Smokers who have ONE cigarette a day can be ‘addicted to nicotine’

Even people who only light up as little as once a day — and think of themselves as casual smokers — can be addicted to nicotine and in need of treatment, a study said.

US experts studied more than 6,700 smokers who had been assessed for addiction — finding that two-thirds of those who smoked 1-4 cigarettes a day were addicted.

However, the team did note that the frequency of more severe addictions appeared to increase with the number of cigarettes smoked daily.

The findings, they concluded, stress the importance of properly evaluating the risk of addiction in all smokers — including those with more of a casual habit. 

‘In the past, some considered that only patients who smoke around 10 cigarettes per day or more were addicted, and I still hear that sometimes,’ said paper author and public health researcher Jonathan Foulds of Penn State University.

‘But this study demonstrates that many lighter smokers, even those who do not smoke every day, can be addicted to cigarettes.’

‘It also suggests that we need to be more precise when we ask about cigarette smoking frequency.’

When assessing people for nicotine addiction — or, tobacco use disorder, as it is formally known — doctors are supposed to use the 11-part criteria outlined in the fifth edition of the Diagnostic and Statistical Manual, or DSM-5, for short.

However, explained paper author and Duke University behavioural scientist Jason Oliver, clinicians often use the question ‘How many cigarettes do you smoke a day?’ as a diagnostic shortcut — but this can prove to be misleading.

‘Lighter smoking is correctly perceived as less harmful than heavy smoking, but it still carries significant health risks,’ Professor Oliver said. 

‘Medical providers sometimes perceive lighter smokers as not addicted and, therefore, not in need of treatment — but this study suggests many of them may have significant difficulty quitting without assistance.’

In their study, the researchers analysed an existing data set collected by the National Institutes of Health — which included information on more than 6,700 smokers who had been fully assessed for nicotine addition against the DSM-5 criteria.

They found that 85 per cent of the daily cigarette smokers were addicted to some degree — whether that was mildly, moderately or severely.

‘Surprisingly, almost two-thirds of those smoking only one to four cigarettes per day were addicted — and around a quarter of those smoking less than weekly were addicted,’ Dr Foulds said.

‘Surprisingly, almost two-thirds of those smoking only one to four cigarettes per day were addicted — and around a quarter of those smoking less than weekly were addicted,’ said paper author and public health researcher Jonathan Foulds of Penn State University

The researchers did find, however, that the severity of cigarette addiction appears to increase the more frequently people smoke.

In fact, 35 per cent of those smoking between one and four cigarettes a day being moderately or severely addicted, as compared to , and 74 per cent of those smoking more that 21 cigarettes on a daily basis.

‘Previous research has found that non-daily smokers are more likely than daily smokers to make a quit attempt,’ Oliver said. 

‘Clinicians should ask about all smoking behaviour, including non-daily smoking, as such smokers may still require treatment to successfully quit smoking.’

‘Yet, it is unclear the extent to which existing interventions are effective for light smokers. Continued efforts to identify optimal cessation approaches for this population remain an important direction for future research.’

The full findings of the study were published in the journal American Journal of Preventive Medicine.