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National I nstitute on Drug r1 ^ Abuse 11) )'-~ 1 t e earch~ ~J A MONOGRAPH SERIES 11 S. OEPApTMFNT [1F HFAI TH Fnll(`&TFnN emn wGi tApG . DIihM Hsakh Cenilrn , ew,hm n..- ew.., TIlVLN 0152357

Cigarette Smoking as a Dependence Process Editor: Norman A. Krasnegor, Ph.D NIDA Research Monograph 23 January 1979 DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Alcohol, Drug Abuse, and Mental Health Administration National Institute on Drug Abuse Division of Research 5600 Fishers Lane Rockville, Maryland 20857 TIIVVIN 0152358

The NIDA Research Monograpn series is preparea ay me vwIaIon u1 RtnVUra1 r u1 the National Institute on Drug Abuse. Its primary objective is to provide critical re- views of research problem areas and techniques, the content of state-of-the-art conferences, integrative research reviews and significant original research. Its dual publication emphasis is rapid and targeted dissemination to the scientific and professional community. Editorial Advisory Board Avram Goldstein, M.D. Addiction Research Foundation Palo Alto, California JeromeJaffe, M.D. College of Physicians and Surgeons Columbia University, New York Reese T. Jones, M.D. Langley Porter Neuropsychiatric Institute University of California San Francisco, California William McGlothlin, Ph.D. Department of Psychology. UCLA Los Angeles, California Jack Mendelson, M.D. Alcohol and Drug Abuse Research Center Harvard Medical School McLean Hospital Belmont, Massachusetts Helen Nowlis, Ph.D. Office of Drug Education, DHEW Washington, D.C. Lee Robins, Ph.D. Washington University School of Medicine St. Louis, Missouri NIDA Research Monograph series Karst J. Besteman ACTING DIRECTOR, NIDA William Pollin, M.D. DIRECTOR, DIVISION OF RESEARCH, NIDA Robert C. Petersen, Ph.D. EDITOR-IN-CHIEF Eleanor W. Waldrop MANAGING EDITOR Parklawn Building, 5600 Fishers Lane. Rockville, Maryland 20857 ~~' ,'~IMN 015~~~

I Cigarette Smoking as a Dependence Process TIMN 0152360,

I ACKNOWLEDGMENT The meeting on which this monograph is based, held June 19, 1978, was sponsored by the National Institute on Drug Abuse and the Conmittee on Substance Abuse and Habitual Behavior of the National Research Council. The National Institute on Drug Abuse has obtained permission from the copyright holders to reproduce certain previously published material as noted in the text. Further reproduction of this material is prohibited without specific permission of the copyright holders. With these exceptions, the con- tents of this monograph are in the public domain and may be used and reprinted without special permission. Citation as to source is appreciated. Library of Congress catalog card number 79-60046 DIO;W publication number (AIM) 79-800 Printed 1979 NIDA Research D'fonographs are indexed in the Index Medicus. They are selectively included in the coverage of BioScienees inforntation Service, ChemicaZ Abstracts, PsychoZogicaZ Abstracts, and Psycho- pharmacoZogy Abstracts. iv . - T'jMN 0152361

Foreword The 1979 Smoki.ng and Health report and its press coverage are giv- ing new proms.nence toTeTiealth risks of smoking. At the same time, the tobacco industry advocates "personal choice" and no restrictions on smoking, and manufacturers are producing more cig- arettes of lowered tar/nicotine content. Most importantly, millions of individuals--from preteens to adults--are making personal de- cisions about smoking: to begin to smoke; to change to cigarettes delivering less tar and nicotine (but no less carbon monoxide); to stop smoking; and, for most of those'who stop, to "light up" again after a period of abstinence. Once a person starts to smoke, future choices are less freely made, because smoking is addictive. The nature of the dependency is not well understood, and new knowledge is vitally needed. Hence the de- pendence process'is the focal point of this volume. The findings of researchers who are now seeking answers to questions about smoking should someday make it possible to influence more in- dividual smoking decisions and to lessen the high economic and social costs of smoking. This will come through increased knowledge of such areas as: social and psychological factors in the initiation of smoking; just what makes cigarette smoking "rewarding"--and also dependence-producing; the effects of nicotine and the many other sol- id and gaseous compounds in cigarette smoke; the sites of action of nicotine in the brain and of possible compounds which may alter or block its effects; the nature of smoking withdrawal and abstinence syndromes. v TIMN 0152362

This volume on Ci aSmoking as a Dependence Process presents the results of some o t e researcTi ai is now eg6-innning to answer such questions and to raise still further questions for which answers are needed. The National Institute on Drug Abuse offers this monograph with thanks to all those who are carrying forward this work and with an invitation to other qualified investigators to join them. As part of NIDA's fulfillment of its charge to carry out and support research on tobacco-smoking behavior, this book takes its place with Research Monograph No. 17, Research on Smok- npon ~in Behavior (1977), and sections on smoking witFin~ monograp~o roa er subject of substance abuse: No. 20, Self-Adm.i.nistration of Abused Substances (1978), and No. 25, Behaviora a ysss an 'I7eatment o stance Abuse (forthcoming)'-- We hope that these pub lications as well as the research reported are a significant contribution to the continuing effort to reduce the toll of disabilities and deaths related to cigarette smoking. William Pollin, M.D. Director Division of Research National Institute on Drug Abuse vi TIM.N 0152363

