There is now an overwhelming consensus amongst the medical and scientific communities that nicotine is addictive (Foulds 1996). The vast majority of people who use cigarettes do so to satisfy their craving for the pharmacological effects of nicotine; that is, to satisfy their addiction. The evidence supporting this view is reviewed comprehensively in the 1988 US Surgeon General's Report, Nicotine Addiction, which showed that the mechanisms causing nicotine addiction are similar to those causing addiction to heroin and cocaine. The work of Russell and colleagues has shown quite clearly that smokers smoke in such a way as to maintain a steady blood nicotine level (Russell 1980). Cigarettes are smoked to get nicotine into the body, but it is the tar and other components that cause most of the disease. A key challenge is to increase awareness of nicotine as an addictive drug amongst the wider public, especially amongst tobacco users themselves. With tobacco still widely promoted and relatively normalised within society there is no real perception of tobacco as an addictive substance. Any effective intervention would have to include an educational component to change perceptions amongst smokers themselves.
It is acknowledged by the scientific community that nicotine is an addictive substance and a poison. In the USA tobacco products are controlled by the Food and Drug Administration (FDA), however, in the UK there is no regulatory framework protecting consumers from cigarettes and other products of the tobacco industry. In sharp contrast, nicotine replacement products - which unlike tobacco products do not contain harmful substances such as tar, of produce dramatic surges in blood nicotine levels or produce strong dependence - are subject to tight regulation under the Medicines Act.
The 10th Edition of the International Classification of Diseases (ICD 10) categorises disorders that are attributable to the use of psychoactive substances. Category F17 covers Mental and behavioural disorders due to the use of tobacco. Three fourth-character subdivisions are relevant to tobacco use.
F17.1 Harmful use
F17.2 Dependence syndrome
F17.3 Withdrawal state
The definitions for each of these subdivisions are given in Appendix Four.
The NHS in Scotland changed from using ICD 9 to ICD 10 during 1997. The above codes were not available in ICD 9. It is likely that many health care workers involved in the diagnosis, classification and coding of disease are not aware of codes F17.1, F17.2 and F17.3. By using these codes in hospital and general practice useful information could be collected about the number of patients whose health is being damaged by tobacco use, the number of patients who are dependent on tobacco use, and the number of patients who are in a withdrawal state.