by Carl V Phillips
Sorry for the blog silence. I have been immersed in working on papers, with some interruptions to give testimony and interviews. I happened to stumble across this page from the U.S. National Institute on Drug Abuse (NIDA) that addresses the question, “Is there a difference between physical dependence and addiction?” As my readers know, I have pointed out that the use of the word “addiction” in scientific analysis is completely inappropriate, given that the word has no accepted scientific definition and, indeed, it appears that no one can even propose a viable candidate for such a definition. Similarly, no policy debate — at least about tobacco products — should ever be allowed to depend on claims about “addiction” since those making such claims are usually implying they have scientific meaning, and even if not, there is not a shared interpretation of the term even in clinical or common language.
But that does not mean that the term lacks a clear enough meaning for casual usage or mass pop communication, as NIDA is engaged in with that webpage. NIDA presents a good quasi-definition of the term that conforms to how it is generally interpreted in popular usage:
Addiction—or compulsive drug use despite harmful consequences—is characterized by an inability to stop using a drug; failure to meet work, social, or family obligations; and, sometimes (depending on the drug), tolerance and withdrawal.
Now if they stopped after the second hyphen, as sometimes is done by people who think they are offering a definition, it would be a complete fail. “Compulsive”, without further clarification, basically just begs the question. And “harmful consequences” without clarification and quantification describes every consumption choice: You cannot do or consume anything without some cost (purchase price, the opportunity cost of not doing something else with your time, etc.).
But they do offer the needed further clarification. It is still imprecise, which is why I call this a quasi-definition rather than a definition. There is little hint of where they would draw the lines in terms of quantification. But they are clearly saying that at least some of these particular harms must occur, and the word “obligations” implies that the harms must be substantial, not just minor diversions. This is in keeping with the example I use (quoted from the above-linked post) to show that there is something most all of us would call “addiction”:
A person uses meth. He knows he needs to go to work today (sober), or he will lose his job, which is his only means of support, paying not only for his food and housing, but also his meth. If he smokes meth now he will have no money in a week. Yet he fails to resist the urge to smoke now, in spite of the dire immediate consequences. That seems to be addiction according to any typical understanding of the term.
NIDA’s restriction to “drug use” — unsurprising given their mission — makes this a quasi-definition of “drug addiction” rather than of “addiction” more broadly. It is difficult to see how compulsive gambling, pursuit of sex, and other behaviors to a degree that has similar impacts does not also fit this notion of addiction. But that is fine for present purposes, since talk about addiction in the context of nicotine and tobacco is about drug addiction.
Nicotine use via the consumption of tobacco products — including smoking — simply does not fit that description. It does not keep anyone from doing their job. It might threaten their employment if their employer has decided to discriminate against tobacco users, but that has nothing to do with a failure of the individual to meet his job obligations. As with every other lifestyle choice, it might affect who he socializes with, but it poses no threat to social obligations. There is no threat to family obligations except where genuine extreme poverty (not merely being among the poorer people in rich countries) means that the purchase price comes out of the money needed to buy food and pay school fees.
The “inability to stop” clause is trickier. It does not actually stand up to scrutiny in isolation: Someone would have to be seriously far gone, acting on pure animalistic urges, for no incentive to be sufficient for him to stop (it happens, but is relatively rare), and physical restraint would still do the job. But the context makes clear that this should be interpreted not as “it is literally impossible for him to stop” but rather “the failure to meet obligations is not sufficient incentive to make him stop.”
Yes, many smokers are hooked and not happy about it, and declare that they “cannot” quit. But their incentives to do so are minor compared to those described by NIDA. They know they are reducing their life expectancy. But while this is substantial incentive, it is nothing compared to the immediate life-destroying threats faced by the meth user in my example, and far short of the immediate failure to meet job, social, and family obligations in NIDA’s quasi-definition. Presumably a few smokers are so hooked that even if tobacco use actually did cause such problems they would still not quit. But if put to that test, most smokers and other tobacco users would stop using. They would not be addicted by NIDA’s definition even then, though that is moot because the hypothetical is false.
