What does the term addiction mean?
Addiction is defined by the World Health Organization as “repeated use of a psychoactive substance or substances, to the extent that the user is:
• periodically or chronically intoxicated, • shows a compulsion to take the preferred substance(s), • has great difficulty in voluntarily ceasing or modifying substance use, • exhibits determination to obtain psychoactive substances by almost any means, and • tolerance is prominent and a withdrawal syndrome frequently occurs when substance use is interrupted.”
The Royal College of Physicians lists the following criteria for addiction:
• a strong desire to take the drug • substance is taken in larger amounts or longer than intended • difficulty in controlling use • a great deal of time is spent in obtaining, using or recovering from the effects of the substance • a higher priority is given to drug use than to other activities and obligations • continued use despite harmful consequences • tolerance • withdrawal.
Is nicotine addictive?
Tobacco addiction (like all drug addictions) is a complex combination of pharmacology, learned behaviour, genetics, and social and environmental factors (including tobacco product design and marketing).
The US Surgeon General acknowledges that “there is no established consensus on criteria for diagnosing nicotine addiction” but asserts that a number of symptoms can be cited as indicators of addiction. These include:
• drug use that is highly controlled or compulsive with psychoactive effects, • stereotypical patterns of use • continued use despite harmful effects, and • relapse following abstinence accompanied by recurrent cravings.
The Surgeon General concludes that “nicotine is the key chemical compound that causes and sustains the powerful addicting effects of commercial tobacco products.”
This report follows a landmark review published in 1988 which had also concluded that cigarettes and other forms of tobacco are addictive and nicotine is the drug in tobacco that causes addiction.
A report by the Royal College of Physicians on nicotine addiction agrees that nicotine fulfils criteria for defining an addictive substance.
The report states that “it is reasonable to conclude that nicotine delivered through tobacco smoke should be regarded as an addictive drug, and tobacco use as the means of self-administration” and concludes that: “Cigarettes are highly efficient nicotine delivery devices and are as addictive as drugs such as heroin or cocaine.”
There is some evidence to suggest that smokers can become addicted to nicotine very quickly. A study from the United States found that adolescent smokers displayed symptoms of nicotine withdrawal within the first few weeks of commencing smoking.
Properties of nicotine . . .
Difficulty in quitting . . .
Other measures of dependence . . .
The Fagerström Test for nicotine dependence . . .
Nicotine withdrawal symptoms . . .
Genetic influence . . .
Nicotine and harm reduction
Although nicotine is the addictive component of tobacco products it is the toxins and carcinogens in tobacco smoke that cause most of the harm from using tobacco. Pure or ‘clean’ nicotine extracted from tobacco can be used to help people overcome their addiction as demonstrated through the use of nicotine replacement therapies (NRT). . . .
Tobacco industry recognition of the importance of nicotine . . .