Note on t*ke Symposi- on Addiction. The Royal
Society. London.
20 th November 1987
The symposium was organised by Charter Clinics,
and the director was
Dr M R Trimble. Speakers were on a wide range of
topics, including
treatment of addiction and recovery. Most relevant
to the tobacco
industry, however, were presentations by Professor
Anthony Clare of St.
Bartholomew's Hospital, London (a well-known
psychiatrist frequently in the
media), Dr Martin Jarvis of the Institute of
Psychiatry. London.
Professor Anthony Clare: "The Problem in
Perspective".
Talking about what he considered to be the major
drugs of addiction,
Professor Ciare put tobacco at the top of his
list, and quoted a figure of
100,000 deaths per year. He believed that, because
tobacco was a legally
available drug, it ought to be considered along
with alcohol and the
psychotropics (valium, etc.) rather than with
heroin.
Professor Clare mentioned that he had recently
been at a meeting of the
Health Education Authority at which he had raised
the problem of
maintaining education when industry was still
advertising and trying to
'recruit new smokers'.
According to Professor Clare, smoking was "an
intrinsically malignant form
of drug dependence maintained by influence, wealth
and vested interests".
He mention _d that many HPs support the tobacco
industry, and that the
Health Promotion Research Trust was funded by the
tobacco industry. He
seriously doubted whether the tobacco industry
should be allowed to sponsor
such work.
Cannabis -as mentioned in relation to tobacco and
Professor Clare mentioned
that its relative acceptability "May mask its own
cancer of some kind".
Alcohol -as viewed as the next most important
'drug addiction'. Professor
Clare was supportive of the 1986 Royal College of
Psychiatrists' report
"Alcohol, our Favourite Drug" but was scathing
about the recent similar
report by the Royal College of Physicians, whom he
described as living in
the last century and still believing that if you
frighten people to death
they'll stop doing things. He believed that
alcohol 'addiction' was a much
more important question than cocaine and heroin
addiction, and that media
attention etc. was totally out of proportion.
During the discussion period, Professor Clare made
the interesting point
that people appear to enjoy tobacco and that if
tobacco were taken away the
question ought to be considered of what kind of
substitute should be
encouraged. He appeared to believe that nicotine
per se was a relatively
"socially innocuous" drug. During the same
discussion, Professor Ghodse of
St. Georse s Hospital, London, suggested that "you
do not need syringes and
needles if you have access from your lung to brain
in seconds".
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Dr Martin Jar-.,;s: "Addiction to Nicotine".
Dr Jarvis began by presenting some statistics on
incidence of smoking, and
said that because the majority of smokers are not
giving up although they'd
like to, they are therefore addicted. A study of
smoking habits in Bristol
secondary schcols showed no evidence that smoking
was about to go away.
The predictors of taking up smoking were: having
ever tried a cigarette,
having ever been drunk. having a boy/girlfriend,
thinking they'll smoke
when they leave school, age, mother working,
pocket money, whether their
friends would =ind and whether their teacher would
mind. Parental smoking
habits and social class were not predictive of
smoking.
Dr Jarvis painted to the following as evidence for
nicotine 'dependence' in
young smokers:
1. Nicotine intake per cigarette was similar to
adults.
2. There was no increase in nicotine intake per
cigarette with age
(N.B. this would normally be considered to be
clear evidence against an
addiction hypothesis!).
3. The majority reported 'withdrawal' when trying
to quit.
4. Cotinine levels appeared to predict
'withdrawal'.
5. 'Withdrawal' was associated with feelings of
calmness when smoking.
Dr Jarvis said he would therefore disagree that
smoking is a merely
psychosocial behaviour at a young age.
Studies claiming to prove that smoking could be
seen in terms of nicotine
self-administration were presented. Dr Jarvis
presented data comparing
nicotine and cocaine on self-administration in
animals (the animal in this
case recei~ved one shot of nicotine or cocaine
after a specific number of
lever presses had been made). He claimed that
nicotine was 'as addictive
as cocaine' because similar levels of responding
for the two drugs
occurred. Ho-ever, what Dr Jarvis failed to
mention was the extremely
important point that this kind of 'schedule of
reinforcement' i.e. one dose
of nicotine fcr many lever presses is the only on
on which animals will
work: if nicot--ne is available too frequently it
appears to become aversive
and animals stop pressing the lever. Cocaine,
however, is
self-administered under any and all circumstances.
It was therefore
extremely misleading to use, as an illustration of
similarity, the only
situation out of many in which the two compounds
are similar!
A study in smckers was described in which smokers
were deprived of smoking
overnight. They then received a slow injection of
either saline or
nicotine over 1 hour, until they achieved plasma
levels comparable to those
had they been smoking. They were then allowed to
smoke one cigarette.
They noticed that the smokers who had received
saline took sufficient
nicotine from their first cigarette to bring them
almost to the level of
those who had received the nicotine; and that
those who had received the
nicotine did not increase their plasma levels
after the first cigarette.
Unfortunately, this was again extremely misleading
use of data, since the
people who had received the slow injection of
nicotine were already close (_,4
to a maximal obtainable nicotine level, and could
not have been expected to
increase much =are. On the other hand, a smoker
who had not smoked for a
while would be bound to show a sudden increase in
nicotine levels. U-1
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- 3 -
The next topic was a brief mention of studies
using nicotine chewing gum as
an aid to smoking cessation. Although Dr Jarvis
seemed to feel it was
interesting that acre people attempted to give up
smoking if they had
nicotine gum (61. with compared to 37% without) he
failed to point out that
the success rate I year later as a percentage of
this figure was no higher.
The finale consis--ed of a brief discussion of
passive smoking: measuring
salivary cotinine in children and discovering that
it increased from
conditions of no parents smoking to amly one
parent smoking to both parents
smoking. He seened to be under the impression that
the 1987 Surgeon
General's report on passive smoking had concluded
that ETS was a cause of
disease, without qualification.
During the discussion Dr Jarvis expressed the
opinion that tobacco
companies should view themselves as drug
companies. The RJR and Favor
'smokeless cigarette' - type products were
mentioned; he did not appear to
believe that nic=r-ine toxicity would be a problem
here. However. he said
that it was unfor--unate that most anti-smoking
organisations are set
against all forms of tobacco; he believed that
'safer' forms should be
encouraged for vliose who will use it. His
colleague, Michael Russell, has
expressed similar views. The Chairman raised the
interesting question of
whether 'depende=ce' without damage to health was
such a bad thing, and
stated that 'caffeine dependence' was an example
of 'addiction' without
harm.
Dr S Boyse
cc Dr R E Thorntca
Mr R L 0 Ely
All members of :he SRG
SB/LES/ADDICTION
18 December 1987
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