I often point out that even if you dumb-down “addiction” to mean “the relatively mild impacts in the direction of ‘real addiction’ that are experienced by cigarette smokers”, it is far from clear that users of other tobacco products are addicted: Cigar smokers are generally pretty casual about it. NRT is officially not addictive. There are no reported cases of anyone becoming addicted to e-cigarettes, even by that weak definition. Some snus users seem to experience what smokers do, but far from all of them.
But all that aside, this shows that according to the unit of the U.S. government that specializes in such matters, the experience of tobacco product users is not addiction.
Reblogged this on jredheadgirl.
Reblogged this on A school of dolphins and commented:
At last an official(ish) definition of addiction.
I read through your post of October 2013 about a definition of the word ‘addiction’ (again), including the comments. It was all very convoluted. I have always been of the opinion, in my simple way, that what differentiates ‘habit’ from ‘addiction’, as regards risky behaviours, is that the consequences of an addiction are much more damaging that than those of a habit. I think that the phrase ‘as regards risky behaviours’ is important.
It seems to me that the (genuine) Health Zealots are applying the word ‘addiction’ to nicotine because they actually believe that the damaging consequences are really, really serious, and, for all intents, unavoidable. the charlatan Zealots know very well that nicotine has benefits and is not, in itself, significantly damaging within the life-time of the human body. How on earth these people get away with claiming that the substance, nicotine, is not addictive in patches, inhalers or gum, but is addictive in tobacco products, of any kind, beats me.
I note that the date of that page (last updated) is Dec 2012. Interesting that it has not turned up before. The group, NIDA, certainly seems to have ‘official’ status.
So the picture painted by NIDA is that the word ‘addiction ‘ carries implications of significant and probably imminent damaging consequences resulting from the activity involved, along with great difficulty in stopping, despite knowing the consequences. NIDA say that ‘dependence’ (needing more and more of the drug and the awful physical and/or mental effects of cessation) are a different thing.
I think that there is a third group between the zealot believers and the charlatans, represented by people like yourself: those who look at the evidence dispassionately. The trouble with that is that you see many variations and nuances both between the risks of smoking/vaping/snus/etc and how to honestly explain them to the general public. Much easier to have a belief or to be a charlatan.
NIDA is definitely official — it is a unit of HHS.
Being a charlatan is definitely much easier.
I agree that some of the zealots actually believe that smoking or even nicotine is The Worst Thing In The World, but clearly they have not really thought it through. I think the non-idiots among them use “addiction” *because* it invokes images of far worse problems than anything that exists in this context. That is why I spend the effort on the point.
Carl, I have run into the ANTZ who use addiction as a way of discounting the views of anyone who either smokes tobacco, uses smokeless tobacco, (snus etc), or vapes liquid containing nicotine. Much more so since it has been shown that both snus and vaping are orders of magnitude safer than smoking tobacco. I also believe they deliberately use this term because they know full well that the general public hear or see the word “addiction” or “addict” and immediately associate the word with the most negative of connotations. They want people to believe that nicotine is “addictive” and anyone who uses it is an addict, so that they can claim a moral superiority, given the public views of addicts in general.
There is another important reason why the ANTZ use this word so often in regards to nicotine use, and that is because it is a way of shutting down those that claim they are not addicted, but merely enjoy using nicotine. They use comments like, “you are in denial” ,(of the supposed addiction), “its the addiction talking, not the person”, “nobody enjoys smoking/vaping/etc, they just say they do because they are addicted to nicotine” , these are just a few of the most common ones I’ve heard.
Personally, I have never been addicted to nicotine, although I would say that I was somewhat addicted, (although I certainly had the ability to stop at will, and did many times), to smoking tobacco, but it was more a case of simply enjoying smoking. Vaping for me, is the perfect solution, because I can enjoy nicotine, without the harmful effects of tobacco smoking.
I can’t speak for everyone that smokes or vapes, and certainly do not think those that say they are addicted to nicotine are being in anyway dishonest, but I also think that for many they have been brainwashed by propaganda and lies put out by ANTZ over the decades into thinking they are addicted, rather than that actually being the case.
If nicotine was what keeps people smoking, then pharma NRT products would have a far higher success rate than they currently have. It would also be the case that vapers would not be able to transition to a vastly lower level of nicotine, or no nicotine at all, if it was addictive as the ANTZ make out that it is.
