Using that word, "addiction."

Addiction Dependence

All too often, indeed depending on the audience, nicotine is being ill-defined. I have deliberately used the word, ‘ill,’ to illustrate the problem we meet nowadays when discussing ‘addiction.’ The definition of ‘ill-defined’ is clearly that we are seeing that a mistake is being made in our understanding of the word, ‘addiction.’ But words carry more than just their denotations... they have connotations and often, sometimes more often than not, these connotations give more meaning to the word than its denotation. As to, ‘ill-defined,’ the connotation is that it is not just a mistake in our perceived meaning of the word, but that it may be the result of a deliberate act.

In the following discussion I am going to look at the word, ‘addiction’ and its use in comparison to DSM-5

DSM‑5 is the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition — the authoritative classification system for mental disorders used by clinicians, researchers, and health systems in the United States and widely around the world. It is published by the American Psychiatric Association (APA) and provides the official diagnostic criteria for all recognised mental disorders. APA_DSM-5-Substance-Use-Disorder.pdf

Official Definition. Addiction.

Under DSM-5, problems with nicotine fall under Tobacco (Nicotine) Use Disorder, which is assessed based on impairment, distress, and continued use despite harm. The framework explicitly moves away from casual or rhetorical use of the term “addiction” and instead focuses on whether a person’s nicotine use constitutes a problematic pattern that interferes with health, functioning, or daily life. https://ginn.global/youth-nicotine-and-the-misuse-of-addiction-in-policy-debate/

Misuse & Moralising & Youth

I contend that, “addiction” is misused deliberately by organisations when discussing nicotine and youth uptake of, in particular, vaping products. They know better, but do not care! They are not interested in health; not any longer. There was a time perhaps, but not now.

Take, for example, Tobacco Free Kids in the USA.

They frame all nicotine products as “highly addictive” in youth. Phrases like “hooking kids” and “promoting addiction to kids” where they treat marketing exposure or product appeal as equivalent to clinical addiction, implying all promoted nicotine products are equally addictive. This flattens product differences (combustible vs non-combustible) and emphasises pharmacologic addictions over behavioural harm. I ask, is a half-truth less harmful as an outright lie? Are non-combustible products really as dangerous as combustible? Of course they are not! But this organisation, and the rest of the gang want you the think, “DANGER,” but in reality, much more, they want you to feel, anger, disgust and all the other emotions that are associated with threats to ‘your’ kids. The flattening of the curve assists in hiding the differentials between dangerous combustible cigarette smoking, and far- far less harmful harm reduction products. That last phrase is what so many people do not want you to know!

When you take the sheer number of very well-funded powerful NGO’s and other organisations who spew out this message is it little wonder that the media and whole governments swallow the message and act accordingly?

Sheer number? Below is (an incomplete) diagram demonstrating the reach and influence of just one billionaire philanthropy. And please note that the oft quoted WHO and of course, under its wing the FCTC, comes first in the queue with its ‘normative, guidance and influence role.

Major international and national actors: at least 20–50 well-known NGOs, professional societies and national public health agencies regularly publish anti‑THR content, but you can add the hundreds of smaller organisations, and all of them following the WHOFCTC line of thought. Then of course you can add the influence of several of the world’s richest billionaires. I suppose we could include ‘poor billionaires’ as well. Until I stopped smoking by using an e-cigarette, I had no idea how easily whole populations and their government could be misled. They are not stupid, but they do fail to see through the sophisticated tactics of determined activists, particularly the well-paid groups acting under the umbrella of the World Health Organisation. As for governments, I am afraid that a myriad of other concerns blinds them. Look at the huge incomes they derive from tobacco taxes; the savings when people die young: savings from pensions; savings in the health services. As for mainstream media, anything which upsets their readers makes good copy and nothing upsets the readers more than to see their children threatened... vaping will get the youngsters hooked... they will become addicted to these filthy devices. And this being incessantly repeated.

And as for governments just following sheep-like what the WHOFCTC dictates look no further than the UK. That’s correct, once one of the golden guys of Tobacco Harm Reduction beginning to buckle. Look no further than the packaging for e-cigarettes. Europe made the initial demands and the UK’s knees began to give way.

Warning this product contains nicotine which is highly addictive

And it is so very wrong. It misleads. Nicotine on its own, if anything, is mildly dependence forming. Nicotine on its own does not fit into the DSM–5 conditions to be categorised as an addictive chemical. The DSM-5 descriptors state that nicotine is included within Tobacco Use Disorder, which is explicitly defined as dependence on nicotine delivered via tobacco products. That’s interesting: are harm reduction [THR] products really tobacco products? Is the reason why THR have been officially classified as tobacco products a deliberate attempt to tie them to comestible tobacco? Yes! I can see that as being a reason why. It looks like smoking. It replaces smoking. The actions of smoking and the effects are similar. And oh! THR products contain nicotine.

“MILDLY addictive? Mildly?”

How do/did you react to that?

And keep in mind that addiction and harm is only in association with combustible tobacco smoking; with nicotine being a part of a whole complex series of interrelationships among the multiple substances involved. Outwith tobacco smoking; without the combustion, nicotine fails to even get a mention as being addictive. I would contend that without ‘harm’ nicotine should not even qualify as being simply dependence forming.

“... the diagnosis of dependence caused much confusion. Most people link dependence with “addiction” when in fact dependence can be a normal body response to a substance.”APA_DSM-5-Substance-Use-Disorder.pdf

A normal body response to a substance. So, what is meant by normal body response?

“A normal body response is the body’s appropriate, proportional reaction to a stimulus or substance—such as food, medication, environmental particles, or microbes—using its built-in physiological or immune mechanisms to maintain homeostasis. This includes recognising the substance, processing it, and returning the body to equilibrium without unnecessary inflammation or distress.” https://pmc.ncbi.nlm.nih.gov/articles/PMC2923430/?utm_source=copilot.com

So, what does a normal body response look like if nicotine is: too small; not a protein; not a pathogen associated pattern; not a toxin in the immunological sense...the innate immune system simply ignores it.

So, what happens with low dosage nicotine intake? It is absorbed; distributed; metabolised and excreted.

Well, (fed up saying ‘so.’) the government warnings on nicotine on THR product packaging, seemingly, are only worthy of being...

Ignored and/or Excreted

But, of course, none of this is relevant to the main problems. Nicotine has only any significance in conjunction with smoking. With THR products all one can say is that e-cigarettes are mildly dependence forming and that goes all the way down to, non-addictive and non-dependence forming in the case of nicotine pouches; that is, causing major harm in the case of combustibles, and minimal (potential) harm in the case of e-cigarettes. As for nicotine pouches...Normal body response.

To cut the clutter we need to simplify...

Addiction = dependence + harm.

Dependence + minimal / low harm

Nicotine on its own = non-addictive / non-dependence forming.

To save lives we need to stress that with THR products addiction does not equate with nicotine.