Tobacco in Australia Facts & Issues
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Tobacco in Australia Facts & Issues A comprehensive online resource tobaccoinaustralia.org.au Book excerpt List of chapters available at tobaccoinaustralia.org.au Introduction Chapter 1 Trends in the prevalence of smoking Chapter 2 Trends in tobacco consumption Chapter 3 The health effects of active smoking Chapter 4 The health effects of secondhand smoke Chapter 5 Factors influencing the uptake and prevention of smoking Chapter 6 Addiction Chapter 7 Smoking cessation Chapter 8 Tobacco use among Aboriginal peoples and Torres Strait Islanders Chapter 9 Smoking and social disadvantage Chapter 10 The tobacco industry in Australian society Chapter 11 Tobacco advertising and promotion Chapter 12 The construction and labelling of Australian cigarettes Chapter 13 The pricing and taxation of tobacco products in Australia Chapter 14 Social marketing and public education campaigns Chapter 15 Smokefree environments Chapter 16 Tobacco litigation in Australia Chapter 17 The economics of tobacco control Chapter 18 The WHO Framework Convention on Tobacco Control Appendix 1 Useful weblinks to tobacco resources Tobacco in Australia: Facts and Issues. Fourth Edition A comprehensive review of the major issues in smoking and health in Australia, compiled by Cancer Council Victoria. First edition published by ASH (Australia) Limited, Surry Hills, NSW, 1989 Second edition published by the Victorian Smoking and Health Program, Carlton South, Victoria (Quit Victoria), 1995 Third edition published by Cancer Council Victoria 2008 in electronic format only. ISBN number: 978-0-947283-76-6 Suggested citation: Scollo, MM and Winstanley, MH. Tobacco in Australia: Facts and issues. 4th edn. Melbourne: Cancer Council Victoria; 2012. Available from www.TobaccoInAustralia.org.au OR <Author(s) of relevant chapter section>, <Name of chapter section> in Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. 4th edn. Melbourne: Cancer Council Victoria; 2012. <Last updated on (date of latest update of relevant chapter section)> Available from < url of relevant chapter or section> Tobacco in Australia: Facts and Issues; 4th Edition updates earlier editions of the book published in 1995, 1989 and 2008. This edition is greatly expanded, comprising chapters written and reviewed by authors with expertise in each subject area. Tobacco in Australia: Facts and Issues is available online, free of charge. A hard copy version of this publication has not been produced. This work has been produced with the objective of bringing about a reduction in death and disease caused by tobacco use. Much of it has been derived from other published sources and these should be quoted where appropriate. The text may be freely reproduced and figures and graphs (except where reproduced from other sources) may be used, giving appropriate acknowledgement to Cancer Council Victoria. Editors and authors of this work have tried to ensure that the text is free from errors or inconsistencies. However in a resource of this size it is probable that some irregularities remain. Please notify Cancer Council Victoria if you become aware of matters in the text that require correction. Editorial views expressed in Tobacco in Australia: Facts and Issues. Fourth Edition are those of the authors. The update of this publication was funded by the Australian Government Department of Health and Ageing. Cancer Council Victoria 1 Rathdowne Street Carlton VIC 3053 Project manager: Michelle Scollo Senior Policy Adviser, with assistance from Merryn Pearce, Policy and Projects Officer, Quit Victoria. Editorial advice and editing: Rosemary Moore Website design: Creative Services, Cancer Council Victoria Design and production: Jean Anselmi Communications Proofreading: Caz Garvey Tobacco in Australia Facts & Issues A comprehensive online resource tobaccoinaustralia.org.au Chapter 6 Addiction Chapter 6: Addiction i Chapter 6 Addiction Margaret Winstanley, 2007 Updated by Wayne Hall and Table of contents Coral Gartner, 2010 6.0 Introduction ........................................................................................... 1 6.1 Defining nicotine as a drug of addiction .................................................... 3 6.2 The physiological effects of nicotine .......................................................... 5 6.3 Psychoactive effects of nicotine ................................................................. 8 6.3.1 The neurobiology of the positive reinforcing properties of nicotine ................................................................................ 