Comorbidity of Mental Disorders and Nicotine Dependence-Reply

Darrel A Regier, MD, MPH; Lewis L. Judd, MD; Mary E. Farmer, MD, MPH; Donald S. Rae, MS; Ben Z. Locke, MSPH; Samuel J. Keith, MD; Frederick K. Goodwin, MD
JAMA. 1991;265(10):1257. doi:10.1001/jama.1991.03460100056017.
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In Reply.—  We appreciate Dr Hughes' concern that omitting reference to nicotine dependence from our analysis implied that smoking is "normal behavior" outside the purview of psychiatric research or clinical practice. Such an implication regarding a formally designated psychoactive substance use disorder (DSM-III-R 305.10), recently estimated by the Centers for Disease Control to account directly for an estimated 434 000 deaths annually,1 certainly was not intended by the authors.In the National Institute of Mental Health-Epidemiologic Catchment Area field study that provided the database for our analysis, time and logistic constraints dictated that inquiry regarding tobacco use be made only in two of five collaborating research centers. Independent analysis of data from one site2 supports findings from other population-based surveys3 that persons who meet criteria for major depression are more likely to smoke and have more difficulty in quitting smoking than those with no psychiatric history. However,


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