A Critique of Nicotine Addiction

247 Pages·2002·1.044 MB·English

by  Hanan Frenk, Reuven Dar (auth.)

A CRITIQUE OF
NICOTINE ADDICTION
NEUROBIOLOGICAL FOUNDATIONOFABERRANT BEHAVIORS
EditorialBoard:
MICHAEL MYSLOBODSKY
Tel-Aviv University&HowardUniversity
STANLEYD.GLICK
AlbanyMedicalCollege
SEYMOUR S. KETY
HarvardUniversity&McLeanHospital
MORRISMOSCOVITCH
UniversityofToronto
DANIELR.WEINBERGER
National Institutes ofHealth/National lnstitute ofMentalHealth
A CRITIQUE OF
NICOTINE ADDICTION
by
Hanan Frenk
TheAcademic College of TelAviv-Yafo
&
Te1-Aviv University
and
Reuven Dar
Tel Aviv University
KLUWER ACADEMIC PUBLISHERS
New York / Boston / Dordrecht / London / Moscow
eBook ISBN: 0-306-47232-5
Print ISBN: 0-792-37225-5
©2002 Kluwer Academic Publishers
New York, Boston, Dordrecht, London, Moscow
Print ©2000 Kluwer Academic Publishers
Boston
All rights reserved
No part of this eBook may be reproduced or transmitted in any form or by any means, electronic,
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Created in the United States of America
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Contents
FOREWORD ix
ACKNOWLEDGEMENTS xi
CHAPTER1:INTRODUCTION 1
1. NICOTINEADDICTION: FACTORTHEORY? 1
2. WHATTHISBOOKISNOTABOUT 3
3. WHATTHISBOOKIS ABOUT, ANDWHOCARES? 5
4. AN OUTLINEOFTHEBOOK 7
CHAPTER2:ADDICTION,COMPULSION,ANDHABIT 13
1. PHARMACOLOGICALDEFINITIONS OF ADDICTION 14
2. BEHAVIORDEFINITIONS OFADDICTION 16
3. THE1993 WHODEFINITIONOFDRUGDEPENDENCE 16
4. THENATUREOFHABITS 18
5.COMPULSIONS 20
6. HABIT CRAVING, WITHDRAWAL, AND RELAPSE 21
CHAPTER3:HABITUALDRUGUSE 25
1. USE OF PSYCHOACTIVE DRUGS WITHOUT
DEPENDENCE 27
vi Contents
2. THEDRUGATTRIBUTIONBIAS 32
CHAPTER4:SMOKINGDEFINEDASANADDICTION 35
1. THESURGEONGENERALREVIVESTHETERM
‘ADDICTION’ 35
2. THESURGEONGENERAL’S 1988DEFINITIONOF
DRUG DEPENDENCE 37
3. PRIMARYCRITERIA 39
4. SECONDARYCRITERIA 40
5. TERTIARYCRITERIA 41
6. THE SURGEONGENERAL’S CONCLUSIONS
REGARDING NICOTINE ADDICTION 42
7. EXPLORING THE EMPIRICALBASIS FORNICOTINEADDICTION 43
CHAPTER5:NICOTINEREINFORCEMENTINANIMALS:
THEORETICALCONSIDERATIONS 45
1. OPERANTREINFORCERS 45
2. PRIMARY AND SECONDARYREINFORCERS 48
3.CONFOUNDINGFACTORS IN STUDYINGTHE
REINFORCING PROPERTIES OFDRUGS 49
4. SPECIFIC PROBLEMSIN STUDYINGNICOTINE
SELF-ADMINISTRATION IN ANIMALS 51
5. CONCLUSION 54
CHAPTER 6: THE REINFORCING PROPERTIES OFNICOTINE
INANIMALS 55
1. ORAL SELF-ADMINISTRATION OF NICOTINE 55
2. INTRAVENOUS SELF-ADMINISTRATION 59
3. DEMONSTRATING REINFORCING PROPERTIES OF 72
DRUGS USING CLASSICAL CONDITIONING
4.CONCLUSION 75
CHAPTER 7: NICOTINE ANDINTRACRANIAL SELF-
STIMULATION (ICSS) 77
1.THEORIGINSOF THEICSSPARADIGM 77
2.THEUSEOFICSS FORSCREENINGPSYCHOACTIVEDRUGS 79
3.THEINADEQUACYOFTHEICSS PARADIGMFOR
ASSESSINGDRUGPROPERTIES 81
4. MORPHINE IN SELF-ADMINISTRATION PARADIGMS
COMPAREDTOICSS 85
5. THESIMILARITYBETWEEN THEEFFECTS OFDRUGS ON
ICSSANDLOCOMOTION 87
Contents vii
6. SUMMING UP: SELF-STIMULATION AND NICOTINE
REINFORCEMENT 89
7. ANOTEONNICOTINE AND DOPAMINE 90
CHAPTER8:REINFORCINGPROPERTIESOFNICOTINE
INHUMANS 93
1. NICOTINEAS APRIMARYREINFORCER 93
2. EVIDENCE FORTHEREINFORCING EFFECTS OFNICOTINE
INHUMANS 95
3. NICOTINEDELIVERY KINETICS AND ABUSELIABILITY 101
4. STUDIES OFNICOTINENASALSPRAY 105
5. SENSORYREWARDS IN SMOKING 107
6.CONCLUSION 112
CHAPTER9:TOLERANCETOANDPHYSICALDEPENDENCEON
NICOTINE 115
1. DEMONSTRATING TOLERANCETO THE REINFORCING
EFFECTSOFDRUGS 115
2. TOLERANCETO THEEUPHORIC EFFECTS OFNICOTINE 117
3. PHYSICALDEPENDENCEON HEROIN 119
4. THE “NICOTINE ABSTINENCE SYNDROME” IN RATS 121