Finally, it is almost seen as a “sin” to say that you enjoy nicotine these days, because of the propaganda focus on pushing people to “give up their nicotine addiction” , rather than simply move to a safer alternative delivery method.
The glaring hypocrisy in the ANTZ propaganda is being noticed.
In the comments on one of the recent blog posts, Carl brought up the point (and I think it’s a very important one to consider when trying to understand ANTZ psychology) that in its early days, the anti-smoking movement was made up in large part of people who once smoked themselves, and could thus identify and empathize with people who still did.
But as the anti-smoking movement slowly morphed into the War on Tobacco (excepting, of course, the few holdouts who chose to embrace science and THR), and then morphed again into the Holy Jihad on Nicotine, its members became almost exclusively people who have never smoked nor used any tobacco/nicotine product whatsoever, and who thus have no useful frame of reference for understanding why people smoke and use tobacco/nicotine in the first place. Here, in my view, was the genesis of the “demonic possession” hypothesis that is now pretty much the linchpin of the ANTZ worldview: no one gains any benefit from any form of tobacco/nicotine use, and “addiction” is the only reason people use tobacco products. Either that or because they saw someone smoke in the movies.
If Uncle Sam says so,then it must be true!
When “public health” types and other ANTZ gleefully throw around the terms “addict” and “addiction,” it serves two different (but equally fallacious) rhetorical functions: it is both an ad hominem attack (whereby the credibility of one’s interlocutor can be dismissed out of hand by labeling them an “addict” who can’t possibly be capable of objectivity or good judgement) and a spurious appeal to emotion (since “addict” and “addiction” are such powerfully evocative terms in the cultural zeitgeist).
I’ve found myself on a few occasions lately trying to explain to people that “addiction” is not, in and of itself, a negative health outcome. But that tends to be an area where, in the American consciousness at least, arbitrary value judgements about the nature of morally desirable behavior tend to override any desire to evaluate those judgements on their own (lack of) merit.
Thanks for the great comments. I strongly agree with many of these observations — their use of “addiction” as a weapon is all that and more. It is an amazing swiss army knife of attacks and rationalizations. It lets them get away with the demonic possession premise, tobacco products having no benefits — it is still absurd if anyone gives it a minute’s thought, but the addiction game allows them to prevent that minute of thinking. It also is good for denigrating the consumer, which they love. But at the same time, and here is the real wonder of it, it allows them to simultaneously pretend (to themselves and others) that they are not really hurting the people that they are attacking (the consumers) and it is all about some malevolent force. They use it to pretend that *they* are not the real malevolent force and that their actions somehow magically benefit people rather than hurting them, as they of course really do.
Sometimes, in my more optimistic moments, I like to believe the ANTZ have finally jumped a sufficient number of sharks (in terms of both scientific malpractice and intellectual laziness, in addition to their stunning disregard for the concept of individual rights) to create a backlash among the non-smoking general public.
But then, in my less optimistic moments, I consider the massive financial resources they bring to bear, the compliant media that happily copypastes whatever nonsense they feed them, the extent to which their worldview has been politically institutionalized and culturally ingrained over the course of the past three decades, and I wonder if it’s a thing that can ever be overcome simply by large numbers of reasonable individuals changing their minds.
I too seem to hover somewhere between being utterly depressed by all the money and propaganda spouted by the ANTZ, and the way some people seem to lap it up, to being cautiously optimistic that at some point, preferably while I’m still alive to see it, enough people will wake up to what is really happening.
One thing I have noticed, very recently, is non-smokers, and never-smokers, questioning the stance that many health related charities, as well as ANTZ, have taken on vaping, and are totally confused as to the reasons they are trying to ban a product that is helping people quit smoking tobacco. I believe this is happening because they may have friends or family, that have quit smoking by switching to vaping, so they have experienced first hand the benefits of THR with those they care about. I hope this trend continues.
I was chatting with a friend at the weekend about how to change things going on in our world,as you do over a couple of beers,when an advert came on for nicotine spray.My friend,a non smoker asked me why all the hassle over vaping when it’s only delivering nicotine in the same way! The confusion that ANTZ are creating can only be to our advantage in the long run.Too smart for their own good,says I.
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