Nicotine Addiction: Fact or Theory?

Reuven Dar

Department of Psychology

Tel Aviv University

Hanan Frenk

Department of Behavioral Sciences

The Academic College of Tel Aviv-Yafo 


Department of Psychology

Tel Aviv University

Is nicotine an addictive drug?Raising this question today would seem preposterous to most scientists and lay people, smokers and non-smokers alike.If one adopts the definition of facts as theories that have acquired a status of unchallenged empirical statements(Lakatos 1970), nicotine addiction has become a fact.Countless research papers begin with variations of the sentences “Nicotine is the active ingredient in tobacco that leads to addiction(Soria et al. 1996, p. 221) or “The reinforcement provided by nicotine is a necessary component of the processes that drive smoking behavior(Donny et al. 1998, p. 83), providing, as a sole reference, the 1988 Report of the Surgeon General (US Department of Health and Human Services, 1988)

In a recent book (Frenk & Dar, 2000), we reviewed the research literature on which the nicotine addiction theory is based.We argued that the unwavering assuredness in which statements about nicotine addiction are typically made is entirely unjustified by available data.Extensive evidence challenges the accepted belief that nicotine is a major determinant of smoking and that its presence in tobacco smoke increases the difficulty of quitting.Ironically, our review suggests that because of the toxicity of nicotine, its major effect of on smoking may be to limit rather than to facilitate the habit.

In the course of working on our book, we were repeatedly struck by the poor quality of the research we were reviewing.The most common problem was a lack of adequate controls for viable alternative explanations of the results.There was almost no control for prior conditioning, for placebo effects, and especially for well-documented effects of nicotine that are unrelated to addiction (e.g., its effect on general activity).In the absence of such essential control conditions, the results of these studies cannot be interpreted as demonstrating the purported addictive nature of nicotine.In most cases, however, neither the original reports nor the reviews summarizing these reports acknowledge these methodological shortcomings or their implications for the validity or generality of the results.It appears that the great majority of nicotine researchers presuppose, rather than test, the proposition that nicotine is addicting.

The “near-consensus” that nicotine is addictive was enshrined in the 1988 report of the Surgeon General, which regarded nicotine addictive in the same sense as drugs such as heroin and cocaine (Stolerman and Jarvis, 1995, p.117).This near-consensus has rarely been challenged since, and was recently reinforced in a report on nicotine addiction in Britain (Tobacco Advisory Group of The Royal College of Physicians, 2000).The report, which purports to provide an updated and objective review of the evidence for nicotine addiction, reiterates instead the view canonized by the Surgeon General.It’s “central conclusion” repeats the Surgeon General’s (US Department of Health and Human Services, 1988) statement almost word to word: (p. 117): “Nicotine is an addictive drug, and the primary purpose of smoking tobacco is to deliver a dose of nicotine rapidly to receptors in the brain.”Both the Surgeon General’s report and its recent British counterpart share a remarkable lack of eagerness for criticism and appear to have been aimed as authoritative anti-smoking manifestos rather than as objective scientific analyses of the nicotine addiction research.We believe that the near-consensus regarding the nicotine addiction hypothesis, “enshrined” by the first report and “re-enshrined” by second, has severe theoretical and practical ramifications. 

One problem, which is both created by the near-consensus and perpetuates it, is economic in nature.In universities and research centers, publications are the major criterion for tenure and promotion.Acceptance of articles into mainstream journals and procuring of grant support for one’s research has real and immediate economic consequences.In a field dominated by consensus, scientists would naturally prefer to write grant applications and articles that are safely in line with the consensus, especially when this consensus is the official position of authorities such as the Surgeon General, the National Institute of Drug Abuse and The Royal College of Physicians.

Psychological factors may contribute even more than economical ones to the unquestioned status of the nicotine addiction thesis.Research on conformity has demonstrated that consensus stifles not only the expressionof opposing views, but also non-conforming beliefs and perception, even when objective reality clearly contradicts the consensual view{Asch 1958 2793 /id}.In the case of the nicotine addiction hypothesis, its social and moral connotations increase even further the reluctance of researchers to explore dissenting views.The word ‘addiction’ is highly charged with morality and values. “A tobacco smoking habit is bad enough, but it is even worse when one thinks of it as an addiction(Akers, 1991, p. 778).When we discussed our book with colleagues, a number of them reacted to our views as if they were tantamount to an endorsement of smoking or a vote of support for the tobacco industry.Suggesting that nicotine is not addictive, then, is clearly not politically correct, a fact that may strongly inhibit potential dissidents.

