DR. GIo &T~ GORI Dr. Christopher F Proctor BA'T Company, LTD Millbank Knowle Green Staines, Middlesex TWU 1DY,~ngland March 26, 1993 Dear Chris, It was so nice to spend some time with you, and thank you very much far your kirJ note. As I was saying, 1 am scheduled to speak in Oxford on May 25, and in London on lune 9. Hope~ully you w~ be in Mwn, and we could meet again I enclose here some of my latest productions~ Let me know what develops, and I shall do likewise, Be happy~.~ Cordially IC~co BATCo document for Legal Senrices : Health Canada 20 May 1999 C8C~M11tTS315.91 H lS SCIEE~ICA1LY GROUNDLESS AND ARBTTRARY TO SPEAK OF AN ADDICTION THRESHOLD FOR NICOTINE There is no independently objective definition of "addicb:on", People define '$ddicb~on" according to their own prejudice, because "addich'on" is a valueladen term thdt Cannot be defined or used sdentifically. "Depende~ee" ~s been suggested as a better term, but according to WHO this also implies value judgment Addiction/dependence are features of individuals, not of substances. Individuals are addicted because of inter~l psychologic sbessors and individual perceptions of sodal incentiveslmotivatoa. if addieb~on behavior is to be modified, one needs to change the psychoio~e makeup oi people who tend to bpmme addicted~ This can be done through education, incentives for hope and a purposeful life In a word, by promoting a con- structive scdal environment. Therefore, - ~ven be present general unders~inding of these words - *addiction" and *dependenee" ale attributes that mnnotbe meaningfully applied to dgarette smoldng. In a behavioral context, "~bituation" is the p~ierted attribute since it simply eonno8s a factual frequency of use without valueladen oveaones. Indeed this was the percep· tion and the conclusion of the first report of the US Surgeon General on Smoking and Health " The tobacco habit should be charaeterit~d as an habituation rather than an addie· tion. In conformity with accepted World Health Organization definitions, since once es~biished there is little tendency to increase the dose; psychic but not physical dependence is developed.. No characteristic abs~jnence syndrome is developed upon withdrawal.~ Dis~oniinua~oo of m~oldfig.. is accompiishe0 bet by rei~ordng factors which interrupt the psychogenic drives. Nicotine substitutes or supplementary medicab:on have not been proven of major benefit in breaking the habit" (Smoking and H~aith, Report of I Adnisory Committee to the SPrXwn CNml of Ihe Public Henltlt SetPicL US. Department a~ Ae~th, EdueaGon, and Welfare. Public Health Service. Publicab:on No. 1103. Washington, DC, 19611. p.354). BATCo document for Legal Services : Health Canada 20 May 1999 "Ihe overwhelming evidence points to the conclusion that smoking - its begifi ning, habihlation, and occasional discontinuatioa - is to a ldge extent psychologi· cally and socially determined" (Ibid, pAO) Smoking is st psychotoxic - an otherwise ouatanding featureof substances of abuse sought after by addiction-prone individuals~ Withdrawal symptoms, also a severe consequence of substance of abuse, are virtually absent in smokes who quit. The reality is ihatmillians have quit and millions will continue to quitsmokiop without help or apparent difficulties, in a climate where cigarettes m legally and readily available. In his regard - from the National [t~Eiitute for Drug Abuse - DL lack Henningfield writes: " The following constraints and inconsistencies should be noted when rorsideringg the evidence for a tobacco withdrawal syndrome. First, a syndrome of reliable physiologe signs,., has Mt been described I~ith the exception of the desire to smoke,,, other phenomena typically occur only in a frarjon of all subjects abshh· ent from cigarettes... Far instance,.. weigh gain, gasointestinal disturbances, or anxiety may each occur inless than one t~rd of all subjects; and up to one half of abstinent subjects may report no symptoms at all. 'Ihe second major issue is that while tobacco withdrawal is commonly equated with nicotine witMrawal, there is little evidence that drotifp produces physiolog· ic dependence... Admifistrabon of rdcatine~rece~to~ ar~tagoristr.Jlas not been shown to evake a withdrawal sjndron~e~~~ [Pjroviding abstinent smokers with a nicotine-containing chewing gum only pa~ally attenuates physical mmplaintr..land] in animal studies, abrupt abstinence is not followed by,.. a withdrawal syndrome, These i~col~,istencies..impose constraints on the compari- sob..of tobacco withdrawal with that of withdrawal from opioids, seda~ves, and ethanol. The relevance of this point goes beyond semantic issues oi classificatio~..lbecause] when withdrawal is considered in the context of drug dependence it generally connotes a more narrowly specified set of conditions [vin a reiiable syndrome of behavioral and physjolo~e