The 1988 US Surgeon General's report Nicotine Addiction: how well has it stood up to three more decades of research?

The 1988 US Surgeon General's Report, entitled Nicotine Addiction, was a comprehensive treatise setting out the evidence that tobacco is addictive and showing that nicotine lies at the heart of this addiction. It likened tobacco to drugs such as cocaine and heroin, and provided a powerful rationale for combining public health and clinical approaches to prevent and combat tobacco addiction. The main conclusions of the report have stood up well to more than 30 years of further research, but there are areas where our thinking needs to be updated. In particular, we now know that different nicotine products are differently addictive and that different tobacco and nicotine products only partially substitute for each other, even when they deliver similar amounts of nicotine with similar rapidity. We also understand that addiction to nicotine products does not depend upon development of physiological tolerance, pleasurable effects or need to relieve adverse mood and physical symptoms. The field of tobacco control needs to embrace a model of tobacco and nicotine addiction based upon nicotine acting in concert with the means of ingesting it to generate cravings. The field also needs to go further in distinguishing between addiction to different tobacco and nicotine products. Crucially, tobacco policy globally needs to do much more to recognize the addictive nature of tobacco and benefits of treatment.