S·bi D1. ~ Buu ~n ~ ~stopher~ Proctor ~ ~~pg ~ Ylt Knowit Clrwn 9~ ~da nls 1~ Eng~Md u~y 1~ ~ Chris, n Ir D ~a ~ I~ m e Ire pr d ~ pr ~ lb P~ ~ mt L I ~g Pk I I ~dd b Ipnl h O~ aY~ ~, ~d L MI m ~ 9. HopeMlp ~1 ~ k bq ~ r oY Idpe ~r o~mi Il~t pJad~, ~ n~ ~ *ht ~(~, d I Y 6 k~, h ~~, 6rb~ ClibPDF - v~~fastio.soni CBI;AD~C153a.95 FIS S~EMIFICAIIY GROUNDIESS AND IIRBIIRARY TO SPEAK OF AN ADDICIION 'IHRESHOU] FOR NICOTINE There i no i~dependently dojcdive defuihbn of "addiction'. People define "addiction" according to their own prejudice, because "addiction" is a vaiue~laden term that cannot be definedor used xientifically. "Dependence" t~s been suggested as a better term, but according to WHO this also implies value judgment Addicfionldependence are features of individuals, not of substances, Individuals am addicted because oiintemal psychologic lawrors and individual perceptiaw of social incentiveslmotivators, If addiction behavior istobemodified,oneneedstod~angethe plyeholo~ m$up of people who tend to become addicted, This canbe done thaough edlllat~ in~n'dver forhope and a purposeful life, In a word, by pmmding a co~ stntc~ve sodal environment, Therefore, - given the present general understa~ing of these words - "addiction" and "d~p~ndw" are at~ibu~es that eaMdtbe meani~c~lly applied b dgarette Imo~nk In a behavioral context "habituat~n" is the preiartd attribute since it simply eannotes a factual hequenly of use wlthoot value-laden ovaones. Indeed O was the percep fix and the condusionOf the ftm rrpwt of the US Surgeon General on Smoldng and Healt~ " The tobacco habit sh6uid be charactuized as an habituatian rather than an addic· tiom In conformity with accepted World Heath Organiz~tion definitions, since once established there is little tendency to increase the dose;psychic but not physical dependence i developed.. No characteristic abstirww syndron~e i developed upon withdrawal.., Discontinuation of snok~g.. is accompli5md best by reinforcing factors which interrupt the psychogerde ddve;. Nicotine substitutes or supplementary medication have not been proven of majorbenefit in breaking the habit' (Smoking end Hmltk I~port oft ~iPisaJ Caamiftrr to UI1 Surgeon Cmnnl o~L Public HFnlth S(roica US, Department of Health, EducaGon, and Welfare, Public Health Service. PubliP~bn Na, 1103, WsJhingto~ DC, 19bl, p354~ Clit; PDF -!::!!::!!::!.f3 StlC.i: 0111 ~~ IIhe overwhelming evidence points to the conclusion that smoking - its be~n~ "ink habiiuab, and occasional discontinuation - is to a large uten~ pryc~logi· OUy and socially determined" Qbid, p40) Smoking is not psyc~toxie - an otherwise outstanding feature of substances of abuse sought after by addic~n-pmne individuals. WitMrawal symptoms, also a severe consequence of substance of abuse, Ire virtually absentinsmokers who quit.'Ihe reality is thatmilIirmr have quit and miilicms will continue to qdrmoking without help or apparent diffirulfies, in a dimate where cigarettes are legally and readily available. In this regard - from the Nab~o~ InsEhle for Dmg Abuse - Dr.lade Hernin6field writes: I Thefollowing to~jtrainl and inconsistencies should be noted when considering the evide~ce for a tobacco withdrawal syndrome. First, a syndrome of reliable physiologic signs.. ~I not been desoibed PNiith the ecception of the desire to Smoke,.. other phenomena typically occur only in a irae~on of all subjects IbsC W' "Om cigarettes.., Tor instance.. weigh gain, gastrointesdnal disturbances, or anxiety may each otolr in le~E than m b6rd oiallsubjects; and up to one half of dbstinent subieits may repoa no symptoms at all. Tne second n~jor issue b that while tobacco withdawal is commonly equated With niroth~e withdrawal, there is little evidence that nicotine produces physiolo~ ie dependence.. Admirisbtion of ~cc~ine~receptot antago~str.Jlas not been shown to woke a withdrawal slnd~ome,, ~lrPvidingabstihent smokers with a "eo~Pmntdining chewing gum only partillly attenuates physical complaintr...[andj in animalstudies, abrupt abstinence is not~ollowed by. a withdrawal syndrome These incoruis~wdeb.immose mnshainb on the compari· soa.df tobacco withdrawal with Ct of withdrawaffom opioidr, sedatives, and ethanol, The relevance of this point gws beyond semantic issues of ddssification.