New insights into the compulsion to use tobacco from an adolescent case‐series

Abstract

Nicotine addiction is the most common preventable cause of premature death presenting during adolescence. No prior study has described the onset of this condition based on case histories. We used trained personnel to conduct individual semi‐structured interviews to obtain case histories from 50 adolescent and young adult current and former smokers.Smokers experience a compulsion to use tobacco that spans a spectrum of severity from wanting, to craving, to needing. The compulsion is commonly experienced as originating foreign to the will of the smoker and recurs with a predictable periodicity that determines the latency from smoking one cigarette to wanting, craving or needing another. Novice smokers could experience latencies as lengthy as a few weeks, and more experienced smokers attributed their escalation in smoking frequency to the shortening of their latencies. Wanting, craving or needing tobacco, as described in this study, are pathognomonic for a compulsion to use tobacco.

Development of a Measure of the Latency to Needing a Cigarette

“…Consistent with published studies [1,4,5], the following has been noted: (1) Self-reported LTNC demonstrated a wide range across individuals, from 6 minutes to 4 weeks, and these values were logically consistent with the individuals' cigarette consumption.…”

“…Through case histories, focus groups, and real-time monitoring, we have established that smokers understand LTNC [1,2].…”

“…Case histories provide the basis for evaluating concurrent validity [1]. Smokers attribute escalation in tobacco use to a progressive reduction in the length of their LTNC over time [1]. A 21-year-old woman reported an LTNC of 2 days after smoking for 1-2 months at age 16.…”

“…Smokers describe the need for a cigarette as an urgent, intense, and intrusive craving that disrupts their mental functioning in such a way that they "need a cigarette" to feel normal again [1]. The need to smoke is a symptom of nicotine withdrawal, which emerges when a smoker goes too long without smoking.…”

“…Our purpose was to extend previous work related to LTNC [4,5] by evaluating a self-completed measure. Case histories provide the basis for evaluating concurrent validity [1]. Smokers attribute escalation in tobacco use to a progressive reduction in the length of their LTNC over time [1].…”