Modern philosophy of science considers plurality of views and competition among research programs an essential attribute of the scientific enterprise (e.g.,Lakatos and Musgrave, 1970).One mechanism designed to promote criticism and multiple perspectives is the process of peer review, which is almost universally applied to grant proposals and to manuscripts submitted for publication.When the investigator and the referees share a common bias, however, peer review loses its advantage, as the referees are likely to be as blind towards methodological flaws as the experimenter is.When results are in line with the accepted theory, no alternative accounts of the data are considered, and both researcher and referee are likely to consider the predicted results as validating the experimental procedure.

The well-known philosopher of science, Imre Lakatos (Lakatos, 1977), noted that scientists “do not abandon a theory merely because facts contradict it.They normally either invent some rescue hypothesis to explain what they then call a mere anomaly or, if they cannot explain the anomaly, they ignore it, and direct their attention to other problems (p. 4).”The area of nicotine addiction research is rich in rescue hypotheses and ignored anomalies.A typical example of a rescue hypothesis is the postulation that the lack of complete suppression of smoking withdrawal symptoms by nicotine gum or transdermal patches is due to insufficient nicotine delivery by these devices (e.g.,Tobacco Advisory Group of The Royal College of Physicians, 2000).In appealing to this rescue hypothesis, researchers ignore obvious contradictions, such as the absence of dose-response curves for suppression of withdrawal symptoms with these devices or of the successful suppression of withdrawal symptoms with denicotized cigarettes.An especially blatant example of ignoring powerful evidence against the nicotine addiction hypothesis is the inexplicable failure of smoking researchers to cite the numerous studies that found no sign of re-addiction to nicotine in ex-smokers who were exposed to nicotine transdermal patches for prolonged periods.One such study (Pullan et al., 1994) was published in the prominent and high-impact New England Journal of Medicine and was cited in 161 studies on ulcerative colitis.Yet, despite its high relevance to the nicotine addiction theory, it was cited in only four smoking-related publications.

The view that nicotine is addicting, then, was successfully “enshrined” in the Surgeon General’s Report.The resulting near-consensus in regard to this hypothesis and its complex social and political ramifications have created an atmosphere in which objective exploration of this hypothesis became practically impossible.Indeed, the possibility that nicotine may not be addictive has rarely been raised since 1988.The nicotine addiction thesis has been uncritically adopted not only within the scientific community but also by the media; in fact, we have never heard a dissenting position expressed publicly.It is hardly surprising, therefore, that this view has had a profound effect on public beliefs regarding the nature of smoking.In 1977 (Eiser et al., 1977), “About four out of five non-smokers regarded the average cigarette smoker as an addict, whereas only about half the smokers saw themselves as addicted (p.334).”Only eight years later, the same group (Eiser et al., 1985) found that only 25 out of 2,312 subjects (1%) answered the question “How addicted do you think you are to smoking?” with the answer “Not at all.”

This, we submit, may be one of the worst effects of the nicotine addiction thesis: it succeeded in convincing smokers that they are chemically addicted to smoking.Perceptions and beliefs can have a critical effect on the success of quitting attempts.An addiction model inherently places control and responsibility outside the individual, thus undermining his or her sense of control and self-efficacy.Smokers who believe that they are addicted perceive quitting as more difficult (Jenks, 1994;Katz and Singh, 1986;Martin, 1990) and have less confidence in their ability to achieve complete cessation(Eiser et al., 1985;Eiser and Van der Pligt, 1986).Moreover, these attitudes seem to act as self-fulfilling prophecies, as they are correlated with shorter duration of cessation attempts and higher relapse rates (Owen and Brown, 1991).

The growth of knowledge depends on an unrelenting attitude of skepticism and continuous competition between theories and research programs (Lakatos and Musgrave, 1970).When theories become “enshrined,” whether or not this move is justified by the alleged welfare of the public, science is in danger of losing its edge over religion and propaganda.The dynamics of near-consensus all but guarantee the stifling of criticism, suppression of novel ideas and proliferation of sub-standard research.It is high time to “disenshrine” the nicotine addiction hypothesis and to encourage an objective and critical re-evaluation of its scientific merits.


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