Tobacco Documents Online

Will'iam Pollin, M.D. Director Natiional Institute on Drug Abuse Alcohol, Drug Abuse, and Mental'. Health Admilni'stration Public Health Service Department of Health and Human Seruilces before the Committee on Labor and Human Resources United States Senate ott Tuesday, March 16, 1982

is the,relative degree of control over the behavior of users which that dYug is ablie to achieve. We have heard' about the severe health consequences that.resuTt fromi smoking~ Smoking behavior itsel!f is the disease process which lead to these heaTth consequences. When we can provide more effective help to: smokers who wish to regain freedan of choice and reduce or discontinue smoking behavior, then the hundreds of thousands of yearly smoking-reliated cancer and heart deaths: can be sharply reduced. Thank you, ritY. Chairman. Il' would be,happy to respond to any questions you may hve at this time.

-3- dependence is consistent. with how we use the term: "dependence!" with other drugs,, such as alcohol and cocaine. Many researchers--some supported by NIDA--are currently exploring the same questions that we ask of any drug-using behavi.or: what factors determine (1) initial experilmentation or use;. (2) the progression from casual recreational usee tol regular, compulsive use; (3'), the maintenance of abstinence; and (4). the high rate of relapse. The bulk of research findings to date implicate nicotine as the main factor in establishing and maintai'ning dependence on tobacco. This results from nicot:i'ne's powerful bi'olog,ilcall and' psychological effects, which include stimulation of the re}ease.of a number of substances (norepinephrine, - epinephrine, growth hormone, cortisoi, vasopressin, and probably beta endorphin); the production of beh.avioral arousal and EEG alierting, patterns; and the fact that it is one of the most rapiidly metaboli'zed of ail self-administered' substances. Nicotine is a psychoactive drug. That is, it, influences subjectiive state and behavi'or. Not all'psychoactive d'rvgs llead to dependence or cravi',ng,c the major tranquilizers, for examplie, are powerful drugs which do not do so. NIDA's Ad'diction Research Center has developed a test --the ARC Inventory-- for precisely quantifying psychological and/dr subjective drug effects. Over the years, this test h;as been admi'nistered to over 3',000 individuals, bcth, with and without drug abuse histories. A,majior finding of current NIDA studies, derived' from this euphoria sub-scale of the ARC Inventory, is the marked! similarilty that

-2- States and ICD-9, the World Health Organization's International Classification of'Dilsease,. both include "Tobacco Dependence"' as a drug: dtpendence disorder. Thus, five major national and'internationali revieas of this question, which have invollved'.thei most knowliedgeabTe and experienced authorities in the area, hav.e all reached the same conclusion: cigarette smoking is an addiction. "Oependence"in~ the classic sense is indicated!by (1) ) persistent reg;ular use of a drwg, (2) attempts to~_stop~such use which leadlto discomfort and which often resutt in termdnation of the effort to stop, (',3), continuedg drug use despite damaging physical and/or psychological problems, and (4) persistent drug seeking behavior. People are drug dependent when a.drug, takes over and controlls their ability to choose to take the drug or not. The relative degree of dependence between the two~most widely used licit drugs in this country--alcohol and tobacco--is demonstrated by the fact that whereas the large majority of' Americans who use alicohol are subjectively and objectively able to , satisfactorily control their leveT of use, and only some 10 percent lose control.The opposite is true with tobacco: smokers: the great maj,ority of smokers report they woul'd like: to smoke less„ or quit smaking, but findlit very O diffikult or impossible to, do,so.. ~ F+ G7 ~ Data from the National Center for Health Statistics tell us that 99 percent of ~ those who say they smoke.tobacco, smoke.regularly. Seventy percent ofthose who report current smoki;ng, say they smoke more,than 15 cigarettes a day. Niine out of 10 smokers say they would like to quit smoking. Unfortunately, between 80 and 85 percentof current smokerswha have ever tried to qpit say'they have been unable to d'o so for more than three months. Smokers spend' time, money, and a liot of energy on a behavior they would rather not engage in. This view of

