Is Nicotine the Most Addictive Drug?

Jacob Sullum | November 14, 2005

Writing in The Washington Times, Brad Rodu and Jeff Stier mark the Great American Smokeout by suggesting smokeless tobacco as a safer alternative to cigarettes. Although they are certainly correct to note that different forms of tobacco pose different health risks (a point the government tends to deny or obscure), they are too quick to accept the anti-smoking movement's article of faith that (as ABC medical correspondent Tim Johnson puts it) "there is no more addictive substance than nicotine."

I am automatically skeptical of assertions like that because addictiveness depends not just on the drug but on the user and the context. If you don't like the effects of nicotine, you will find that it is not at all addictive. Even if you like nicotine, you may like another drug more. While anti-smoking activists make much of people who say cigarettes are harder to give up than heroin, for example, most heroin addicts report the opposite. And while it's true that the typical cigarette smoker, who consumes about a pack a day, can reasonably be viewed as a heavy user or addict, the same is not true of the typical cigar or pipe smoker. Although the drug is the same, the patterns of use are quite different, with occasional use more common than daily use.

The "addictiveness" of cigarettes--as measured by the share of experimenters who become regular users or the share of current smokers who light up every day--is largely a function of nicotine's compatibility with everyday activities (in contrast to, say, alcohol or heroin) and the cigarette's (now vanishing) convenience and social acceptability. People tend to smoke cigarettes all day, every day (as opposed to drinking whiskey all day, every day) partly because they can do so without compromising their ability to meet their responsibilities at work and at home. In recent years, as it has become increasingly difficult to find places to smoke, occasional cigarette smoking has become more common. Does that mean nicotine has become less addictive?

The point is not that pharmacology doesn't matter at all. But it's not very meaningful to compare the addictiveness of different substances without regard to set and setting.

Comments

|11.14.05 @ 2:33PM|#

Pipes and cigars are smoked very differently than cigarettes - cigarette smoke is inhaled deep into the lungs, increasing the amount of nicotine delivered into the system.

The difference in addition rates between them is not the result of social forces, but the greater amount of the drug that works on the receptors.

|11.14.05 @ 2:36PM|#

I am automatically skeptical of assertions like that because addictiveness depends not just on the drug but on the user and the context.

I am automatically skeptical of assertions like that because of the remarkable convenience that -- of the hundreds of different drugs out there -- the drug they happen to be writing about is also the most addictive.

While addictiveness and interest in writing the story are not completely independent variables, the odds of such a remarkable coincidence that the statement is true are pretty low. Exceptional claims require exceptional proof.

|11.14.05 @ 2:37PM|#

I've been smoking for quite some time now, and I have to say that the physical addiction to nicotine is much less prevalent than the psycholocgial addiction. I can go without a cigarette for a fairly long time (for a smoker) without too much physical stress. When I do feel a "nic fit", it usually only lasts a short time and then subsides again for a few hours.

Given this, I should be able to quit or at least significantly reduce my cigarette consumption, but I don't. Part of that is certainly the ease of carrying out normal responsibilites while smoking, but it goes beyond that. There are numerous times throughout the day, when the thought of having a cigarette trumps my actual need for one. I once observed that not being able to smoke everywhere has actually increased that psychological addiction, as now every major activity bookended by a cigarette.

Ultimately, this is one of the reasons for the failure of quitting aids for many. They don't crave nicotine nearly as much as they crave actually having a cigarette.

|11.14.05 @ 2:57PM|#

Pharmacology has never been and will never be a primary or all-encompassing explanation for addictive behaviors. Addiction is as much or more of a social and behavioral phenomenon as it is a biological one, and shoot-from-the-hip reductionist theories have gotten us into all sorts of anti-drug quagmires. Cigarettes have a certain cachet that pipes and cigars don't. I presume that carrying a pipe around is a pain in the rear, and who has time to smoke cigars? The list can go on and on, but Jacob's last point is one that needs to be addressed by anyone advocating any theory of addiction.

