Are you addicted to nicotine?

The tobacco industry knew for more than 40 years that the nicotine in tobacco smoke was addictive. In private, the reason why people smoke – namely addiction to nicotine – has know as the primary reason why people smoke. In public, the tobacco industry has denied this, or, more recently, tried to alter the definition of addiction. As a whole, the industry claims that it has never been deceitful on the issue of nicotine and addiction:

“We have not concealed, we do not conceal, and we will never conceal….[We] have no internal research which proves that smoking…is addictive.” (BAT, 1996)

There are numerous publicly available (thanks to lawsuits) documents that contradict this stance though…

“We have, then, as our first premise, that the primary motivation for smoking is to obtain the pharmacological effect of nicotine.” (Philip Morris, 1969)

“Different people smoke for different reasons. But the primary reason is to deliver nicotine into their bodies. Nicotine is an alkaloid derived from the tobacco plant. It is a physiologically active, nitrogen-containing substance. Similar organic chemicals include nicotine, quinine, cocaine, atropine and morphine.” (Philip Morris, undated)

“Let’s face facts: Cigarette smoke is biologically active. Nicotine is a potent pharmacological agent. Every toxicologist, physiologist, medical doctor and most chemists know that. It’s not a secret.” (Philip Morris, 1982)

To mitigate the evils of tobacco smoke, the tobacco industry has viewed itself as selling nicotine, rather than cigarettes:

“Nicotine is addictive. We are, then, in the business of selling nicotine—an addictive drug effective in the release of stress mechanisms.” (Brown & Williamson, 1963)

“In a sense, the tobacco industry may be thought of as being a specialized, highly ritualized, and stylized segment of the pharmaceutical industry. Tobacco products uniquely contain and deliver nicotine, a potent drug with a variety of physiological effects.” (RJ Reynolds, 1972)

“It may be useful, therefore, to look at the tobacco industry as if for a large part its business is the administration of nicotine (in the clinical sense).” (BAT, 1967)

“…BAT should learn to look at itself as a drug company rather than as a tobacco company.” (BAT, 1980)

Although the tobacco industry has fought government efforts to regulate cigarettes as drug-delivery devices, in private that is exactly how they see their product:

“The cigarette should be conceived not as a product but as a package. The product is nicotine.…Think of the cigarette pack as a storage container for a day’s supply of nicotine.…Think of a cigarette as a dispenser for a dose unit of nicotine. Think of a puff of smoke as the vehicle of nicotine.…Smoke is beyond question the most optimised vehicle of nicotine and the cigarette the most optimised dispenser of smoke.” (Philip Morris, 1972)

“…The primary motivation for smoking is to obtain the pharmacological effect of nicotine. In the past, we at R&D have said that we’re not in the cigarette business, we’re in the smoke business. It might be more pointed to observe that the cigarette is the vehicle of smoke, smoke is the vehicle of nicotine, and nicotine is the agent of a pleasurable body response.” (Philip Morris, 1969)

“A cigarette as a ‘drug’ administration system for public use has very, very significant advantages: Speed. Within 10 seconds of starting to smoke, nicotine is available in the brain. Before this, impact is available, giving an instantaneous catch or hit, signifying to the user that the cigarette is ‘active.’ Flavour, also, is immediately perceivable to add to the sensation. Other ‘drugs’ such as marijuana, amphetamines, and alcohol are slower and may be mood dependent.” (BAT, undated)

Animal experiments referenced in the literature and found in tobacco company documents confirm the companies’ awareness of the addictive properties of nicotine:

“…Monkeys can be trained to inject themselves with nicotine for its own sake, just as they will inject other dependence-producing drugs, e.g., opiates, caffeine, amphetamine, cocaine. … The absorption of nicotine through the lungs is as quick as the junkie’s ‘fix’.” (Brown & Williamson, 1973)

Philip Morris conducted studies in rats demonstrating that nicotine is self-administered by rats and has other hallmark properties of addictive substances. Therefore, The companies realize that reducing and/or eventually eliminating nicotine from tobacco products will cause smokers to quit:

“If, as proposed above, nicotine is the ‘sine qua non’ of smoking, and if we meekly accept the allegations of our critics and move toward reduction or elimination of nicotine in our products, then we shall eventually liquidate our business. If we intend to remain in business and our business is the manufacture and sale of dosage forms of nicotine, then at some point we must make a stand.”'(R.J. Reynolds, undated)

The companies continue to deny that they can or do manipulate nicotine levels in cigarettes. Their internal documents say otherwise. The nicotine level of cigarettes

“…was not obtained by accident….[We] can regulate, fairly precisely, the nicotine and sugar levels to almost any desired level management might require.” (BAT, 1963)