8 6.4 The role of genetic factors in addiction .....................................................10 6.5 Measures of tobacco dependence .............................................................12 6.6 The association between addiction and socio-economic status.............................................................................14 6.7 Addiction and the adolescent smoker .......................................................16 6.8 Tobacco ‘chippers’ ..................................................................................18 6.9 Nicotine withdrawal syndrome ................................................................20 6.10 Nicotine and other drug use ....................................................................22 6.11 Smokers’ attitudes to and beliefs about addiction .......................................24 Date of last update: 6 Dec 2011 Tobacco in Australia: ii Facts and Issues Tables and figures Table 6.1.1 Summary of diagnostic criteria for drug dependency from classifications developed by the American Psychiatric Association (DSM-IV) and the World Health Organization (ICD-10) Table 6.5.1 The Fagerström Test for Nicotine Dependence Table 6.6.1 Mean number of cigarettes smoked per week— by social characteristics, by sex, 2010, current smokers aged 14 years or older, (number) Date of last update: 6 Dec 2011 Chapter 6: Addiction 1 6.0 Introduction Much of this chapter is based on information in the reports of the US Surgeon General (The Health Consequences of Smoking. Nicotine Addiction, 19881) and of the Tobacco Advisory Group of the Royal College of Physicians (Nicotine Addiction in Britain, 20002), both of which provide extensive, fully referenced reviews of the chemical, physiological and psychoactive properties of nicotine. Readers requiring more detailed information are referred to these publications. Nicotine is the drug in the tobacco plant that causes tobacco users to become addicted to cigarettes and other tobacco products.1, 2 An essence of tobacco was first extracted in the early 1800s and named ‘Nicotianine’ to commemorate Jean Nicot, the French diplomat and scholar who introduced tobacco to the French court in the late 1500s. German scientists in Heidelberg isolated the pure form of Nicotianine in 1828, calling it ‘Nikotin,’ but it took another century before its addictive nature was first suspected.1 Research during the 1920s and 1930s linked nicotine with the dependency observed among tobacco users. In 1942, Johnston showed that injections of pure nicotine reduced his need to smoke tobacco and concluded: ‘Smoking tobacco is essentially a means of administering nicotine, just as smoking opium is a means of administering morphine’.3 p 742 The publication of major reports on smoking and health in the 1960s confirmed the role of nicotine in perpetuating tobacco use.1 However the prevailing view at the time was that tobacco smoking was best understood as a socially learned behaviour, and that it reflected a psychological ‘habituation’ rather than physical addiction.4 Treatment options for smoking cessation primarily used psychological models of behaviour modification. This was to change over the next 20 to 30 years, as awareness increased of the physiological role of nicotine in tobacco addiction.2 In a report of the US Surgeon General in 1979, persistent tobacco use was described as ‘the prototypical substance- abuse dependency’.5 p 1–32 In 1980, the American Psychiatric Association for the first time included tobacco use in its Diagnostic and Statistical Manual of Mental Disorders as a substance abuse disorder, signalling a greater emphasis on the psychoactive effects of nicotine, and a move towards viewing tobacco addiction through a disease model. The US National Institute on Drug Abuse took a similar stance during the 1980s.1 The report of the US Surgeon General in 1988 focused solely on nicotine and concluded that (p9):1 1. Cigarettes and other forms of tobacco are addicting. 2. Nicotine is the drug in tobacco that causes addiction. 3. The pharmacologic and behavioural processes that determine tobacco addiction are similar to those that determine addiction to drugs such as heroin or cocaine. The US Surgeon General’s report of 2000 argued: ‘Tobacco dependence is in fact best viewed as a chronic disease with remission and relapse’.6 The Royal College of Physicians’ report in the same year observed: ‘Doctors, other health professionals and indeed society as a whole, need to acknowledge nicotine addiction as a major medical and social problem’ (pxvi).2 Cigarettes are now commonly understood to be a highly efficient nicotine delivery system that both causes and sustains addiction.2, 7, 8 Nicotine is a drug that ‘captures’ more of its users than do ‘hard’ drugs such as heroin and cocaine.1, 2 The tobacco industry has long recognised addiction to nicotine as the primary motivation for persistent smoking,9 and has worked since the 1960s to make cigarettes as efficient