Suggested Draft for Clive Turner's Reply to Mr.
Morgan (Lundbeck
In response to my request for proof of your
advertised claim that
"there is now conclusive evidence that smoking is
a true addiction"
you kindly providad some rcfcrcncoc. Wowover,
thace hardly provide
conclusive evidence of true addiction. They merely
demonstrate what
is not in dispute, and that is that some people
have claimed that
smoking (and just about everything else under the
sun) is an
addi cti on. Such an allegation is not new: it is
over sixty years
since Sir Humphrey Rolleston remarked that "to
regard tobacco as a
drug of addiction my be all very well in a
humorous sense, but it is
hardly accurate"(1). Much more recently, a review
came to the
conclusion that "in spite of the fact that some
well known
investigators believe that cigarette smoking is an
addiction, the
majority of Investigators In the field hold the
view that smoking is
best thought of as a habit"(2).
Not only is there no unanimity over the notion
that smoking is an
addiction, there would seem to be no consensus
regarding the meaning
of the word itself. An editorial in the British
Journal of Addiction
summarising the Addiction Society's Centenary
Meeting concluded that
"the Centenary Meeting was quite evenly divided
between those who
thought that they alone knew what was meant by
addiction, and those
who thought that nobody on the face of this earth
knew what was meant
by the term"(3). Professor Warburton has
considered this confusion in
a paper which I commend and enclose for your
attention (4). He
concludes that "it is clear that there is no
agreement about the
definition of the term 'addiction' In the medical
and psychological
iiterature ... cne meaning is CUrIfU31F19 VIUL
u-ily Lu Ft4ple
but evei to the scientific community"(4). He asks
(with particular
pertinence here) "if there Is no consensus on the
definition of
addiction, how can the word be used ... on
advertisements ?"(4). The
terins 'addiction' and 'dependence' (also used by
you) are apparently
what have been referred to as "fat words"(5) as
they bring under
single headings types of behaviour that are
extremely disparate (4).
To quote Professor Eysenck: "The persistence of
the smoking habit Is
often blamed on 'addiction', but this is a largely
meaningless word,
Ln
or perhaps one should say, a word that has so many
different meanings L114
that it has no scientific status at all"(6). CY\
Continued
BATCo document for Province of BritiSh Columbia 29
October 1999


Now a specific comment on some of your references.
Firstly, there is
considerable dispute and even caution from Ashton
A Stepney on whether
smoking really affects an addiction model. They
reported that "there
are intriguing cases (relatively few but
nevertheless disturbing for a
:traightforward acidiction view of smoking) of
heavy smakers ho quit
the habit suddenly and apparently without
experiencing withdrawal
sym;tgmi. In addlVgn. many jip9k9r; are able to
refrain from smoking
for relatively long perlods, tor practical or,
tellgious reasons,
without apparently experiencing hardship - coal
miners who cannot
smoke at the pit face and orthodox Jews who do not
smoke on the
Sabbath are examples. It Is unclear how the
experience of these
groups of people could be incorporated into a
conventional addiction
view of smoking"(p.65). It is particularly
noteworthy that they
concluded from this (and other considerations)
that "the tendency for
some medical authorlties to label the use of
cigarettes as an
addiction may do a disservice to the smoker ...
the rationale for
labelling them as acdicts is not convincing"(pp
140-141). And the
"relatively few" intriguing cases referred to
above are arguably a
gross underestimate "moulded largely by that
self-selected hard-core
group of people whc ... go to therapists ... the
only easily available
subjects for studles"(7). Professor Schachter
concludes that "the
rates of succes:ful self cure of cigarette tmoking
Bra considerahly
higher than anything yet reported In the
therapeutic literature ...
people can and do cire themselves of smoking ..
they do so in large
numbers .. permanently" (7).
Henningfield (1984) has promulgated his
widely-quoted study In a
number of such publications ostensibly equating
nicotine with opium
u5 e. Huwt:vt:r-, IL ha~, -L-v4u-Llf been shown
that Hemmingficld
misinterpreted his data: "there are remarkable
differences in the
scales ... the results take on a different picture
when plotted on the
same scale ...(and) if the scores for the
difference between
assessment of the substance and placebo are
plotted"(8). An
independent re-assessment of Henningfield's study
concluded "from the
data it seems that nicotine ... does not act like
other compounds in
the maintenance of other kinds of substance
self-administration, i.e.
it is not like mor-phine in opium use" (8).
Continued .....
BATCo document for Province of British Columbia 29
October 1999


.IMF
NIDA Research Monograph 23 further highlights
disagreement In the
existing literature: e.g. "reluctance to label
tobacco as a
dependence-producing substance rests on doubts
concerning the
existence of d tobacco withdrawl syndrome"
(Shiffman, p158), "simply
because nicotine has many pharmacological effects
in smoking doses, it
does not follow that these effects are
reinforcing" (Russell, p119),
"despite extensive and long-term exposure to
nicotine, we seem to have
p1'013), and "the sae4al
ceptabiIity of obarco use and dependence is at
present in a class
by Itself" (Jaffe, p12).
Finally. in your letter, you state that "WHO
recognised tobacco as
drug dependence as long ago as 1974". But this was
the document which
denounced the descripticn of tobacco use as an
addiction and condemned
the use of addiction as a useful term. One cannot
have It both ways.
Further, the American Psychiatric Association's
094 111, which you
cited. has now been superseded by their 094 IIIR
diagnostic manual.
In this, tobacco withdrawal is not included
Nicotine dependence and
nicotine withdrawal have, however, been
substituted, which could
render Nicorette susceptible to your own
allegations!
Orr
14
BATCo document for Province of BritiSh Columbia 29
October 1999