Our objective was to examine the evidence concerning the validity and reliability of the International Classification of Diseases criteria for tobacco dependence (ICD-TD). A literature search was conducted of 16 databases using the search terms addiction, cigarettes, Diagnostic and Statistical Manual of Disease, DSM, dependence, International Classification of Diseases, ICD, nicotine, smoking and tobacco. The search produced 37 relevant articles. We found no data supporting the predictive validity of the criteria, and none supporting the characterization of dependence as having a three-symptom threshold. We found no data concerning the validity or reliability of the official instrument, which inappropriately excludes nondaily smokers from being evaluated for dependence. We found no evidence that the ICD-TD diagnosis had been used for clinical decision making, in a smoking cessation study, or for longitudinal epidemiological surveillance. We contrast the utility of the ICD-TD criteria to an approach of diagnosing tobacco addiction on the basis of a single criterion of a compulsion to use tobacco.
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