Is nicotine addictive?

In February 2000, the Royal College of Physicians published a report on nicotine addiction which concluded that “Cigarettes are highly efficient nicotine delivery devices and are as addictive as drugs such as heroin or cocaine.” [1] Two years earlier, the report of the Government’s Scientific Committee on Tobacco and Health stated that: “Over the past decade there has been increasing recognition that underlying smoking behaviour and its remarkable intractability to change is addiction to the drug nicotine. Nicotine has been shown to have effects on brain dopamine systems similar to those of drugs such as heroin and cocaine”. [2] Both the RCP and SCOTH reports confirmed the findings of the landmark review by the US Surgeon General in 1988 on nicotine which also concluded that cigarettes and other forms of tobacco are addicting and that nicotine is the drug in tobacco that causes addiction. [3]

Despite these authoritative reviews, there has been some debate about the extent to which the smoking habit is controlled by physiological addiction. The debate has arisen because there is no universally accepted definition of addiction although the World Health Organization has defined addiction as: “A state, psychic and sometimes also physical, resulting in the interaction between a living organism and a drug, characterised by behavioural and other responses that always include a compulsion to take the drug on a continuous or periodic basis in order to experience its psychic effects, and sometimes to avoid the discomfort of its absences. Tolerance may or may not be present.” [4] On the basis of this definition, it is possible to demonstrate a scientific basis for defining nicotine as an addictive substance.