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Definitions of'Tobacco Dependence' or'Nicotine addiction'
The American Psychiatric Association
The APA '. in cric -Union or its -Diatmoscic and Statistical Manual or Mental
Dis,:;rders' :ere-rea to as DS.1,1 111, produced a set of criteria specifically defined to
de=@: rnba,:a Th.- rc%ised version of this manual. DSM III-R. published in
11;3-. substitutes ::-.c :c= .-i;cot:ne dependence'. This definition stresses the importance of
N%L,,:,,Jrawai is a ch3ra.-.-zr!sn,: of dependence. although notes: 'In any given case it is
to ai.tinituisn a virhdrawal elect from the emergence of psvchoicizica; trairs char
%%-e:% suppres,ed. conro,:zz. or alzered b% the effects oi nicotine or from a behaviour3i
rtac::un ic; rruscrart--n -o the loss of a re:nforc:r-. It is generally agreed that this Ls nor a
pamcuiariv help!ui de;in;::un: it begins bv assuming a prion that nicotine is addictive Ithc
dc::n.:.un pro,!dc, zr:%ria co decide either way; and SIMPiV prOVLd.-s a so: of critena. for
-e,:,qnibing i icr o;
mrr-,-is whici m3v or may nor represent withdrawal.
The US Surgeon-General
The US Suritcon-Gencral. in 1931', pub!i,hed a reporr enriried 'Nicotine Addicrion'. The
Su.::on-General a.so 7v,-::d ch.;. nicotine or tobacco smokine did not it readiiv into
stan 'ard definitions -w a,:cizrion. His response was differenc irom that of the AFA. who
proceed a riarroner or tobacco devenclencer alone. Instead. the Surgeon-Gener2l
brozzened Timor,. a: addtc:;on so wideiv char it could now include smoking or use or
nicT:= @ as is anv other be.,ijviciur that people tridulee -.n..
The Surecon-Gene:al'i zrirerij tor addiction fall into two categories: primarv
and a-'ainon2i znctna:
Pnmarv criteria
HLg@,Iv :on-,ro:led or compulsive use
Drjg-re-.n.,or,;c.' behav:our
Additional c6teria
Nddicrive behaviour often involves:
. sterron-pic ;arrerns of use
- Use despite harmful effects
- relapse followinz abstinence
* recurrent drug :-3vtngs
Dependcricc-producing drugs often produce
ph% near dependence
-:-tcaianr cut'horanci liters
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The Suraeon-Genera;'i criteria ror ;i!aicnon .3r: open to exacriv the same cnricisms as
previous Jennmori@ of jdL!sc-!nrL. and :n:re :s no -,--srificanon for considering it as definitive.
More irnporrandv. this definition or addw-mn diiiers in various important ways from
pre% lous Jcilriirwn@:
ii, the Surgeon-Generzi relegated zz.-rain k.--. cntena of previous definitions oi addiczon
lcolerari,r. ph,sic@l dependence and eu@noria. or 'p-,vchologlcal depcndenc:') -co the
bottom of his as-.. as occasionai. bu- unne-zesiary correlates ot addictions
ui, these previousiv !mporrant zritcra now second place to some new, and rather
vaeue. cracni ties' in-:
Mosr or '-c Surgeon Genirrj:'i cn:tria. ind the reasons why the%- do nor casily
appiv to tobacco @rnckzng. have 1@-ctn ;L"U@Ied in -.he previous @ezzion. However. the new
are discusid_@ '_-C:Ovv.
Psychoactive effects
This criterion is a riew one for denn.-.:ons or ada:=,on. or in the field of substance use in
-central. It is also a Trivial one. aric -o zonsider it as a primary criterion is highly
Zuesnonabie. means -,::at the ounce in question :an alter mood bv its
e!fecu on the brain. Manv subszances t-!cc-s on mood. Du: this does not -nake there.
