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Criteria of a Pharmacologic Withdrawal Syndrome-Reply

John R. Hughes, MD; Dorothy K. Hatsukami, Phd
Arch Gen Psychiatry. 1987;44(4):392. doi:10.1001/archpsyc.1987.01800160108017.
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In Reply.—  If self-medication is defined as using a drug to abate symptoms other than withdrawal symptoms, there are abundant data consistent with the first part of the hypothesis, ie, smokers self-medicate.1 However, this may occur even in smokers who do not have a preexisting abnormality; smokers may use nicotine not to correct a deficit but rather to improve on the norm.1There are also data consistent with the second part of Dr Goldstein's hypothesis, ie, some smokers have a preexisting abnormality. For example, adults with psychiatric disorders have a 50% to 200% increase in the prevalence of smoking.2 Smoking has also been associated with attention deficit disorder and conduct disorders in children.3 More importantly, prospective studies have shown that children who are impulsive or neurotic are more likely to begin smoking.4 Also consistent with this hypothesis are studies in twins and adopted children, which indicate that smoking is as heritable as alcohol use.5

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