UCSF

In 1964, the United States Surgeon General published a report "Smoking and Health" that stated cigarette smoking was causally related to lung cancer and the magnitude of the effect far outweighed all other factors. In the report, the Surgeon General specifically characterized "smoking as a habituation rather than addiction". For the next twenty years, research investigating how smoking affected the body as well as the pathology of smoking behavior culminated in another Surgeon General's report. The 1988 report titled, "The Health Consequences of Smoking: Nicotine Addiction", classified the act of smoking and more specifically the ingestion of nicotine as an addictive process with not only deleterious physiologic consequences but psychological as well. These two reports loosely bind a critical 25 year time period in which the taxonomy used with relation to smoking went through a significant shift. This paper analyzes the role nicotine played in that shift. Specifically, through basic science reports, physician testimonies, and the development of quantifiable objective measures it is argued that the development and use of nicotine as a therapeutic to alleviate symptoms associated with smoking cessation was necessary for the change in classification of smoking from habituation to addiction. The use of therapeutic nicotine not only helped individuals overcome the difficulties associated with smoking cessation, but the intervention led to the development of criteria used to define and treat tobacco dependence and addiction. Nicotine replacement defined the disease for which it was developed to treat.