Warren|11.14.05 @ 3:12PM|#

I've played around with more drugs than I care to list. In addition to smoking, I've been at one time or another, a regular user of alcohol, marijuana, and cocaine. Cigarettes, once they got their hooks into me, were by far the hardest to put down. No other drug scares me like the siggies. It took three months, from the time I quit smoking till I spent a day without a craving. I have no fear of becoming a wino, junky, or crack-head, but I won't take even one drag from a cigarette because of the effort required not to take the next one.

So while I understand (and even share in) Jake's skepticism and criticism, I can testify from personal experience that when it comes to addiction, nothing comes close to cigarettes.

FWIW: I will however, on special occasions enjoy a cigar. Also, while I like the smell of pipe tobacco, I need the guy next to me to smoke the pipe. If I smoke it myself, it kills the smell.

|11.14.05 @ 3:23PM|#

I've played around with more drugs than I care to list. In addition to smoking, I've been at one time or another, a regular user of alcohol, marijuana, and cocaine. Cigarettes, once they got their hooks into me, were by far the hardest to put down. No other drug scares me like the siggies.

I'll second what Warren Just said. I "quit" smoking about 3 years ago and I still have the urge to (and many times do have an occasional smoke here and there in certain social situations) it's especially hard when all my friends were smokers and I was one of the few that quit.

Luckily for me my friends have all started quitting as well (only one still smokes) and thus the "urges" come much fewer and farer between.

I still want one like crazy whenever someone in a movie lights one up.

So from my personal anectodal experience, I must say agree cigs are pretty damn tough to kick. Luckily I have a wife who polices me pretty strictly and only allows me the occasional indulgence (1-2 cigs a month and only in certain social situations) otherwise it would be quite easy to go from "just one here and there" to "just one pack here and there"

R C Dean|11.14.05 @ 3:32PM|#

I smoked a pack or so a day for 4 or 5 years, and had no trouble at all quitting.

The difference in addition rates between them is not the result of social forces, but the greater amount of the drug that works on the receptors.

Spoken like someone who has never smoked a strong cigar, which can deliver enough nicotine even if not inhaled to make you black out, if you are stupid enough to keep puffing on it after the nausea and the shakes kick in.

Addicts like a lot of little doses through the day. In modern society, it is very difficult to keep a pipe or cigar lit through the day, but with cigarettes you can still get this addiction-compatible pattern.

|11.14.05 @ 3:34PM|#

Set and Setting

Way to go Jacob with the Leary reference!

I quit smoking 2 years ago and it was actually *easier* than I had been led to believe.
You just have to be want it and be ready . .

|11.14.05 @ 3:37PM|#

Ultimately, this is one of the reasons for the failure of quitting aids for many. They don't crave nicotine nearly as much as they crave actually having a cigarette.

Bingo. It's not so much the drug. I hardly notice any physical effect. Maybe I'm a little calmer after a smoke, but I'm usually calm to begin with. When I am stressed a smoke helps, but I don't know if it's the nicotine or the ritual of smoking that chills me out.

For the most part I just like to smoke. I don't think, man I could use some nicotine right now. I think, man I could use a smoke right now. It's much more about taking a break or having something to gesture with when talking shit than inhaling a drug.

|11.14.05 @ 3:45PM|#

I had a friend in highschool that started using heroin. He was only on it for about a month and one night when he didn't have any money to buy some, he robbed a copy store. This is a kid from the suburbs raised by decent people. I love cigarettes but i'm not going to commit armed robbery if I can't afford a pack.

|11.14.05 @ 3:59PM|#

For me the behavior patterns were the most difficult to change. I used nicotine patches, but they didn't make it much easier (relative to previous efforts). After I became accustomed to doing things that usually were accompanied by a cigarette, morning coffee, dinner, and so forth, I just stopped the patch. And that's when I kicked the nicotine; it was trivial. The habit was hard, the drug was easy. I still smoke on occasion. Two or three times a year my wife and I will buy a pack when drunk and smoke it over the next week or so. It's nice, the sensation of the smoke, the relaxation.

