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Miscellaneous Statements on Drug Policy


* Taking the drug more often or in larger amounts than intended.

* Unsuccessful attempts to quit; persistent desire, craving.

* Excessive time spent in drug seeking.

* Feeling intoxicated at inappropriate times, or feeling withdrawal symptoms from a drug at such times.

* Giving up other things for it.

* Continued use, despite knowledge of harm to oneself and others.

* Marked tolerance in which the amount needed to satisfy increases at first before leveling off.

* Characteristic withdrawal symptoms for particular drugs.

* Taking the drug to relieve or avoid withdrawal.

Before applying a test of the nine criteria, the expert first determines if the symptoms have persisted for at least a month or have occurred repeatedly over a longer period of time.

Asked about the tobacco executives' testimony on addiction, Dr. Kozlowski said, "In a way, I can see how they could say that. It has to do with a mistaken image of what addiction is, and I have many well-educated, intelligent people say something like that to me. People often think of a person taking one injection of heroin and becoming hopelessly addicted for the rest of their lives. That is wrong."

In addition, he said, when people tend to think of the high that heroin produces, one that is about as intense as cocaine and alcohol, they cannot believe cigarettes are in the same category. And they are not. Even though in large doses nicotine can cause a strong high and hallucinations, the doses used in cigarettes produce only a very mild high.

But researchers now know, says Dr. Jack Henningfield, chief of clinical pharmacology at the Addiction Research Center of the Government's National Institute on Drug Abuse, that many qualities are related to a drug's addictiveness, and the level of intoxication it produces may be one of the least important.

If one merely asks how much pleasure the drugs produce, as researchers used to do and tobacco companies still do, then heroin or cocaine and nicotine do not seem to be in the same category. Dr. Kozlowki said, "It's not that cigarettes are without pleasure, but the pleasure is not in the same ball park with heroin."

But now, he said, there are more questions to ask. "If the question is How hard is it to stop? then nicotine a very impressive drug," he said. "Its urges are very similar to heroin."

Among the properties of a psychoactive drug - how much craving it can cause, how severe is the withdrawal, how intense a high it brings - each addicting drug has its own profile.

Heroin has a painful, powerful withdrawal, as does alcohol. But cocaine has little or no withdrawal. On the other hand, cocaine is more habit-forming in some respects, it is more reinforcing in the scientific terminology, meaning that animals and humans will seek to use it frequently in short periods of time, even over food and water.

Drugs rank differently on the scale of how difficult they are to quit as well, with nicotine rated by most experts as the most difficult to quit.

Moreover, it is not merely the drug that determines addiction, says Dr. john R. Hughes, an addiction expert at the University of Vermont. It is also the person, and the circumstances in the person's life. A user may be able to resist dependence at one time and not at another.

A central property of addiction is the user's control over the substance. With all drugs. including heroin, many are occasional users. The addictive property of the substance can be measured by how many users maintain a casual habit and how many are persistent, regular users.

According to large Government surveys of alcohol users, only about 15 percent are regular. dependent drinkers. Among cocaine users, about 8 percent become dependent. For cigarettes, the percentage is reversed. About 90 percent of smokers are persistent daily users, and 55 percent become dependent by official American Psychiatric Association criteria, according to a study by Dr. Naomi Breslau of the Henry Ford Health Sciences Center in Detroit. Only 10 percent are occasional users.

Surveys also indicate that two-thirds to four-fifths of smokers want to quit but cannot, even after a number of attempts. Dr. John Robinson, a psychologist who works for the R. J. Reynolds Tobacco Company, contests the consensus view of nicotine as addictive. Using the current standard definition of addiction, he said at a recent meeting on nicotine addiction, he could not distinguish "crack smoking from coffee drinking, glue sniffing from jogging. heroin from carrots and cocaine from colas."

It is not that Dr. Robinson and other scientists supported by tobacco companies disagree with the main points made by mainstream scientists. but that they define addiction differently. Dr. Robinson says intoxication that is psychologically debilitating is the major defining trait of an addicting substance. It is a feature that was part of standard definitions of the 1950's, and is still linked to popular ideas about addiction, but which experts now say is too simplistic and has been left behind as scientific evidence accumulates.


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