[belalwJ when withdrawatis mFddered in the context of drug dependence I generally connotes a more nanowly spedied Eetd conditiora (viz a reliable syndrome of behavioral and physiolo~e Lha~es)." (Henningfield jE, Ilpiofilphonmmlpgy g cigwrtfr smd~h~ in Advances in behavioral ptsmmacoiogy. Thompson T, Dews PB,BarreB P, Eds., Academic Press, New York, 19II~ pp.142118l C: I i I; PDF -!::!!::!!::!.f3 StlC.i: Dill Such statepants amount to an admission t~t - by ccrmparisan to the withdrawal syndromes from opioidr - smoking withdrawalsimply does not exist Most smokers quit without co~wquence whatsoever A few may experience the mildest disrorlort, which quiddy disppeem spontaneously or is tumble by the mildest intervenh~cd Severe cam are said to exist, but are undocun~ented in the scientific literature, even at the anecdotal level. If anything. i! ran be argued that smokers may now be sconewhat less comfortable about quaba becatae the "addiction* propaganda and the proliferti tionofteaa~bndiniesanddwieer malresd~emtt~nk-mnxiouslyaMt-thatsuit- tins L become a ditr~ult ordeal. T~s view is sllppated by ~ce~u writings of pmmi· "ent ad69moldng advocates plapmaq S.: Snmkns: mlry do ~y start · nnd continud World health Forum, WN0,16:19~ 1995) Inreality, nothing factual ~s e~nged since the furt U5 Surgeon General's report on smoking and health, nor since Henrdngfieid's writings. What seems to have intervened, is a willingws to append new meanings to a ttaditio~i vocabulary,Still, when it is understood that the extension of"addietion" to include smoking i a rhetorical device, then 'sdPnldfiC" dairns tojusfify ttis ectension also become rhetorical devices. By neces~ sary extension the same applies to any attempts of de~ing 'Kieddticall~r a, nicotine threshold that may prevent "addittion" to smoking, as receplly suggested by the Com· misrioner of the I1S. Food and Drug Admanistrahbh Indeed - and even by keeping to tradib~o~al definitiors - is nicohe the smoke rolr ponent thatdelermines habituationt Is it possible to think of a threshold value for~c~ tine insmoke that would dismurage habitw~onl Here, ii is essential to realiz~ that Smoldng habituadon is Mt Ipimodd~ but ratber a mulh~-face~ed condition The first Surgeon General's report on smoking and heaithhad this to say: '5moking appears to be not onebehavior but a rang of psyd~olo~cally diverse behaviors each of w~d~ maybe induced by a different combination odfactors and may serve different needs. therefore no single explanation may site," (n~id, p~37a). The habit of smokingis sustained by a constellationof effe&I. ~edine, although an important component of smoking, provides aniy some of the aany reasons people like to smoke. In fact, nimtine~related rewards may not be the most important C: I i I; PDF -!::!!::!!::!.f3 StlC.i: 0111 Besides, different individuals perceive and reaH d3fsedly to various rewards of Shoking, and the same individualmay have different perceptions and reaction in different situatio~. 'Iherefore, seeking a germa~ed ca~ol of ~abi~uaBon by imposing a ttues~d for nicotine ispointiest It cannot Lye a rdentifically objecb:ve juSb~ficahbh muldmlattain the purposer fmwhirhitbadva~ated, andmaybeactuallymunte~- produdve buse smokers may compensate by smokingmore cigarette. nhrshold iPlerences simplistically derived from dippers re an even mene worthless exercise dependent on an added s~ing of arbitrarlend plainly wrong assumptions, Erst among them that dppers are all thesame and a valid representation of all smokers. The OU1Mme cbsudh an exercise mP Fst app~ to dipperr themselves, n~K to leenap· ers who start smoking, nor to adult smokers. Labeling smoking as an addiefian comparable to the addiction to heroin and cocaine d~es common sense.As a concept, addilfionbehnvior has a range of qualitative and quantitative attributes that apply differently to craving for food, tobacco, cocaine, or heroin 'Ihe semantic issues in the current debate over the use of tobacco reflect funda· mental differences over the importance of psychotoxidty as one dt~hallma~s oi substances assodated with har~ul addic~on~. heed, and although, many are now incli~ed to include tobacco use among IddiC~dDFS har~ul to individual behavior, tobacco use is not psychotoxie while psychoto~dty is a central feature of substances such as alcohol, ~ocaipe, or heroin which are sought out by addlcb'.on prone individwls. Suchindividuals enpedenw loss of perraal control, behaviors that an injurious to tt~mrelws and to society, and swan withdrawal symptoms when athmpting to stop USe. In no way does smoking impair an indbidual smol's judgment and behavior On the mntary, a good deal dovidsreindirates that m~okh~g has subtle but positive co~tive and behavioral consequences. C: I i I; PDF -!::!!::!!::!.f3 StlC.i: 0111 j VI O O lp I CI~ 0\ C: I i I; PDF -!::!!::!!::!.f3 StlC.i: 0111