5. NICOTINEWITHDRAWALIN HUMANS 126
6. CONCLUSION 130
CHAPTER 10:THEDIFFICULTYOFCURTAILINGTHE
SMOKINGHABIT 133
1. COMPLIANCEWITH LEGALRESTRICTIONS 135
2. MEASURINGTHE DIFFICULTY OF ABSTINENCE 137
3. COMPLETECESSATION IN PROSPECTIVE STUDIES 140
4. SINGLE-TRIAL VS. MULTI-TRIAL CESSATION RATES 142
5. SUMMARY: THE SIMILARITYOF SMOKING ANDHEROIN
ABSTlNENCERATES 145
6. OVEREATING: ANOTHER IRRESISTIBLEURGE 145
7. THEIMPORTANCE OFMOTIVATION FOR QUITTING 147
8. CONCLUSION 150
CHAPTER11:“NICOTINEREPLACEMENTTHERAPIES” 151
1. THELIMITED EFFICACY OF “NICOTINE REPLACEMENT”
DEVICES 152
2. METHADONE TREATMENTFOR OPIATEADDICTION 154
3. METHADONE MAINTENANCE VS. “NICOTINE
REPLACEMENT”THERAPY 155
viii Contents
4. WHYDOESNRT SUPPRESS WITHDRAWALSYMPTOMS
ALTOGETHER? 157
5. CONCLUSION 158
CHAPTER 12: THE TALEOFNICOTINECOMPENSATION 159
1. THENICOTINE COMPENSATION HYPOTHESIS 159
2. SHORT-AND LONG-TERM SWlTCHING STUDIES 160
3. CROSS-SECTIONAL “COMPENSATION” STUDIES 164
4. NICOTINE’S ROLE IN LIMITING SMOKING:
PHARMACODYNAMIC SATIATION 168
5. SUMMARY: THE ROLE OFNICOTINE IN SMOKING TITRATION 170
CHAPTER13:EPILOGUE 173
1. ISNICOTINEAN ADDICTIVEDRUG? CONCLUSION 173
2. WHATWENTWRONG IN NICOTINE ADDICTION RESEARCH 177
3. A PLEAFOR DISENSHRINEMENT 185
REFERENCES 187
INDEX 241
Foreword
In her book, 'Defenders of the Truth', Ullica Segerstrale posed a rhetorical
question, What makes a hardcover academic book a hot seller: "How does
one convince academics and the general public that this is a book that they
absolutely need to have?". The prospects are surely increased by an
intriguing name, an appealing cover, when a book is loaded with full-page
drawings, and if its price is satisfactory. However, in the recipe for
success these are all necessary, but not sufficient ingredients: "The
answer", she submits, "is, of course, controversy". If we trust her
judgment, the book by H. Frenk and R. Dar is the right book to succeed.
It is about nicotine, the topic where the battle lines are long drawn. The
authors marshaled convincing evidence that nicotine is not addictive, and
that proponents of nicotine addiction barked up the wrong tree. It rubs
many influential opponents the wrong way, and it is published in a climate
after the Florida nicotine trial. Recommending this scholarly book to a
reader I have to caution him not to misunderstand its message. It is not
against potential dangers of smoking, nor does it argue that nicotine is a
worthy substance to use, even if some of its effects are salubrious and can
be employed in medicine. It is only about the addictive potential of
nicotine or rather, it is about the fact that the passion with which debates
are conducted in science may vary inversely with the depth of knowledge
on which convictions are based.
Michael Myslobodsky
Acknowledgements
We would like to thank Zalman Amit and Robert E. Lubow for their
insightful comments on various parts ofthis manuscript. This in no way
implies that these friends and colleagues agree with any of the opinions
expressedinthisbook. We are also grateful forthe invaluableassistanceof
Yafa Shaar, Chaya Amir and Liel Rubinsky in preparing the manuscript.
Most ofall, we are eternally indebted to our life companions, Levanna and
Rachelli,fortoleratingourtiresomesingle-mindednessforsuchalong time.
H.F. wishes to dedicate this book to the memory of John Liebeskind, a
friendandmentor,wholeftavoidthatremainsunfilled.
R.D.wishestodedicate this booktothememoryofhismother,Ruthie,
thefirstpersonhewouldhavelikedtoshareitwith.