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Nicotine is almost universally believed to be the major factor that motivates smoking and impedes cessation. Authorities such as the Surgeon General of the USA and the Royal College of Physicians in the UK have declared that nicotine is as addictive as heroin and cocaine. This book is a critique of the nicotine addiction hypothesis, based on a critical review of the research literature that purports to prove that nicotine is as addictive drug. The review is based on a re-examination of more than 700 articles and books on this subject, including animal and human experimental studies, effects of `nicotine replacement therapies', and many other relevant sources. This review concludes that on present evidence, there is every reason to reject the generally accepted theory that nicotine has a major role in cigarette smoking. A critical examination of the criteria for drug addiction demonstrates that none of these criteria is met by nicotine, and that it is much more likely that nicotine in fact limits rather than facilitates smoking.
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A CRITIQUE OF NICOTINE ADDICTION
NEUROBIOLOGICAL FOUNDATION OF ABERRANT BEHAVIORS Editorial Board: MICHAEL MYSLOBODSKY Tel-Aviv University & Howard University STANLEY D. GLICK Albany Medical College SEYMOUR S. KETY Harvard University & McLean Hospital MORRIS MOSCOVITCH University of Toronto DANIEL R. WEINBERGER National Institutes of Health / National lnstitute of Mental Health
A CRITIQUE OF NICOTINE ADDICTION
by Hanan Frenk The Academic College of Tel Aviv-Yafo &
Te1-Aviv University and Reuven Dar Tel Aviv University
KLUWER ACADEMIC PUBLISHERS New York / Boston / Dordrecht / London / Moscow
eBook ISBN: Print ISBN:
0-306-47232-5 0-792-37225-5
©2002 Kluwer Academic Publishers New York, Boston, Dordrecht, London, Moscow Print ©2000 Kluwer Academic Publishers Boston All rights reserved No part of this eBook may be reproduced or transmitted in any form or by any means, electronic, mechanical, recording, or otherwise, without written consent from the Publisher Created in the United States of America Visit Kluwer Online at: and Kluwer's eBookstore at:
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Contents
FOREWORD
ix
ACKNOWLEDGEMENTS
xi
CHAPTER 1: INTRODUCTION 1. NICOTINE ADDICTION: FACT OR THEORY? 2. WHAT THIS BOOK IS NOT ABOUT 3. WHAT THIS BOOK IS ABOUT, AND WHO CARES? 4. AN OUTLINE OF THE BOOK
1 1 3 5 7
CHAPTER 2: ADDICTION, COMPULSION, AND HABIT 1. PHARMACOLOGICAL DEFINITIONS OF ADDICTION 2. BEHAVIOR DEFINITIONS OF ADDICTION 3. THE 1993 WHO DEFINITION OF DRUG DEPENDENCE 4. THE NATURE OF HABITS 5. COMPULSIONS 6. HABIT CRAVING, WITHDRAWAL, AND RELAPSE
13 14 16 16 18 20 21
CHAPTER 3: HABITUAL DRUG USE 1. USE OF PSYCHOACTIVE DRUGS WITHOUT
25
DEPENDENCE
27
Contents
vi 2. THE DRUG ATTRIBUTION
BIAS
CHAPTER 4: SMOKING DEFINED AS AN ADDICTION 1. THE SURGEON GENERAL REVIVES THE TERM
35 35
‘ADDICTION’
2. THE SURGEON GENERAL’S
1988 DEFINITION OF
37 39 40 41
DRUG DEPENDENCE
3. PRIMARY CRITERIA 4. SECONDARY CRITERIA 5. TERTIARY CRITERIA 6. THE SURGEON GENERAL’S
CONCLUSIONS REGARDING NICOTINE ADDICTION
7. EXPLORING
32
THE EMPIRICAL BASIS FOR NICOTINE ADDICTION
CHAPTER 5: NICOTINE REINFORCEMENT IN ANIMALS: THEORETICAL CONSIDERATIONS 1. OPERANT REINFORCERS 2. PRIMARY AND SECONDARY REINFORCERS 3. CONFOUNDING FACTORS IN STUDYING THE REINFORCING PROPERTIES OF DRUGS
42 43
45 45 48 49
4. SPECIFIC 5.
PROBLEMS IN STUDYING NICOTINE SELF-ADMINISTRATION IN ANIMALS CONCLUSION
CHAPTER 6: THE REINFORCING PROPERTIES OF NICOTINE IN ANIMA