6.0 Introduction

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Much of this chapter is based on information in the reports of the US Surgeon General (The Health Consequences of Smoking. Nicotine Addiction, 19881) and of the Tobacco Advisory Group of the Royal College of Physicians (Nicotine Addiction in Britain, 20002), both of which provide extensive, fully referenced reviews of the chemical, physiological and psychoactive properties of nicotine. Readers requiring more detailed information are referred to these publications.

Nicotine is the drug in the tobacco plant that causes tobacco users to become addicted to cigarettes and other tobacco products.1, 2 An essence of tobacco was first extracted in the early 1800s and named 'Nicotianine' to commemorate Jean Nicot, the French diplomat and scholar who introduced tobacco to the French court in the late 1500s. German scientists in Heidelberg isolated the pure form of Nicotianine in 1828, calling it 'Nikotin,' but it took another century before its addictive nature was first suspected.1 Research during the 1920s and 1930s linked nicotine with the dependency observed among tobacco users. In 1942, Johnston showed that injections of pure nicotine reduced his need to smoke tobacco and concluded: 'Smoking tobacco is essentially a means of administering nicotine, just as smoking opium is a means of administering morphine'.3 p 742

The publication of major reports on smoking and health in the 1960s confirmed the role of nicotine in perpetuating tobacco use.1 However the prevailing view at the time was that tobacco smoking was best understood as a socially learned behaviour, and that it reflected a psychological 'habituation' rather than physical addiction.4 Treatment options for smoking cessation primarily used psychological models of behaviour modification. This was to change over the next 20 to 30 years, as awareness increased of the physiological role of nicotine in tobacco addiction.2

In a report of the US Surgeon General in 1979, persistent tobacco use was described as 'the prototypical substance-abuse dependency'.5 p 1–32 In 1980, the American Psychiatric Association for the first time included tobacco use in its Diagnostic and Statistical Manual of Mental Disorders as a substance abuse disorder, signalling a greater emphasis on the psychoactive effects of nicotine, and a move towards viewing tobacco addiction through a disease model. The US National Institute on Drug Abuse took a similar stance during the 1980s.1

The report of the US Surgeon General in 1988 focused solely on nicotine and concluded that (p9):1

1. Cigarettes and other forms of tobacco are addicting.

2. Nicotine is the drug in tobacco that causes addiction.

3. The pharmacologic and behavioural processes that determine tobacco addiction are similar to those that determine addiction to drugs such as heroin or cocaine.

The US Surgeon General's report of 2000 argued: 'Tobacco dependence is in fact best viewed as a chronic disease with remission and relapse'.6 The Royal College of Physicians' report in the same year observed: 'Doctors, other health professionals and indeed society as a whole, need to acknowledge nicotine addiction as a major medical and social problem' (pxvi).2

Cigarettes are now commonly understood to be a highly efficient nicotine delivery system that both causes and sustains addiction.2, 7, 8 Nicotine is a drug that 'captures' more of its users than do 'hard' drugs such as heroin and cocaine.1, 2 The tobacco industry has long recognised addiction to nicotine as the primary motivation for persistent smoking,9 and has worked since the 1960s to make cigarettes as efficient as possible in delivering doses of nicotine to the brain's receptors.7–9 These aspects of product development are discussed further in Chapter 12.

References

1. US Department of Health and Human Services. The health consequences of smoking: nicotine addiction. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office of Smoking and Health, 1988. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/previous_sgr.htm

2. Royal College of Physicians of London. Nicotine addiction in Britain. A report of the Tobacco Advisory Group of the Royal College of Physicians. London: Royal College of Physicians of London, 2000. Available from: http://www.rcplondon.ac.uk/pubs/books/nicotine/

3. Johnston L. Tobacco smoking and nicotine. Lancet 1942;240(6225):742.

4. Mars S and Ling P. Meanings & motives: experts debating tobacco addiction. American Journal of Public Health 2008;98(10):1–11. Available from: http://www.ajph.org/cgi/reprint/AJPH.2007.114124v1

5. US Department of Health and Education and Welfare. Smoking and health: a report of the Surgeon General. DHEW Publication no (PHS) 79–50066. Atlanta: US Department of Health, Education and Welfare, Public Health Service, Office of the Assistant Secretary for Health, Office on Smoking and Health, 1979. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/previous_sgr.htm

6. US Department of Health and Human Services. Reducing tobacco use. A report of the Surgeon General. Atlanta, Georgia: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2000. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/2000/complete_report/index.htm

7. Brandt AM. The cigarette century. New York: Basic Books, 2007.

8. Ray R, Schnoll R and Lerman C. Nicotine dependence: biology, behavior, and treatment. Annual Review of Medicine 2009;60:247–60. Available from: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19630572

9. Kessler DA. A question of intent: a great American battle with a deadly industry. New York: Public Affairs, 2001.

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