Trend
400
300
220
200
100
70
Year
Source: Peto et al
Addiction
40 35 30
Ar er t al i
25 20 15 10 5 0 10 -
Venous
10
20
30
40
50
60
70
Ti m e( m ns i )
c i g a re tte sm oked
Rating IV nicotine and cocaine: Jones et al (1999) Compared 3 doses of cocaine and nicotine given IV double-blind + saline placebo Nicotine high and rush rated stronger than cocaine, also jittery
M ari j uana Tranqui l l i zers sl eepi ng pi l l s A mphet ami nes O pi at es C ocai ne Psychedel i cs hal l uci nogens
B ase n =9792
35 30 25 20 15 10 5 0
A bst ai ner O ccasi onal Li ght M oderat e Fai rl y heavy H eavy Ver y heavy
35 30 25 20 15 10 5 0
E x
3-4
5-6
7-8
9-10
11-12
13-14
Self-assertion . . .
To account for the fact that the beginning smoker will tolerate the unpleasantness we must invoke a psychosocial motive. Smoking a cigarette for the beginner is a symbolic act. The smoker is telling his world, 'This is the kind of person I am.' Surely there are variants of this theme, 'I am no longer my mother's child,' 'I am tough,' 'I am not a square.' Whatever the individual intent, the act of smoking remains a symbolic declaration of personal identity . . . Philip Morris (Bates no. 1003287836)
. . . and addiction
. . . As the force from the psychosocial symbolism subsides, the pharmacological effect takes over to sustain the habit . . .
Philip Morris 1969 document (Bates no. 1003287836)
Addiction -
Factors favouring study of smoking as compared with other drug taking behaviours
High prevalence Legal Little stigma, so self-reports largely accurate Unlike alcohol, excellent biomarker of intake available
Brief dependence scale 1. How soon after waking do you smoke your first cigarette of the day?
Less than 5 minutes Between 5 and 15 minutes Between 15 and 30 minutes Between 30 min. and 1 hr Between 1 and 2 hours Longer than 2 hours
2. How easy or difficult would you find it to go without smoking for a whole day?
Very easy Fairly easy Fairly difficult Very difficult
25 20 15 10 5 0
30 m i n t o 1 hr
S al i va co ti n i n e (n g / ml )
95%
CI
TI M E TO
F I RS T
CI G ARE T T E O F
T HE DAY
440
330
220
110
M ean + 95% C I
0
N= 130
1
108
2
96
3
99
4
120
5
149
6
136
7
143
8
160
9
108
10 11
73 38
3
2
0 .5
0
0 1 -4 5 -9 1 0 -1 4 1 5 -1 9 2 0 -2 4 2 5 -2 9 30+
2. 0
He a lth Su rv e y fo r En g la n d 1 9 9 4 &1 9 9 6
1. 5
1. 0
0. 5
Ge o m e tric m e a n + 9 5 % CI
0. 0 0 1- 4 5- 9 10- 14 15- 19 20- 24 25- 29 30+
M en
% prevalence
40 30 20 10 0
1972 1976 1980 1984 1988 1992 1996
Women
% prevalence
0 Most affluent
5 Poorest
DEPRIVATION SCORE
% quit
1973 1998
0 Most affluent
5 Poorest
DEPRIVATION SCORE
200
Effective
Nicotine replacement products
P r edicted and actual nicotine intakes per cigar ette sm oked by nom inal nicotine yield of usual br and
1 .6 1 .4 1 .2 1 .0 0 .8 0 .6 0 .4 0 .2
0 - .1 . 1. 2. 4. 5. 6. 7. 8. 91. 0 +
P r edicted and actual nicotine intakes per cigar ette sm oked by nom inal nicotine yield of usual br and
1 .6 1 .4 1 .2 1 .0 0 .8 0 .6 0 .4 0 .2
0 - .1 . 1. 2. 4. 5. 6. 7. 8. 91. 0 +
Trend
400
300
220
200
100
70
Year
Source: Peto et al
Trend
400
300
220
200
100
70
Year
Source: Peto et al
Trend
400
300
220
200
190
100
70
Year
Source: Peto et al
Conclusions
Nicotines legal status and lack of adverse effects on performance have hampered recognition of its status as a drug of dependence
Nicotine is pharmacologically a hard drug, on a par with heroin and cocaine Cigarette smoking is by far the biggest problem of drug dependence in the UK