_5_ because they may exacerbate the user's tendency to continue its use. Toierance„ for instance,, reduces the pharmacollogical effects of drugs and may lead to more frequent admilnistration of higher doses of the drug, which in tnrn may produce graver health and social consequences for the user. Tolerance has~been demonstrated for some of'the effects of smoking cigarettesand also to the effects of'many of the components of cigarettes. As most of us know, nausea:andl dizziness is common among novice smokers, but disappears with experience. Metabolic tolerance can be demonstratediin smokers to various components of cigarette smoke (for example,, ni'cotine)I„ as well! as to a wide vaxiety of drugs such as barbiturates andi chlorpromazine. As with other drugs of abuse, withdrawal! si'gms do appear when heavy smokers abruptly quit. There is some variability in withdrawal symptoms, but it is not unusual for a smoker who stops smoking to, show a decrease in excreted epi~nephrine and norephinephrine and its metaboliites. Furthermore, there is a decrease i.n mean EEG frequency, in heart rate, an~ increase in appetite and.weight, and an: impairment in performance on psychomotor tasks and~in eoncentration., oisturbance in: sleep may occur and the iindividuals may feel anxious, irritable and evern. aggressive. Finally, most O iinidivid'uals who are tryiingto stop feel an increased craving: for tobacco ~ F+ smoking. ~ iJ1 O Mr. Chairman, it is likely that d'rugs such as nicotine and cocaine, wMich are verypowerfully habit forming:, and yet,do not show irrefutablle evi,dence of being physilcal'.ly ad'd'ictilve, maynot do so because we have not yet learned enough about the reTationship betweeo brain, drugs, andibehavilor to be able to identify those physical systems which are at the basis. of compul'silve drug use patterns. The Important point which must be stressed inithe di'scussion of psychoactive drugs

Mr. Chairman and,members of the Committee, thank you for the opportunity to testify on the addictive properties of tobacco smoking. On the.basis of our review of this question and of research, conducted ih, our own laboratories, it is our conclusion that cigarette smoking represents a prototypi,c dependence process - and is in fact the most wi~despread example of drug dependence in this country. Let me summarilze the evidence for these conclusions. There had been frequent suggestions in the past from bothi research and policy sources that the question of the.possible addictilve~nature of cigarette smoking needed review. Dn J'uly 1978, NIDA andilthe National, Academy of Sciences cosponsored a, conference which explored the background of this issue: a copy of the proceedings of that. meeti!ng "Cigarette Smoki!ng as a Dependence Process," anda list of participants has,been submitted for the record. Finally, in,August 1979'., a NI~DA sponsored Technical' Review was held to~ specifically review the question "Is cigarette smoking an addiction?"; it concluded, andil quote, "Cigarette smoking behavior should be consideredi a form of addiction, and tobacco in the form of cigarettes, an addicting substance." A surmary of that review and!the, partiicipants, has aiiso been submiltted. More recently, the Nati,onal Advi'sory Council on Drug Abuse passed'' the foll',owing resolution: "The National Advisory Counciili on IDrugiAbuse strongly recommend's to the Surgeon Gener,al that words be added C W to the warning an cigarette packages. The label should N W read "The Surgeon General', has determi'ned that ci arett g e smo.king, is, addictive and dangerous to your hieal'th"." Consistent with these conclusions and recommendations iis the fact that DSM-III, the current, standard diagnostic manual! of psychiatric disorders: in the United

-4- exists between morphine, cocaine, and nicotine. During the first several minutes after administration of the drugs, there.is an immediate and marked change in feeling-state (euphoria). This reflects the fact that duringithis period morphine:, cocainey and.nicotilne all "feel" very much, alike. The subject experiences a'"rush,"' which after a few minutes shows a variable course depending on the particular drug. Both from self-reported information and'.from intravenous adMnistration of' nicotine„ we have found that subjects who have hilstories of narcotic addiction say they "tike': tobacco and'¢or nicotine as well as or even~ more than other drugs. A British epidemiol'ogical study of 210 subjects seeking treatment for opiate addiction showed that (an a scale of one to five, with.fi!ve being the "most lilked!"'), tobacco received' a "liking" score, of 4.3, compared with 4.7' for heroin, 4.2 for cocaine, and 2.4 for amphetamine., This same study measured! these subjects"comparative perceived "need" for different drugs. On.a scale of 0 to 4, with 4 representing the "most needed", tobacco received the highest,score: 3.3--compared to 2'.8' for heroin, and 1..5 for cocaine. Although there may be questions as to the generalizabil.ity of the felt needs of individual's in treatment for drug abuse tothe general! popuiation, we think that these data are. indicative of the powerful,.compulsive effect of tobacco smoking in general and'd the ingestion of nicotine iln particular. These data support both, the MIDA ARC studies and the common anecdotal report that heroin addicts fi'ndlit more difficult to give up tobacco than heroin. As. with, other classic dkug,s of abuse such as the, opi'oid's and sedatives, tolerance and physical dependence are important characterilstics of a drug