People who use smokeless tobacco, or “snuff,” are just as hooked on nicotine as cigarette smokers, if not more so, new research from Sweden shows.

And those who smoke and use snuff may be especially nicotine-dependent, Dr. Ann Post of the Karolinska Institute in Stockholm and her colleagues found.

The researchers looked at more than 800 teen boys and girls who used tobacco, including 466 who only smoked cigarettes, 209 who only used snus (the traditional Swedish type of snuff), and 144 who used both. Eighty-seven percent of the entire group reported having symptoms of nicotine dependence. The average age of the study participants was around 18.

Post and her team looked at nine different symptoms of nicotine dependence, including using tobacco within a half-hour of waking up in the morning; using tobacco despite being sick; and trying to quit and failing. They also asked the study participants whether they’d experienced any of 12 different withdrawal symptoms when they stopped using tobacco, such as craving, restlessness, and difficulty concentrating.

All but two of the nicotine dependence symptoms were more frequent among exclusive snus users than among smokers, the researchers found, while every symptom was more common among the dual users than the exclusive smokers. For example, around 70 percent of the exclusive smokers said they felt addicted to tobacco, compared to nearly 80 percent of the snus-only users and about 90 percent of the dual users.

The risk of withdrawal symptoms for exclusive snus users and exclusive smokers was fairly similar, but the snus plus tobacco users were two to five times as likely to experience these symptoms as exclusive smokers.

Eighty percent of both snus users and dual users said they had used tobacco on the day of the survey, the researchers note, compared to 56 percent of the smokers, “probably indicating a more advanced stage of progression towards regular use.”

They also found that the snus-only users reported fewer quit attempts than the smokers.

“The findings in this study,” the researchers say, “support the conclusion that smokeless tobacco in adolescence has a potential to induce nicotine dependence which is at least as high as for cigarette smoking.”

SOURCE: Addiction, online February 9, 2010.