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March 25, 1994 Page 4 



Nicotine, a central nervous system stimulant, produces 

 effects in the brain that are reinforcing. The consumer becomes 

 addicted as he or she seeks the sensations nicotine provides 

 again and again, and the individual gradually requires an 

 increasing dose to obtain the desired effects. Suddenly stopping 

 nicotine use often produces a characteristic withdrawal syndrome 

 characterized by such central nervous system effects as 

 irritability, difficulty concentrating, headache, trouble 

 sleeping, changes in appetite, and feelings of anxiety or 

 depression. These symptoms can persist for weeks unless nicotine 

 is ingested once again, either in the form of a cigarette or some 

 other tobacco product or in the form of a nicotine replacement 

 product such as nicotine gum or a nicotine patch. 



The Public Health Service uses a different definition of 

 addiction from that preferred by the cigarette makers. The data 

 strongly support the conclusion that nicotine regularly causes 

 addiction in a very high proportion of users. The government's 

 policies towards tobacco products should be based on its best 

 understanding of the process, as reflected in its understanding 

 of addictive processes and the entire range of relevant data. 



Spokesmen for cigarette makers frequently draw attention to 

 the large number of people who have stopped smoking as evidence 

 that nicotine is not addictive. While a large number of people 

 have managed to stop smoking, the conclusion is false. It 

 ignores the fact that more than two-thirds of those who continue 

 to smoke want to quit but feel they cannot. It ignores the fact 

 that a third of smokers try to stop each year. It ignores the 

 fact that the overwhelming majority of quit attempts end in 

 failure. It ignores the fact that spontaneous recovery is a 

 well-known feature of all addictions. (In fact, clinicians and 

 public health officials have long used general advice to stop 

 using drugs to take advantage of this well-known phenomenon.) It 

 ignores the fact that people who have addictions to more than one 

 drug, such as heroin, cocaine, alcohol and nicotine, often regard 

 their addiction to nicotine as the most difficult addiction to 

 stop. Millions of people smoke and are also addicted to alcohol. 



