Dependence Not Addiction for Nicotine Users?

Professor Caitlin Notley, lead of the Addiction Research Group, argues that experts need to reconsider using the term ‘addiction’ when applied to nicotine. Her comments come following the release of a study looking at people’s understanding of “nicotine and addiction”, and she feels that it doesn’t reflect the actual day to day impact of nicotine use.

Professor Caitlin Notley is the Director of the Faculty of Medicine and Health Citizen’s Academy and the Lead of the UEA Addiction Research group. She specialises in smoking relapse prevention, e-cig use, addiction, mental health and young people. She also contributes to The Cochrane review of electronic cigarettes for smoking cessation – a respected project solely focused on evidence
The Addiction Research Group produces high quality research evidence to impact upon people who are affected by addiction, including service users, carers, health professionals and policy makers. The research approach emphasises responsiveness to social, cultural and pressing health needs, and supporting high risk or disadvantaged groups.

The recent study, Addicted to smoking or addicted to nicotine?, found: “Participants across all smoking status groups associated nicotine with tobacco products, but consistently misperceived that nicotine caused disease. Perceptions of addiction were largely negative and varied by smoking status. Experienced smokers (exclusive smokers, former smokers and dual users) differentiated tobacco use from other addictions and minimized their own experiences of addiction.”

The idea that nicotine causes disease has spread from the kind of stories carried by national newspapers. Smokers, ex-smokers and never smokers alike all share them in large numbers.
Professor Notley commented that the study showed how these “narratives of addiction” are deeply engrained in society, based in strong, morally focussed emotions.
She believes that the way vape products are promoted, the messages contained on the packaging warning about containing nicotine, has the unintended consequence of linking vaping to smoking and therefore (wrongly) telling people that nicotine is responsible for tobacco-related disease and death.

“Although nicotine use may result in dependence it need not result in addiction”.
She agrees with recent calls to rethink how vape products should be promoted and labelled so that the misunderstanding about the real risk of nicotine can be addressed.
Rather than considering nicotine as “addictive”, she prefers the term “dependence” as it includes other aspects of why people continue to vape after having given up smoking.
Such aspects include vaping for pleasure, sharing the experiences with a real-life or online social group. By focussing on other aspects and getting rid of the term “addiction”, she believes would help encourage smokers to switch and reduce relapse back from vaping to tobacco.
Professor Notley said: “Current and non-smokers expressed the view that switching to other nicotine products would be simply ‘exchanging one addiction for another’, without wider consideration of harm to health of different routes of nicotine administration. This is concerning, as it demonstrates a preoccupation with the concept of ‘addiction’ that may potentially negatively impact health behaviour through discouraging switching to reduced-harm nicotine-containing products.”
Addiction implies a negative impact on the person using the substance whereas dependence means people want to use nicotine but it “does not cause significant harm to population health.”
She feels it is vital to draw a clear distinction between dependency upon nicotine and addiction to smoking as an urgent public health priority to help save lives that will otherwise be lost to tobacco.