Nicotine as an Addictive Substance: A Critical Examination of the Basic Concepts and Empirical Evidence

• DOI: 10.1177/002204260103100202
• Published date: 01 April 2001
• Date: 01 April 2001
• Subject Matter: Article

JOURNAL OF DRUG ISSUES 31(2), 325-394, 2001

NICOTINE AS AN ADDICTIVE SUBSTANCE: A

CRITICAL EXAMINATION OF THE BASIC CONCEPTS

AND EMPIRICAL EVIDENCE

DALE M. ATRENS

The present review is acritical analysis

of

the concepts behind and the empirical

data supporting the view that tobacco use represents an addiction to nicotine. It

deals with general aspects

of

the notion

of

addiction, while concentrating on specific

problems associatedwithincorporating nicotine into current frameworks. The notion

of

addiction suffers from unprecedented definitional difficulties. The definitions

offeredby various authorities are very different, even contradictory. Definitions that

reasonably include nicotine are so broad and vague that they allow many trivial

things, such as salt, sugar, and watching television, to be considered addictive.

Definitions that exclude the trivia also exclude nicotine. The addiction hypothesis,

in general, is strongly shaped by views that certain drugs bring about amolecular

level subversion

of

rationality. The main human evidence for this is verbal reports

of

smokers who say that they can't quit. On the other hand, the existence

of

many

millions

of

successful quitters suggests that most people can quit. Some smokers

don't quit, but whether they can't is anothermatter. The addiction hypothesis would

be greatly strengthened by the demonstration that

any

drug

of

abuse produces

special changes in the brain. It has yet to be shown that any drug produces

changes in the brain different from those produced by many innocuous substances

and events. The effects

of

nicotine on the brain are similar to those of sugar, salt,

exercise, and other harmless substances and events. Apart from numerous

conceptualand definitionalinadequacies with the addiction concept in general, the

notion that nicotine is addictive lacks reasonable empirical support. Nicotine does

not have the properties

of

reference drugs

of

abuse. There are so many findings

that conflict so starkly with the view that nicotine is addictive that it increasingly

appears that adhering to the nicotine addiction thesis is only defensible on extra-

scientific grounds.

Dale

Atrens

received a B.A. from the University of Windsor, an A.M. from Hollins College, and a Ph.D.

from Rutgers University. He has held appointments at universities in North America. Europe, Asia, and

Australia. He is currently aReader in psychobiology at the University of Sydney. He Is the author of

several neuroscience textbooks and a number of popular books on diet and lifestyle.

JOURNAL OF DRUG ISSUES 0022·0426/01/02 325-394

ATRENS

INTRODUCTION

The addiction model has dominated smoking research for over ageneration

(Benowitz, 1988; Benowitz, 1996; Benningfield &Heishman, 1995; Peele, 1990a;

Rose, 1996; Russell, 1990a; Stolennan &Jarvis, 1995). Tobacco smoke is said to

contain numerous agents that cause

ill

health (Gupta, Murti, &Bhonsle, 1996;

Trichopou!os, Li, &Hunter 1996) as well as a powerful addictive drug, nicotine

(Altman et al., 1996; Anonymous, 1996; Benowitz, 1996; Busto, Bendayan, &

Sellers, 1989; Dewey et a!., 1999; Griffiths, 1996; Grunberg, 1994; Henningfield,

1984; IIenningfield, Cohen, &Slade, 1991; Rose, 1996; Shytle, Silver, &Sanberg,

1996; Stephenson, 1996; Waldum, Nilsen, Nilsen, Rorvik, Syversen, Sandvik,

Haugen, Torp, & Brenna, 1996; Altman et al., 1996). According to the dominant

model, as the nicotine addiction develops, the smoker becomes progressively less

able to stop (Anonymous, 1995; Foulds &Ghodse, 1995; Frantzen, 1996;

Benningfield, 1983). The essence

of

the nicotine addiction hypothesis is that

smokers are unable to stop because nicotine changes the brain in such a way as to

perpetuate its use. More broadly, drug addictions are seen as representing brain

dysfunctions.

It

is this hypothesis and related issues that are examined in the present

work.

The 1988 Surgeon General's Report on Smoking and Health states the nicotine

addiction viewpoint succinctly:

Cigarettes and other forms

of

tobacco are addicting. Nicotine is the

drug in tobacco that causes addiction. The pharmacologic and

behavioral processes that determine tobacco addiction are similar to

those that determine addiction to drugs such as heroin and cocaine.

