Tobacco dependence

Psychoanalysts have made a characteristic contribution to the problem. 'Getting something orally', one asserted..., 'is the first great libidinous experience in life'; first the breast, then the bottle, then the comforter, then food and finally the cigarette.13

Sigmund Freud, inventor of psychoanalysis, was a lifelong tobacco addict. He suggested that some children may be victims of a 'constitutional intensification of the erotogenic significance of the labial region', which, if it persists, will provide a powerful motive for smoking.14

While psychological dependence is strong and accounts for part of the difficulty of stopping smoking, nicotine possesses all the characteristics of a drug of dependence and there is powerful reason to regard nicotine addiction as a disease. A report on the subject concludes that most smokers do not do so from choice but because they are addicted to nicotine.15 The immediate satisfaction of smoking is due to nicotine and also to tars, which provide flavour. Initially the factors are psychosocial; pharmacodynamic effects are unpleasant. But under the psychosocial pressures the subject continues, learns to limit and adjust nicotine intake, so that the pleasant pharmacological effects of nicotine develop

13 Scott R B 1957 British Medical Journal 1: 67 1.

14 Quoted in Royal Collage of Physicians 1977 Smoking or health. Pitman, London. In 1929 Freud posed for a photograph holding a large cigar prominently. 'He was always a heavy smoker—twenty cigars a day were his usual allowance and he tolerated abstinence from it with the greatest difficulty'. Jones E 1953 Sigmund Freud: life and work. Hogarth Press, London.

and tolerance to the adverse effects occurs. Thus to the psychosocial pressure is now added pharmacological pleasure.

Tolerance and some physical dependence occur. Transient withdrawal effects include EEG and sleep changes, impaired performance in some psychomotor tests, disturbance of mood, and increased appetite (with weight gain), though it is difficult to disentangle psychological from physical effects in these last.

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