Nicotine, delivered from tobacco through smoking or oral use, is an addictive drug and tobacco use is, for the majority of smokers, essentially a form of nicotine self-administration. The tobacco industry was aware of this in the early 1960s, as revealed by the following quotation from a general counsel to the tobacco company Brown & Williamson: “Moreover, nicotine is addictive.We are, then, in the business of selling nicotine, an addictive drug…”.

The most common form of nicotine use is through cigarette smoking. Cigarette smokers have precise control of nicotine intake. The very rapid absorption of nicotine (once tobacco smoke is in the lungs, nicotine takes just 10 seconds to reach the brain) and the high blood levels that result, promote rapid and strong behavioural reinforcement from smoking.

Tolerance to the toxic effects of nicotine, like nausea, develops rapidly and persists. The reinforcing effects of nicotine are renewed with each cigarette because the fall in nicotine level between cigarettes allows resensitisation of the nicotinic receptors in the brain. In summary, cigarettes are extremely efficient nicotine delivery devices which, combined with the pharmacokinetics of nicotine, promote a powerful physical and psychological addiction. How soon people smoke their first cigarette after waking is a measure of addiction. In the UK for example, just over one-third (34%) of smokers in the UK have their first cigarette within 15 minutes of waking.

There are two well known and widely used systems for classifying diseases that address the issue of tobacco use, the WHO’s International Classification of Diseases (ICD-10) and the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Both clearly classify tobacco use as an addiction and highlight the occurrence of a withdrawal syndrome as a key characteristic of addiction. The withdrawal syndrome, which can be severe, is one of the most important factors in maintaining smoking in individuals.

Tobacco withdrawal symptoms include: anxiety, restlessness, poor concentration, irritability, depression, craving, decreased heart rate and increased appetite. Craving, the urge to smoke, is the clearest predictor of relapse to smoking in ex-smokers.

Looking just at data from nicotine users who have been through a treatment programme and stopped smoking emphasises this point from a different perspective. About 75% of those stopping smoking in intensive, professional treatment programmes will be smoking again one year later.

Finally, nicotine has been compared with other addictive drugs, according to several characteristics of addiction or causes of concern. The 1998 Report of the US Surgeon General concluded that: “the pharmacologic and behavioural processes that determine tobacco.

Tobacco Use and Effects on Health

Nicotine addiction are similar to those that determine addiction to drugs such as heroin and cocaine”, a finding endorsed by the English Royal College of Physicians in its report on nicotine.

Since cigarette smoking causes more deaths than these other drugs and yet tobacco is the most used psychoactive drug in the world after caffeine, we can summarise all these findings by saying that nicotine is a classic drug of addiction. However, despite this, stopping smoking is possible. Indeed, many millions of smokers in the EU have managed to give up smoking permanently.