391 



March 25, 1994 Page 3 



smoking is nicotine, and addiction to nicotine largely sustains 

 the practice (USDHHS, 1988) . Without nicotine, adolescent 

 tobacco use would all but vanish. 



Nicotine Addiction 



The 1994 Surgeon General's Report tells us that it is not 

 the first cigarette that produces addiction. It is the second, 

 the third, and those that follow. Most adolescents who have ever 

 smoked as few as half a carton of cigarettes have a very 

 difficult time stopping. 



What do I mean by the term "addiction"? The standard 

 clinical definition for a drug addiction — also called a drug 

 dependence — is loss of control over use of the substance plus 

 its continued use despite problems. This definition is embodied 

 in the approach taken to the addictions in the current edition of 

 the Diagnostic and Statistical Manual (DSM) of the American 

 Psychiatric Association, published in 1987 (American Psychiatric 

 Association, 1987) . The DSM is the standard authority for 

 diagnosing addictions in this country. Nicotine fits this 

 definition very well. Nicotine also fully satisfies the 

 research-oriented criteria employed by the Public Health Service 

 the 1988 Surgeon General's Report, The Health Consequences of 

 Smoking: Nicotine Addiction (USDHHS, 1987) .^ 



^ Spokesmen for cigarette makers have taken issue with 

 whether or not nicotine is addicting. While questioning the 

 interpretation of some of the data on which this conclusion is 

 based, they have mostly questioned the definition of addiction. 