c~nges): (Henningfield ~, BeltnPiornl phomu~cology of cigaret~r smokillg, he Advances in behavioral phannacology. Tnompson T,Dews PB,Barrett ~, Eds., Academic Press, New York, 1984, pp.l~l·148). BATCo document for Legal Services : Health Canada 20 May 1999 Such statements amount to an admission that - by comparison to the withdrawal syndromes from opioids - smoking withdrawal simply does not exist. Most smokers quit without consequence whatrcewr, A few may experience the mildest discomfort, which quickly disappear spontaneously or is curable by the mildest intervention. Severe cases are said to exist, but are undocumented in the scientific literature, even at the anecdotal level. if any~iYlg, it can be argued t~Lltimokerr, may now be somewhat less comfortable about quitting because the sddicSon" propaganda and the proliiera- tion of cessation clinics and devices makes them think - ronrdously or not - that quit- ting has become a dif fiollt ordei This view is supported by recent writings of promi· nent antismoking advocates (C~pman, S.: Smokers: o~ do tllry start · and continue! World health Forum, WI~O, 1611-9, 1995) In reality, nothing factual has changed since the first US Surgeon General's report on smoking and health, nor since Herningiieid's writings. What seems to have intervened, is a willingness to append new meanings to a tradib~o~ vocabulary. Still when it is understood that the extension of "addiction" to include smoking is a rhetorical device, then "sdentific" claims to jus~y this extension also become rhetorical devices. By neces· sary extension, the same applies to any attempts of defining 'sden~fically" a nicotine threshold that may prevent "addictiod' to smoking, as recently suggested by the Com· missioner of the U.S. Food and hug ~dminis~ation. Indeed - and even by keeping to hadjtio~l definih:oFs - is nicobhe the smoke com· potent that determines habituationl Is it possible to think of a ~wshold value for niuF· tine in smoke that would discwtage habitua~onl Here, it is essen~al to realize that smoldng habitua~on is not unimodal but rather a multi-iaceted mndifioh The f~st Surgeon General's report on smoking and health had this to say: "Smbking appears to be not one behavior but a range of psychologically diverse behaviors each of which may be induced by a different combi~tion of factors and may serve diifwent Ileeds,'fiiereiore no single explanation may suffice." ~id~ P.3n). The habit of smoking is sustained by a coratellafion oi efieeb. Nicotine, although an impc~ad component of smoking, provides only some of the many reasons people like to smoke. in fact, nicotine~related rewards may not be the most important BATCo document for Legal Services : Health Canada 20 May 1999 Besides, different individuals perceive and react diffewltly to various rewards of smoldng, and the same individual may have ditfexnt perceptions and reactions in different situatiors. Therefore, seeking a generalized control of habituation by imposing a threshold for ~cohhe is pointless It cannot ~ve a sdentifically objective justificadon could not attain the purposes for which it is advocated, and may be actually countep produbve because smokers may eompenrateby smoking more cigarette. Threshold inferences simplistically derived from chippers are an even more worthless exercise dependent on an added sting of arbitrary and plainly wrong assumptions, ~st among them that cippers are ail the same and a valid representation of all smokers. The outcome of such an exercise could not apply to chippers themselves, nor to teenag· ers who start smoking, nor to adult smokers. Idbeling smoking as anaddic~io~ comparable to the addibn to heroin and cocaine defies common sense. As a concept, addich~onbehavior has a range of qualitative and quantitative at~ibutes that apply differently to Isaving for food tobacco, cocaine, or heroin The semantic issues in the current debate over the use of tobacco reject funda· mental differences over the importance of psychotoxidty as one of the hallmarks of suj,tan,, associated with harmful addic~ons. Indeed, and although many are now inclined to include tobacco use among addicb~ons harmful to individual behavior, tobacco use is not psychotoxic while psychotoxidty is a central feature of substances such as alcohol, cocaine, or heroin which are sought out by addiction prone individuals. Suchindividuals experience loss of perso~ con~ol, behaviors that are injurious to themselves and to society, and severe withdrawal symptoms when attempting to stop use. in no way does smoking impair an individual smoker'sj~dgment and behavior. On the contrary, a good deal of evidence indicates ttu~t smoking has subtle but positive co$iCve and behavioral consequences. BATCo document for Legal Services : Health Canada 20 May 1999 CT~ O O 03 L L~ BATCo document for Lglal Services : H$alth Canada 20 May 1999