Quitting is simple, just don't smoke. If you can't help yourself you are self indulgent and weak willed. Neither is good, so I imagine the least of your problems are the cigarettes.

|11.14.05 @ 3:59PM|#

"They don't crave nicotine nearly as much as they crave actually having a cigarette."

I have to agree with that. I "quit" smoking more than 15 years ago. Sometimes I want a cigarette, and I indulge myself. I smoke about a half a pack a year, maybe less. This is not a physical addiction. It's not an addiction, period--no more than it is an addiction that I want spaghetti now and then.

R C Dean|11.14.05 @ 4:04PM|#

Mmmm, spaghetti.

|11.14.05 @ 4:13PM|#

On a couple of occasions, I've quit for several months. My experience is that the first 3 days or so are pretty bad, but that the physical craving goes away after that. Contrast that with opiods. People in withdrawl from those drugs can become very sick, and hallucinate in extreme cases. Alcohol also has some nasty physically addictive properties. A sane examination of the physical withdrawl symptoms will indicate that nicotine is nowhere near as addictive as some other drugs.
The psychological side, however, is different. For a lot of reasons, it's hard to stay off the cancer sticks. After three months of boot camp, for example, I had no physical addiction left at all. I did, however, buy a pack on the way home. That decision had more to do with wanting a bit of my old life, and the fact that I couldn't smoke while at MCRD.
My plan right now is to switch to a pipe. They looks goofy stuck in the face of someone my age, but I do enjoy pipes. And they're less horrible for you.

The Owner's Manual|11.14.05 @ 4:45PM|#

I quit smoking for five years, than tried a Cuban cigar. Hmmmm. Then I tried a pipe. Hmmmmm. Not long after, I was back smoking.

As Napoleon might have said were he here, "If you're going to stop smoking, stop smoking."

I stopped smoking cold turkey aided but nothing but willpower almost twenty-five years ago and haven't smoked since. As noted elsewhere, the habits associated with smoking, not the smoking itself, took the longest to break.

|11.14.05 @ 4:58PM|#

I've smoked cigs socially for nearly a decade now and haven't found them to be the slightest big addictive. I've gone months without smoking and not even noticed. I tried going on Atkins once to lose 15lbs though, and I couldn't for the life of me go a week without eating pasta. I eventually lost the weight, but not through Atkins and not without sacrificing my pasta. Addictions are personal things. For me pasta and sex have always been more addictive than cigs, booze, cocaine, or pot, all of which I enjoy socially but could easily give up for months on end if I so desired.

|11.14.05 @ 9:07PM|#

The smokes were tough to give up, but I'm sure the blogosphere is much more addictive.

|11.14.05 @ 9:53PM|#

the article in washington times is complete bullshit. it says nicotine does not cause cancer, smoke does. then it says there are smokeless tobacco products, but the ones it mentions contain no tobacco. its not smoke that contributes most to cancer. it is the tobacco and the additives and pesticides on it. smokeless tobacco products include dip, chew and snuff, all of which contain tobacco and cancer (of the mouth throat and nose as opposed to the lungs).

|11.15.05 @ 1:18AM|#

I sure wish I had some of whatever y'all have been smoking, because quitting was quite literally agonizing for me. I spent a week with my nerves on fire accompanied by shakes and other physical symptoms.

If it hadn't been a choice (that is, if it had been a money issue or something) I could see myself stealing cigarettes or stealing money with which to buy them. I will never light up again; I never, ever want to repeat that kind of anguish.

|11.15.05 @ 3:21AM|#

I sure wish I had some of whatever y'all have been smoking, because quitting was quite literally agonizing for me. I spent a week with my nerves on fire accompanied by shakes and other physical symptoms.

