6.0 Introduction
Show / hide chapter menu
Much of this chapter is based on information contained in the reports of the US Surgeon General (The Health Consequences of Smoking. Nicotine Addiction, 1988)1 and of the Tobacco Advisory Group of the Royal College of Physicians (Nicotine Addiction in Britain, 2000),2 both of which provide extensive fully referenced reviews describing the chemical, physiological and psychoactive properties of nicotine. Readers requiring more detailed information are referred to these publications in the first instance.
Nicotine occurs naturally in the tobacco plant, and is the drug in cigarettes and other tobacco products which causes addiction.1, 2 Tobacco essence was first extracted in the early 1800s and named 'Nicotianine,' in commemoration of Jean Nicot, the French diplomat and scholar who had introduced tobacco seeds to the French court in the late 1500s. Scientists in the German university town of Heidelberg isolated the pure form of Nicotianine in 1828, calling it 'Nikotin,' but another century would pass before its addictive nature came to be suspected.1 Research during the 1920s and 1930s linked nicotine with the dependency observed among tobacco users. In 1942, Johnston concluded in The Lancet that 'Smoking tobacco is essentially a means of administering nicotine, just as smoking opium is a means of administering morphine.'3 p 742
With the publication of major reports on smoking and health in the 1960s, the role of nicotine in perpetuating tobacco use was confirmed.1 However the prevailing paradigm for tobacco use at the time—that it was best understood as a socially learned behaviour, and that it was a psychological 'habituation' rather than a physical addiction—continued to hold sway. Treatment options centred on smoking cessation, based on psychological models of behaviour modification, remained in the ascendancy. This was to change over the next 20 to 30 years, with a conceptual shift towards the physiological role of nicotine as central to tobacco addiction.2
In the Report of the US Surgeon General issued in 1979, persistent tobacco use was understood to be addiction-driven and was described as 'the prototypical substance-abuse dependency.'4 p 1–32 In 1980 the American Psychiatric Association first included tobacco use as a substance abuse disorder, signalling a greater emphasis on the psychoactive effects of nicotine use, 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, reaching the following three major conclusions:1 p 9
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 firmly positioned nicotine addiction within the disease model, stating that 'Tobacco dependence is in fact best viewed as a chronic disease with remission and relapse.'5 The Royal College of Physicians' report of the same year observed that 'Doctors, other health professionals and indeed society as a whole, need to acknowledge nicotine addiction as a major medical and social problem.'2 p xvi
Cigarettes are now commonly understood to be a highly efficient nicotine delivery system which both causes and sustains addiction,2, 6, 7 and a drug which 'captures' as many or more users than '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,8 and has worked since the 1960s on optimising manufacturing techniques to make cigarettes capable of transporting the required dose of nicotine quickly and effectively to the brain's receptors.6, 8 These aspects of product development are discussed further in Chapter 12 .
Copyright © 2012 The Cancer Council. All rights reserved.