Preface Cigarette smoking is a dangerous habit. It can lead to a variety of ailments and serious disorders, from impaired breathing to de- bilitating and fatal illness, such as heart disease and cancer. Cigarette smoking is "slow-motion suicide," in the words of Joseph A. Califano, Jr., Secretary of Health, Education, and Welfare. Such facts are widely known and accepted by most--including many who smoke. Yet, some 54 million Americans smoked 615 billion ciga- rettes last year. The immediate question that comes to mind is "why"? Surveys find 90 percent of smokers saying they have tried to quit or probably would if they had an effective way to do so. In the past 15 years, 30 million smokers have quit the habit, almost all of them on their own. Again, the question is "why"? If this habit were merely an irritating or unpleasant practice, it might be interesting to explore as another curious facet of human behavior. But the smoking habit is a case of widespread self- injury with.enormous health consequences that cost the Nation an estimated $27 billion a year, not to mention the personal toll in sickness and death. We face a major public health problem created by millions of individual decisions to risk well-being for a puff of smoke. Why? There are many theories to explain such behavior but only pieces of possible answers. Because of the magnitude of the problem, those concerned with protecting the, public health are compelled to promote the prevention of smoking in the first place and to find ways to help others break the habit. To achieve those ends, we must understand the basis of the smoking habit and its mechanism. The papers collected in this monograph are steps toward that under- standing. vii i TIMN 0152364

i The authors of these papers are among the first to admit that they do not have final answers, that questions far outnumber answers ~ in this field. But good questions lead to solutions, and this effort represents a move toward that goal. The health consequences of smoking have been studied intensively, as reflected by more than 30,000 articles on the subject and the research summarized in the 1979 Report of the Surgeon General on ~Sm~ok~i~n ~and FIealth. But, until recently, little serious research F~a.s~~een con u3 ctea into the reasons why the smoking habit begins and how it maintains its hold. Simply put, that is the subject of these scientific papers: To define the habit that leads indi- viduals to act counter to common sense, and to discover why. It is appropriate that the National Institute on Drug Abuse assume leadership in the exploration of these questions because smoking is surely the most widespread example of drug dependency. The drug, nicotine, for example, is but one of the 2,000 components of cigarette smoke and a pack-a-day smoker of cigarettes self- administers more than 50,000 puffs--or doses--a year. That is in- deed drug dependency. The smoking habit is an excellent subject for research into the biological, behavioral, and psychosocial aspects of the dependency process. This kind of research can help us learn why more than 4,000 young- sters take up the habit daily; why women, smoking in greater num- bers than ever, find it more difficult than men to quit; why some individuals can break the habit "cold turkey" and others find it impossible to quit. There are many other questions that need an- swers: Is the smoking habit a "true" drug addiction, or is it a learned social or behavior pattern? Are there nicotine receptor sites in the central nervous system that can be blocked by medi- cation to break the habit? Why, in other words, do people persist in the habit despite know- ledge of the health consequences? And how can they be helped? Such questions are explored.in these papers in the hope that the theories they present, the clues they offer, and the ideas they prompt will lead to the answers we need. John M. Pinney Director Office on Smoking and Health "T1MN 0152365

Contents Foreword WiZZiam PoZZin . . . . . . • • . • . . . . . v Preface John M. Pinney . . . . . . . . . . . . . . vii Chapter 1 Introduction Norman A. Krasnegor . . . . . . . . . . . . . 1, Part I. PSYCHOSOCIAL FACTORS Chapter 2 Smoking as an Addictive Disorder Jerome H. Jaffe and Maureen KanzZer ........ 4 Chapter 3 Psychological Analysis of Establishment and ' Maintenance of the Smoking Habit Danie Z Horn . . . . . . . . . . . . . . . . 24 Chapter 4 Cigarette Smoking as a Precursor of Illicit Drug Use John A. 0'DonneZZ . • • • • • • . • • • • • • 30 Chapter 5 Patterns of Tobacco Use in the United States Dorothy E. Green • • . • • • • • • • • . . 44 Part II. BEHAVIORAL FACTORS (hapter 6 Nicotine as a Discriminative Stimulus to Behavior: Its Characterization and Relevance to Smoking Behavior John A. Rosecrans • . . . . . • • • • • • • . 58 Chapter 7 Nicotine Self-Administration in Rats H. M. Sanson, C. A. Ivester, and B. R. Morton ••• Chapter 8 The Effects of d-Amphetamine, Meprobamate, and Lobeline on the Cigarette Smoking Behavior of Normal HLunan Subjects C. R. Schuster, B. R. Lucchesi, and G. S. EbaZey .. ix • .70 TIMN 0152366