Addicr.ve. Ditieren- iabstar-:es zaii na%c --er% :-.z;erent psv@:'-oiogical eifcc-.;. Minor
.r,inqULlh5CfS such as vaoum or ba..inn::.%res -Itppress mood b%- sedaring the person who ;2ses
rhem. Substances as arnpt-am-.n.- lea.: :o sz:rnularory eii--c-s on mood jnA Seneral
ACIVICV. Heroin an" cocaine. %kn..sz injucine euchoriant CffCCTS. LMpair performance and
luJeerrienr. Nicotine. m contain. s nor -Hill% reported co induce -euphoria. improves
performance and con.;enrranon. and :,.as 1,een reTorted to induce either surriulatorv or
depressant erfec-.s on mood dece-ding on the person's circumstances. Anti-depressani: drugs
alter mood' to imorove a state of .`cpmssion. and -cec there has never been a suggestion that
thev are addicvve. Santlariv. rijior -..jnq'L1'.!lLSerS are used to improve mood and other
pivchological processes in illnesses such as ichtzophrenia. but are not believed to be
addictive. It is cieariv invalid co use. as a motor component of a Definition of addiction. a
concept that applies zo zhe many different efiects of many different kinds of drug. some of
which are clear:v nor addictive.
Drug-reinforced behaviour
This criterion is included on the basis of studies carried out in laboratory animals. Studies
show chat animils such as laboratory cars "n be t-a-med to product a certain behaviour ieg
pressing a lever in a c@oxi by givirg them a reward. The reward Ls said to 'reinforce' the
behaviour, and thus another word 'Or 'reward' in this situation is 'reinforcer'. Some
e% idence suggesis that niconric zan azz. as a reward in such situations. Some scientists have
argued by anuicigy tnat nicotine Ls -:-.-rc!ore like heroin and cocaine, which can also
.reinforce' behaviour .% this v%av. and z4ar thtreirore ' LS. like heroin mind cocaine. 3ddiCrLVC.
Ho %% c% e r. man% different rhiaLs can ac: as revvards wr Worarorv ats, who cannot bv anv
,-,7ct,:h of the irriavunanon @e cons-.Z.-red zo lea@l exciring lives. Novel food or drink.
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,@ho,ularc. access to a female for :ne dc-pri-ci male cat... all of these things will induce a rat
co :@%ss a lever in a box. 'AJd;.;::ar%' is )ra: ; necessa-v corollary.
Also. cark studies in ::ns rield i=,gest that cars %%-ill oniY press a lever zzo obtain
ritonint undcr cer-ain undinoni: !r rhev @:zn predi,;r wrien -he nicotine is euina, -u arrve,
ana J The% do not have to %vork :crv hard 4or Le. In contrast. rars will press a h.undreds
C- @- ea (@L)Usanjs -)@ --mes, Ur-.f- %-rru_,P-- _nv circums-zanc:s. to obtain a dose of @-erciiri. [C
iN ci,.creforc qUJe Lnvalid co sta::. an he _-asii ut such requite. Chat ni,ormc s lik: '-Ir-oin. It
r. '.1,T far more like tood. Cie. or sex.
Stereotypic patterns of use
7-i, mejns that a benaviour mar dtveiop :n-,o regular temporal and physt"i patterns of use.
The Implication ii ionic use bezomes less f"exible. less an ac-nvitv with sociai meeting. and
,om:tninct done tar --s )%,vr. fast. This may appiv :a heroin. but it date noc apply
to :.4arerre @mok.nq. which many pe-.jptc Ls in azciviv. in rebponic :a ctr:ain local
-._lcions. or to Z..e end of a :net,. .-)r :@-t arrival of j cut, of coffee. Heroin ait mav be
r--:nartl% under me zontroi wuhdrvva@ svmprorns. @ur cigarette smokmz is more
rrez-entiv @.in-@er @onrrol of Tarriculzr situation in %vhz'-, a smoker ;;nds hUmsaii.