The companies recognize that by publicly admitting that nicotine is addictive, they would undermine their argument that people’s decision to smoke is a “free choice”:

“…The entire matter of addiction is the most potent weapon a prosecuting attorney can have in a lung cancer/cigarette case. We can’t defend continued smoking as ‘free choice’ if the person was ‘addicted’.” (Tobacco Institute, 1980)

“To some extent the argument revolving around ‘free choice’ is being negated on the grounds of addiction. The threat is that this argument will increase significantly and lead to further restrictions on product specifications and greater danger in litigation.” (Brown & Williamson, 1973)

“It has been suggested that cigarette smoking is the most addictive of habits — that nicotine is the most addictive drug. Certainly large numbers of people will continue to smoke because they are unable to give it up. If they could they would do so. They can no longer be said to make an adult choice.” (BAT, 1980)

So publicly, the industry argues that nicotine is important for taste or flavour and that nicotine is not addictive:

“The claim that cigarette smoking causes physical dependence is simply an unproven attempt to find some way to differentiate smoking from other behaviors. … The claims that smokers are “addicts” defy common sense and contradict the fact that people quit smoking every day.” (Tobacco Institute, 1988)

“Those who term smoking an addiction do so for ideological—not scientific—reasons.” (Philip Morris, 1996)

These denials culminated in U.S. Congressional hearings in 1994 when the chief executive officers of the seven largest American tobacco companies all testified that nicotine is not addictive:

“I do not believe that nicotine is addictive.” — Thomas Sandefur (Brown & Williamson)

“I believe nicotine is not addictive.” — William Campbell(Philip Morris)

In the late 1990s, as these damning internal documents came to light, the companies responded by trying to fudge and change the definition of addiction—which they now apply to such activities as shopping or the Internet:

“The definition of addiction is wide and varied. People are addicted to the Internet. Others are addicted to shopping, sex, tea, and coffee. The line I would take is that tobacco isn’t addictive but habit forming.” (Tobacco Marketing Association, 1998)

Should we trust the tobacco companies’ new image?

Recently, the tobacco industry has been advertising itself as being a reformed industry. Because of this, it seems to think collectively that we should not judge it based on its past behaviour. This past behaviour includes over 50 years of lies and deceit about cancer and nicotine.

On one hand, tobacco companies sell us tobacco products which clearly kill the consumer and on the other hand, tobacco companies are involved in preventative health campaigns and funding scientific research into protecting us from tobacco.
Evidence forced into the open now indicates that what the tobacco companies say to the public and to the government largely contradicts what they say to themselves in their boardrooms. Tobacco companies are determined to put their profits ahead of your health and long life.

If you think for one moment that tobacco companies are in any way interested in anything but your cold hard cash, think again.

Tobacco is the single largest cause of premature death in the world. Over 400,000 Americans die every year from tobacco related illnesses, another 100,000 in the United Kingdom and over 10,000,000 throughout the world by 2010.

In any other walk of life, these products would not be allowed on the shelves and because of their whole hearted determination to protect their industry, the tobacco industry should not be given a role to play in crafting the long term solution to this problem.

To emphasise the point regarding the tobacco industry’s sincerety regarding its new touchy-feely approach to the evils of tobacco, a recent report from the UK’s House of Commons said:

It seems to us that the companies have sought to undermine the scientific consensus until such time as that position appears ridiculous. So the companies now generally accept that smoking is dangerous (but put forward distracting arguments to suggest that epidemiology is not an exact science, so that the figures for those killed by tobacco may be exaggerated); are equivocal about nicotine’s addictiveness; and are still attempting to undermine the argument that passive smoking is dangerous.

It is not in the interests of tobacco companies, their employees or shareholders to undertake any activity which actively restricts, regulates or tightens their ability to grow their market share.

The main objectives of the tobacco industry – to sell more tobacco to more and more users – has not changed. The presentation and spin (PR Strategy) has.

Tobacco companies are working against legitimate evidence based research that is used to justify public health campaigns against tobacco use.

The tobacco industry continues to question the evidence that nicotine is addictive and threat tobacco smoke is a major factor in many illnesses including lung cancer.

The companies have merely accepted, grudgingly, a small number of selective facts that are beyond reasonable doubt. Even these have been accepted with new qualifications and distracting caveats.

Whilst on the one had saying that they should be restrained in marketing their products as a result of their ill-effects on health, tobacco companies continue to target campaigns on youth and younger generations (to provide them with longer term smokers/customers).

The companies continue to support health campaigns that do not work.

The companies still resist the regulatory standards other products must adhere to for legal sale.

The industry as a whole has never withdrawn any earlier false and misleading statements.

