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.