(United States Department

of

Health and Human Services, 1988, p. 4)

The addiction model continues to generate strong views. This is reflected in

titles such as: "The nicotine addiction trap: A 40-year sentence for four cigarettes"

(Russell,

199Gb,

p. 293). Goldstein refers to smoking as "addictive suicide"

(Goldstein, 1994, p. 7). Another article indicted cigarettes as being among the most

addictive substances known to man (Schelling, 1992). The eminent biologist, D.S.

Jordan, who was the first president

of

Stanford University, expressed his opinion

of

smoking in 1913: "The boy who smokes cigarettes need not be anxious about his

future, he has none" (Sullum, 1996, p. 32).

Thomas Edison stated that cigarette smoke "...has a violent action on the nerve

centers, producing degeneration

of

the cells

ofthe

brain, which is quite rapid among

boys. Unlike most narcotics this degeneration is permanent and uncontrollable"

(Sullum, 1998, p. 32). Edison's statement is a forerunner

of

the contemporary view

that cigarette smoking is maintained by changes in the brain produced by nicotine.

326 JOURNAL OF DRUG ISSUES

NICOTINE ADDICTION

At the moment, it is nearly impossible to find a contemporary document on

smoking that doesn't mention nicotine addiction as an incontestable point in the

first paragraph. Many believe that the recent admissions

of

tobacco companies

constitute furtherproofthatnicotine is addictive (Allis, Lafferty, McAllister, &van

Voorst, 1997; Carey, France, Dunham, &Greising, 1997). This beliefis peculiar

since the earlier denials

of

the tobacco companies were widely held to be false and

self-serving (Sullum, 1998). The validity

of

the nicotine addiction hypothesis is not

about admissions. assertions, or concessions; it is about logic and data.

CONCEPTUAL ANALYSIS OF THE ADDICTION

MODEL

With sufficient use, certain drugs are said to change the brain in such a way as

to make cessation difficult or impossible (Leshner, 1997, 1998, 1999a, 1999b).

Drug users frequently state that they cannot help themselves (Luik, 1996; Schaler,

2000). The nature

of

this alleged helplessness remains unclear. Drugs such as

opiates and cocaine are clearly very enjoyable, and users often report that such

drugs produce intense feelings

of

pleasure (Epstein, Silverman, I-Ienningfield, &

Preston 1999; Heishman, Schuh, Schuster, Henningfield, &Goldberg, 2000). It is

Possible that intense pleasure could account for persistent drug use. On the other

hand, drugs such as nicotine have only small and variable subjective effects (Duka,

Tasker, Russell, &Stephens. 1998; Rusted, Mackee, Williams, &Willner, 1998).

Although smoking may be pleasant, the effects are not at all comparable to

traditional drugs

of

abuse. Nicotine's lack

of

potent subjective effects necessitates

some other sort

of

mechanism to account for persistent use. This other mechanism

requires a unique pharmacological property, apleasure-independent ability to lead

the user into repeated use. However, at the moment there is no evidence

of

any

neural mechanisms that could mediate such an unprecedented effect.

The most direct form

of

evidence supporting the beliefthat drugs induce a form

of

helplessness incertain users is the verbal reports

of

the users themselves (Davies,

1998; Gori, 1996). That users may not stop is obvious; whether they cannot stop

is another matter. The utility

of

the verbal reports

of

drug users is compromised by

at least two major factors. Drug users, including smokers, tend to suffer from

diverse forms

of

psychopathology (Bergen &Caporaso. 1999; Coelho et aI., 2000;

Franken &Hendriks, 2000; Holmen, Barrett-Connor, Holmen, &Bjermer, 2000;

Riggs. Mikulich. Whitmore, &Crowley, 1999; Stassen et aI., 2000; Tanskanen et

aI., 2000). Thus, even with the best

of

intentions, the fidelity

of

their verbal reports

is uncertain (Davies. 1998). However, drug users often do not have good intentions.

They tend to explain their behavior in a manner that minimizes personal

responsibility (Davies, 1997, 1998; Schaler, 2000). This has clear social and legal

advantages. Such considerations suggest that the verbal reports

of

drug users may

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