No one in the industry has apologized, resigned, or been fired as a result of making false or misleading statements.

Every smoker who quits smoking is a lost customer. Tobacco companies only support quit smoking methods that are known to be unsuccessful.

Ask yourself why would any industry campaign against its own interests?

The tobacco industry continues to aggressively promote tobacco use in every corner of the globe. The reality is that the tobacco industry has not really changed despite the claims it makes in public – it has just changed its.

If history has taught us anything about the tobacco industry, it is that it will change only if it is forced to change, and that change will come only if imposed from outside. The Framework Convention on Tobacco Control could be that vehicle for change providing tobacco companies are not allowed to hijack the initiative.

Quit smoking cold turkey success rates

I have been thinking about why people think that quitting smoking cold turkey has such a low success rate. I think I have come up with an answer too. To understand what I mean it is important to understand what I mean by quit smoking cold turkey.

To quit smoking cold turkey merely means that you should not be using any intervention other than verbal or written word. You should not be on varenicline, (chantix and champix), zyban (wellbutrin and bupropion), nicotine patches, gum, lozenges, tabs, nasal sprays or inhalers. You should not be using acupuncture, laser therapy, silver acetate sprays, aversion therapies, chain smoking, hypnosis, clonidine, opoid antagonists, anxiolytics, anti-depressants, nicocure, nicobrevin, lobeline or mecamylamine – to mention a ‘phew’ of the options!

To quit smoking cold turkey, all you should be using is education and knowledge and that is the key.

Most people think to quit smoking cold turkey as just stopping smoking one day, without any help, support or education. But it shouldn’t be like that. It should involve education and support.

I promise you that every time I tried to just quit smoking, out of the blue, I would fail miserably. Even when I read all the pamphlets and advice from my doctor and the stuff in the nicotine patch packet, it didn’t help one bit.

Telling me why I should stop smoking is different from telling me how I should stop smoking!

I needed to know how and when I did, it was a cinch!

The reason why people think that quitting smoking cold turkey has such a low success rate is because it has never been studied properly. It is assumed that quitting smoking cold turkey just means trying to stop smoking using willpower alone. When you know how to quit smoking, you don’t need any willpower anyway, you just need to want to quit smoking.

In most studies, the ‘control group’ (the cold turkey group) are just told to quit smoking. They may be given some sugar pills or some sticky patches (without nicotine) but they are normally just left to their own devices. No surprise then that they all fail miserably with only about 5% successfully quitting.

There is a difference between just trying to abandon smoking and learning how to quit smoking. One you have learned how to quit smoking, your potential success rate rises to 100%. Let me use an analogy to explain.

Imagine sitting in front of an internet-enabled computer for the first time and being told you have 1 week to build a database of all the employees of a company with all the relevant details of pay and personal circumstances. Do you think you might need help?
Well, 5% of the population might just figure it out all by themselves but at least 95% wouldn’t and that is what quitting smoking is like. You are either lucky/smart/clever enough to figure out for yourself how to do it or you are like the rest of us who need to be pointed in the right direction.

It is important to realise why you should quit smoking. There are more medical reasons to quit smoking then for any other ailment. Smoking poisons your whole body, not just you lungs – virtually every aspect of your body and metabolism is affected by tobacco smoke. Knowing this gives you the motive to quit smoking. Understanding how to quit smoking cold turkey will give you the means to quit smoking and finally, you will need the opportunity. What most people don’t realise is that today is as good an opportunity as you will ever be presented with.

Never stop trying to quit.

How addicted are you?

A “yes” answer to any question indicates some degree of impairment; the more “yes” answers, the more serious the problem. Here are the questions:

1. Have you ever tried to quit, but couldn’t?

2. Do you smoke now because it is really hard to quit?

3. Have you ever felt like you were addicted to tobacco?

4. Do you ever have strong cravings to smoke?

5. Have you ever felt like you really needed a cigarette?

6. Is it hard to keep from smoking in places where you’re not supposed to?

When you haven’t used tobacco for awhile, or when you tried to stop smoking . . .

7. Did you find it hard to concentrate because you couldn’t smoke?

8. Did you feel more irritable because you couldn’t smoke?

9. Did you feel a strong need or urge to smoke?

10. Did you feel nervous, restless or anxious because you couldn’t smoke?

Courtesty of J.R. DiFranza, J.A. Savageau, K. Fletcher, J.K. Ockene, N.A. Rigotti, A.D. McNeill, M. Coleman, C. Wood, “Measuring the loss of autonomy over nicotine use in adolescents: The Development and Assessment of Nicotine Dependence in Youths Study.” Archives of Pediatric Adolescent Medicine. 2002;156:397-403.