This only means you had a more severe physical addiction. In other words, I have a different problem with nicotine than you. Different people have different experiences with different drugs. As I said, given the physical side effects I've had not smoking for a few days, I should be able to quit fairly easily. For me, the mental addiction is more prevalent than the physical (though still palpable) addiction.

People shouldn't smoke cigarettes. It's stupid. At this point, almost everyone knows that. That said, the reasons people smoke are as varied as the people themselves. That doesn't mean that nicotine, in and of itself, is particularly worse than other drugs.

Brad Rodu|11.15.05 @ 9:50AM|#

Jacob and I have had our disagreements about whether nicotine is addictive, or whether cigarette smoking is simply a matter of personal choice. But I hope we can agree that smokers deserve information about tobacco harm reduction, the substitution of modern (read: invisible, spit-free) smokeless tobacco products that are 98% less hazardous than cigarettes. The reactions to Jacob's commentary reflect a broad spectrum of how people deal with smoking and nicotine. But I have spent 28 years at major university-based medical centers. I know how people deal with smoking-related disease and death. Smokers with life-threatening illnesses always wish -- yes, it's often a wish at that point -- that they had had one more option to quit. "One more option" is the promise of tobacco harm reduction, regardless of your view of the addictiveness of nicotine.
Brad Rodu
Professor of Medicine
Endowed Chair of Tobacco Harm Reduction Research
University of Louisville

|11.15.05 @ 9:58AM|#

[i]the article in washington times is complete bullshit. . . its not smoke that contributes most to cancer. it is the tobacco and the additives and pesticides on it.[/i]

Your comments are complete bullshit.

First, it is a silly myth that the additives and pesticides in tobacco play a major role in smoking-carcinogenesis. Experimental tests comparing smoke condensate "tar" from 'organic' versus conventional cigs show that the carcinogenic potencies are the same. None of the experts in this field consider that additives play a significant role.

Second, it is well-established that the combustion products in tobacco smoke play the dominant role in smoking-induced carcinogenesis. This is obvious if you bother to consult the extensive experimental literature on the subject. A good place to start might be Hecht (2003).

Hecht, 2003. Tobacco carcinogens, their biomarkers and tobacco-induced cancer. Nature Reviews Cancer 3. 733-744.

[i]smokeless tobacco products include dip, chew and snuff, all of which contain tobacco and cancer (of the mouth throat and nose as opposed to the lungs).[/i]

That depends on whether the tobacco is rich in tobacco-specific nitrosamines (TSNAs), which are the compounds that appear to cause most of the oral cancer risk.

Amongst populations that use low-TSNA snuff, for instance Sweden, the association between snuff use and cancers is undetectable (Foulds et al, 2003; Lewin et al, 1998; Nilsson, 1998; Rodu and Cole, 2004; Schildt et al, 1998). In a recent review in the journal Tobacco Control, Foulds et al (2003) state that [i]"there is consistent evidence from two case�control studies in Sweden showing no increased risk of cancer of the head, neck, or mouth among snus users."[/i] In fact, it appears the snus-use has little if any measurable impact on mortality or on any disease rate.

Foulds et al, 2003. The effect of smokeless tobacco (snus) on smoking and public health in Sweden. Tobacco Control 12, 349-59.

Lewin et al, 1998. Smoking tobacco, oral snuff, and alcohol in the etiology of squamous cell carcinoma of the head and neck: a population-based case-referent study in Sweden. Cancer 82, 1367-1375.

Nilsson, 1998. Qualitative and quantitative risk assessment of snuff dipping. Regulatory Toxicology and Pharmacology 28, 1-16.

Rodu and Cole, 2004. The burden of martality from smoking: comparing Sweden with other countries in the European Union. European Journal of Epidemiology 19, 129-131.

Schildt et al, 1998. Oral snuff, smoking habits and alcohol consumption in relation to oral cancer in a Swedish case-control study. International Journal of Cancer 77, 341-346.