In addinun. -manv o:nt: =-vities develop :r,-o relief pa-:t:-nS_ 'Eacing LS
a:-.,- of Them. Is e:nnst also adz-.@-.,ve btca-use, like heroin uie. it is usua,11v zarne@ our in
--@-jnse to ph%-s-.,:ai sympromi L.- @Lunzzr '- Again. this znrcricia is so as to be
The Royal Society of Canada
In 1 -1@9 me Health Prorec-non B-an,:h of H-aich and Weltare Canada r-quested !he Rovai
Soc:t:v to prepare a reziort 'Tobacco. Nicotine and Addicuon". T@c :,.es::on put to
C.-.,: koval Socierv wa!;. -whjCL
s -,he mcii: appropriate Term 'addicrion'. 'deTencencc', or
'h.l:!!: formation" :a :@wrzctcnte -Ic risk of dependence an mcocine and. by exiension. the
us@: or cobazzo pro w;-,L a priori asiurrip-non that miconne -icei have The
capat,tiny or induc,nz dependent. :his revart comes to the following conclusion: -The term
deT-ndence. as recommended @-- -.h.- Wor!d Health Org;inisaron, is potenti.211v ambiguous
unltii further spec:ficd bv the ;se of modirving terms that life its general applicability To
druzs of different pharmacti'aitical classes. The terms 'nabir. habit formation, and
habituation are even more arnzistuous. vacuelv defined and scientific3liv ill-founded in
rv:.1--;3n to drug use. and shou.1-1 ::a Longer @- used in This cor:e.Nz-- IC LS Then :amended that
The -.arm -addiction' LS more appropriate; however, along with every other group that have
cnn@-Jered This issue. the Rovai sociev finds it necessary to produce yer arocher definition
of tradition: 'Drug' addiction ii, a @rronglv established pattern of behaviour :haricterised by
;1@ -h.- repeated SC!;-.1dMLnLscra-1;on of a d,--.:,z in amounts wh::h reliablv pro-1t;,ze rcmicircing
PivZ'WaCMe CffCC-3 and (2) g:tzt alfficul-v in achieving voluntarv lonz-te= zes;ancin of
suc,@ ase, even when The user is 4--onelv motivated to stop-. Whac The Rova, do not
cakz mro account is zhe iact ch.:: the term 'addiction' L-. cq-.;.illv ambiguous. @ezause of its
e-.-er---J,av usage and r is completiv arbirray co decide co da:,.ne this term -iiare ngorously
an- -Joe one or The cit@--rs.
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Conclusion
inere have beef rwo responses co the rea':.-sarion thar ni@cinne or Tobacco smok:ng does lot
c verv corn'orrably into standard de; nitions of addiction. One. the response of the
,r, N A,ioc.,2non. is m -isum- : ;::,).i hx- n..;..:,1e is :0
concenrr:ire simpiv on producing a list of 'diagnoszx criceria' char can help to recogn3se
zMain charac-t-risric svmptoms' of giving up cigarerzes.
The iezond type of response is n-aiiied by .4e reporr of :ie US Surecon-General in
11938. As has been discussed above. this report broa."zried the deiinicion of addic-ion so far
-41r I, has bezome meaningless. Trivial activities fail :rro the various criteria jus-, as weil as
zoes heroin u@e. and one is rnererore ,e.-: with the :.-ioice of accepting vtrtjai:y aii jaiiv
;@MVMCS as jdjd:crive, or of -electing the deiinicion as ::-,appropr:ace and invalid.
Warburton (1989)-' took the la::,-.- appro.3z::. He notes. -The Surgeon-Gentrai's
Report conc!uJei mar nicotine is addi,;-:-.,! an :he ba.,s or IO znzerza. These cr,:c:-.a do not
niconne use very wel!. except in a supen:-.6al sense... Of course. nicotine use :-Z)t '-,e cailed
'addic-non': someone. like the 5urgeon-rjencrah -_i: has to say --iar it is... .7-lov.-e-er. the
mosc imporranc measure for a scientific z;aim is experimental verification. noc polincal
:ronouncerren:s. however mascer;U!'.
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BATCo document for Province of British Columbia 19 April 1999