Quite often, Tobacco Control operatives like to tell us that nicotine is as addictive as heroin. It’s one of those facile statements that you’re meant to sagely nod along with for fear of being exposed as some sort of oaf who doesn’t understand basic human physiology.
It’s hard to tell where it all started. Here’s a New Yorker article from 1987 which includes a quote from a psychology professor called Dr. Sharon Hall saying, ''Heroin addicts say it is easier to give up dope than it is to give up smoking,''
Here’s a headline from the Council on Chemical Abuse that manages to squeeze two dubious statements into a nine-word headline. You have to admire that from a pure copywriting standpoint. Fearmongering has rarely been so efficient.
Here’s one from the Cleveland Clinic that I like. It uses the classic “some people say” rhetorical device to distance themselves from the statement they are making.
We also have a Royal College of Physicians report from 2000 suggesting that smoking is as addictive as heroin or cocaine. They’re a sober and credible source, so we have to give it some weight.
Where do these claims seem to come from
One of the most commonly cited references for this claim comes from the US Surgeon General's 1988 report on smoking.
The report suggests heroin and tobacco have similar addiction profiles, basing their claim on five points. So, let’s kick the tires.
#1. Heroin and tobacco stimulate the release of the pleasure neurotransmitter dopamine
OK, so they work similarly. But there are lots of substances and activities that stimulate dopamine in the brain, such as:
- Caffeine
- Sugar
- Social media
- Running
- Music
- Exercise
Heroin: Heroin enters the brain, converts to morphine, and rapidly binds opioid reactors. The result is a huge surge of dopamine.
Nicotine: Nicotine has molecular similarities to a naturally occurring neurotransmitter called acetylcholine. It binds to nicotinic acetylcholine receptors, triggering dopamine.
The thing is, heroin releases far more dopamine, as shown in comparative brain imaging scans.
Saying that because heroin and nicotine both release dopamine, so they’re just as addictive as each other is, being kind, an oversimplification.
#2. Both sets of users experience tolerance and withdrawals
The withdrawal point is interesting. Examining this claim involves looking at a response to another report that caused the nicotine/heroin claim to spread like wildfire. It was called Nicotine Dependency and Compulsive Tobacco Use, and it’s referenced in this excellent article from 1986 in the Washington Post.
The article is incredibly readable and takes the Harvard research to task for using “invalid syllogism” and “specious claims,” in making its argument.
On the subject of withdrawal, the authors say this:
“The fact that withdrawal symptoms are categorized similarly does not mean that cessation of the use of heroin and nicotine produces similar urges, nor does it inform us as to the degree to which free will is diminished among users of either drug.”
#3. Both users frequently relapse when they try to quit
This website suggests that 40-60% of people with addictions who get sober will relapse at some point in their lives.
However, they suggest that 91% of heroin addicts relapse.
For smoking, that number is higher, according to some studies. However, there is a lot of contrasting evidence that suggests that as much as half of all people who smoke are successful during their first serious attempt.
#4. In animal studies, the subjects would self-administer nicotine in the same way they would heroin
Animal studies, while interesting, have severe limitations. It’s challenging to replicate the blend of psychological, environmental, and social factors that are at play with human dependence or addiction.
These results can provide a foundation, and the results can be helpful, but let’s just say that there is a reason why a drug is not tested on mice and immediately brought to market for humans based on data from animal studies.
#5. Self-reporting by people with addiction
The Surgeon General’s report also used self-reporting about nicotine and heroin addiction similarities as a cornerstone of its report. However, there are reasons, like social desirability bias, that should give us pause about confusing these anecdotes for data points.
Final thoughts
The statement “nicotine is as addictive as heroin” has passed into perceived wisdom. However, it’s worth taking a step back and checking the foundations of this “wisdom” for structural integrity. As it turns out, they’re a bit shakier than permitted building regulations.
So, there are a few ways we can think about this.
Let’s say we define addiction as involving:
- A loss of control
- An intense desire or urge for the substance
- Severe withdrawal symptoms
- Desire to continue to access the substance despite harm to personal relationships, ability to work, reputational damage, and serious harm to health.
And then we think about dependence as involving:
- Physical adaptation to the substance
- A strong urge to use the substance
- Significant withdrawal symptoms.
Using those criteria, it’s clear to me that heroin is an addiction, while using smoking alternative products is, at most, a dependence.
Of course, sometimes you just need to ask yourself a question that cuts through the noise. For me, it is this:
Would you prefer if your family member was regularly using nicotine or heroin?
It’s not a difficult question to answer.
