this that the broad concept of ‘nicotine addiction’ as a clinical syndrome lacks empirical validity. Instead we should be focusing on dimensions of psychological need for specific nicotine and tobacco products in specific populations and contexts.