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i Copyright 1994 National Public Radio NPR SHOW: Morning Edition (NPR 6:00 am ET) May 9,1994 Transcript # 1341-5 TYPE: Package SECTION: News; Domestic LENGTH: 1164 words HEADLINE: Defining Addiction When Nicotine's the Drug in Question GUESTS: C. EVERETT KOOP, Surgeon General; JOHN SLADE, Robert Wood Johnson Medical School; DAVID WORBITON, University of Reading, England; BYLINE: RICHARD HARRIS HIGHLIGHT: The FDA is still up in the air over whether nicotine should be regulated as an addictive substance, but many scientists have already reached the conclusion that nicotine meets the criteria. BODY: BOB EDWARDS, Host: Scientists disagree about how to categorize a drug called nicotine. Defining addiction after headlines from Jean Cochran. [news headlines] EDWARDS: Renewed controversy surrounds nicotine after recent allegations that tobacco companies manipulate nicotine levels in cigarettes to keep smokers from kicking the habit. The head of the Food and Drug Administration says the agency may regulate cigarettes as drugs if tobacco companies are indeed using nicotine to keep smokers addicted. But as this controversy continues, scientists still are debating just how addictive nicotine is and what exactly 'addictive' means. NPR's Richard Harris reports. RICHARD HARRIS, Reporter: Every year since 1964, the U.S. Surgeon General has ~ put out a report about the hazards of tobacco - how smoking causes lung cancer,

~ emphysema, heart disease and harms fetuses. The 1988 report, issued by Surgeon General C. Everett Koop is one of the landmarks. C. EVERETT KOOP, Surgeon General: This report addresses why people continue to smoke despite the known health hazards, and the short answer to that is that cigarettes are addicting. HARRIS: That conclusion emerged from two converging trends - first, the scientific evidence that had been accumulating about nicotine and, secondly, a changing definition of addiction. Scientists gradually redefined addiction from a personality disorder to a problem rooted in biochemistry. There's no strict scientific definition of addiction, but John Slade at the Robert Wood Johnson Medical School in New Jersey says that in the 1980s, scientists settled on three animal tests that together determine a drug's potential to be addictive. JOHN SLADE, Robert Wood Johnson Medical School: One is a test of self- administration - can you arrange things so that the animal will do work in order to receive the drug. The second is a test for tolerance. ~ HARRIS: Will an animal gradually need a higher dose of the drug to achieve the same affect. Mr. SLADE: And the third is is there withdrawal? That is if the drug is suddenly stopped, does the animal exhibit some change in behavior? HARRIS: Nicotine met all three of these criteria. In fact, in animal studies, he says, nicotine is similar to alcohol, cocaine, and heroin. But addiction isn't defined entirely by the biological effect in animals. Slade says a key component of addiction is how that biological effect is played out in a social context. Mr. SLADE: In our culture, these drugs exist in a specific cultural context with different pricing, different availability, different levels of legality, different expectations about use in the culture. And under those circumstances, the regular use of alcohol in our culture leads to addiction about 10 percent of the time, while the regular use of nicotine leads to addiction in the range of 70 percent of the time. HARRIS: Slade says cocaine and heroin users are actually less likely to end up addicted than nicotine users. And there is some evidence, he says, that it's easier to quit heroin than it is to stop smoking. Mr. SLADE: When the American soldiers who had become addicted to opiates in Vietnam returned back to the U.S., many of them spontaneously stopped using heroin. 0 And my understanding is that the rate of recovery without any formal treatment was

0 about 30 percent a year. Compare this with one or two percent a year of people who are able to stop smoking. HARRIS: Altogether, Slade says, the evidence is overwhelming. Mr. SLADE: It's a settled issue. Nicotine is an addicting drug. HARRIS: Most psychologists agree with that statement, but there are some exceptions, and they aren't all simply on tobacco company payrolls. One school of thought holds that nicotine is addictive, but it's more akin to caffeine than heroin. Caffeine has many of the same effects in animals as nicotine. Quit caffeine cold turkey, and you could end up with a miserable withdrawal headache. But it's not classified as addictive because it isn't considered harmful. And there are a few scientists, including David Worbiton [sp] of the University of Reading in England, who dispute that nicotine is addictive at all. He says smokers are in control of cigarettes, not the other way around. And he argues that smokers continue their unhealthy habits because they benefit from the drug while they're using it. DAVID WORBITON, University of Reading, England: My explanation of why they don't quit and why they don't want to quit is because of the psychological resources * they're getting from it in terms of the improved mood and the mood improvement doesn't interfere with everyday life and performance. And that's a very important aspect, in fact, it actually improves performance. So it's completely compatible with everyday living. HARRIS: That distinguishes nicotine from all other drugs that have been declared addictive. It's not nicotine, but largely the other chemicals in cigarettes that may even kill smokers. That may seem like a distinction without a difference, but Worbiton argues that the issue is not simply semantic. Mr. WORBITON: I find it a very unhelpful label in several sorts of ways. Firstly, I don't think it helps the smoker who desires to give up, if they feel they're addicted, then they have all of those descriptions of withdrawal syndrome and the difficulties in giving up. And I think this may be off-putting to many smokers and they may use it as an excuse for not giving up. HARRIS: Worbiton says the stigma of addiction has also made it difficult for him to get money to study nicotine derivatives as therapeutic drugs. Nicotine-like chemicals are being explored as possible treatments for Alzheimers' and Parkinsons' disease, since nicotine mimics the natural brain chemicals that are upset in those diseases. p co ~ 0) V N W .

John Slade at the Robert Wood Johnson Medical School counters that if the term addiction stigmatizes research, the answer is to inform people that addicts aren't necessarily strung-out junkies standing on street corners. . Mr. SLADE: Those stereotypes are fueled by the tabloid press and by the fears of crime and the rest, and that's not fundamentally what addiction's about. Addiction's about a drug coming to rule a person's mind and lead them to continue seeking the drug and the means necessary to continue to ingest the drug. HARRIS: The fact that nicotine is legal and cheap makes it less destructive socially than other addictive drugs, Slade says, but even so, cigarettes kill more than 400,000 Americans each year. This is Richard Harris in Washington. [music] The preceding text has been professionally transcribed. However, although the text has been checked against an audio track, in order to meet rigid distribution and transmission deadlines, it may not have been proofread against tape. LANGUAGE: ENGLISH LOAD-DATE: May 9,1994 N 0 00 w rn _ ~ N m ~

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