Nicotine dependence and psychiatric disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions

Arch Gen Psychiatry. 2004 Nov;61(11):1107-15. doi: 10.1001/archpsyc.61.11.1107.


Background: No information is available on the co-occurrence of DSM-IV nicotine dependence and Axis I and II psychiatric disorders in the US population.

Objectives: To present national data on the co-occurrence of current DSM-IV nicotine dependence and other psychiatric disorders by sex and to estimate the burden of all US tobacco consumption carried by nicotine-dependent and psychiatrically ill individuals.

Design: Face-to-face interviews.

Setting: The United States.

Participants: Household and group-quarters adults (N = 43 093).

Main outcome measures: Prevalence and comorbidity of current nicotine dependence and Axis I and II disorders and the percentage of cigarettes consumed in the United States among psychiatrically vulnerable subgroups.

Results: Among US adults, 12.8% (95% confidence interval, 12.0-13.6) were nicotine dependent. Associations between nicotine dependence and specific Axis I and II disorders were all strong and statistically significant (P<.05) in the total population and among men and women. Nicotine-dependent individuals made up only 12.8% (95% confidence interval, 12.0-13.6) of the population yet consumed 57.5% of all cigarettes smoked in the United States. Nicotine-dependent individuals with a comorbid psychiatric disorder made up 7.1% (95% confidence interval, 6.6-7.6) of the population yet consumed 34.2% of all cigarettes smoked in the United States.

Conclusions: Nicotine-dependent and psychiatrically ill individuals consume about 70% of all cigarettes smoked in the United States. The results of this study highlight the importance of focusing smoking cessation efforts on individuals who are nicotine dependent, individuals who have psychiatric disorders, and individuals who have comorbid nicotine dependence and other psychiatric disorders. Further, awareness of industry segmentation strategies can improve smoking cessation efforts of clinicians and other health professionals among all smokers and especially among the most vulnerable.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Alcohol-Related Disorders / diagnosis
  • Alcohol-Related Disorders / epidemiology
  • Comorbidity
  • Confidence Intervals
  • Diagnosis, Dual (Psychiatry)
  • Female
  • Health Surveys
  • Humans
  • Male
  • Mental Disorders / diagnosis*
  • Mental Disorders / epidemiology*
  • Nicotiana / adverse effects
  • Personality Disorders / diagnosis
  • Personality Disorders / epidemiology
  • Prevalence
  • Smoking / epidemiology
  • Smoking / psychology
  • Smoking Cessation / methods
  • Smoking Prevention
  • Substance-Related Disorders / diagnosis
  • Substance-Related Disorders / epidemiology
  • Tobacco Use Disorder / diagnosis
  • Tobacco Use Disorder / epidemiology*
  • Tobacco Use Disorder / prevention & control
  • United States / epidemiology