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Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly

The Four C's test for Nicotine Addiction

Purpose : The Four Cs test can be used to assess a patient's dependence on nicotine.


Admin time : 1-3 min

User Friendly :  High

Administered by : GP or nurse 


Content : Questions pertaining to tobacco use

Author : Unknown


Copyright :

Public domain. Free to use.

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The Four C's Test for Nicotine Addiction

The Four C's Test for Nicotine Addiction

Psychiatrists, psychotherapists, social workers and addiction counselors rely on criteria in the Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV) to diagnose substance dependence These criteria apply to all addictive substances (e.g., alcohol, opioids, cannabis, amphetamines) and can be grouped into four categories that conveniently begin with the letter “C”:


Addiction is a chronic dysfunction that involves the reward, motivation and memory systems in the brain.

To separate addiction from other neurological disorders, four factors must be present. These four factors, compulsion, craving, consequences and control, are unique to addiction alone and are classified as the 4 C's.


The behaviors of most addicts are very similar. This is why the 4 C's of addiction apply to any type of addiction including, but not limited to, drugs, nicotine, alcohol, gambling, video games, sex and caffeine.


1. Compulsion

Compulsion means that an individual has an absolute and overpowering urge to fuel their addiction. The behavior may start impulsively, but as the addiction grows, it becomes a compulsive habit. By not partaking in the habit, agonizing anxiety occurs, affecting all other behaviors.

2. Craving

The urge to fuel the addiction becomes as demanding as hunger pain, mimicking a physical need. It feels like it is vital for survival. This urge often manifests as restlessness, insomnia and lack of appetite.

3. Consequences

Even when negative consequences become apparent, the behavior continues. Consequences of addiction include relationship, work, legal and money problems.

4. Control

Control of when or how the individual fuels their addiction is lost. Oftentimes, in the early stages of addiction, an individual will try to cut down or eliminate the behavior. This is impossible when the lack of control stage of addiction is reached.


The 4 C's model is a simple approach to determine if someone is dealing with an addiction.


Family physicians who feel comfortable discussing psychologic issues with their patients may prefer this approach, which documents a DSM-IV–based diagnosis of nicotine dependence.

smoker's hand

This Tool is used in the assessment of Smoking in Late life

Back To : Smoking in Late Life

Thorny Issues

Back To : Thorny Issues

This is one of several topics presented in the Thorny Issues sector of this toolkit

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