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To the Editor: The recent World Health Organization (WHO)-sponsored survey of serious mental disorders reported 12-month prevalence rates of substance use disorders ranging from 0.1% to 6.4% across locales.¹ Although not explicitly stated, these rates appear to exclude nicotine dependence. For example, the US 12-month prevalence rate of nicotine dependence alone ranges from 7.0% to 9.0%,^2-3 yet the US 12-month prevalence rate of serious substance abuse/dependence in the WHO survey is 3.8%. Furthermore, since the current 12-month prevalence rate of tobacco use in several of the non-US countries surveyed by the WHO is 1.5 times the rates reported in the United States,⁴ 12-month prevalence rates of nicotine dependence in non-US countries are likely to be 10.0% or more.

Since most tobacco users are not able to stop despite repeated attempts, and half of tobacco users will die due to nicotine dependence–related disorders,⁴ it can be argued that nicotine dependence is . . . [Full Text of this Article]

John R. Hughes, MD
john.hughes@uvm.edu
Department of Psychiatry
University of Vermont
Burlington

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