Howard I. KUSHNER
Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
hkushne@emory.edu

Recent studies suggest that nicotine dependence may serve as an attempt to alleviate an underlying psychiatric disorder such as attention deficit hyperactivity disorder, conduct disorder, depression, schizophrenia, anxiety disorders, and Tourette syndrome. The connection between persistent smoking and self-medication is rarely directly addressed in smoking reduction campaigns and policies. The limited attention given to the role of self-medication in smoking reduction efforts is as much historical as scientific. The reasons for this neglect are tied to the evolution of classification systems of psychiatric syndromes and addictive behaviors. In the immediate postwar period, addiction was often understood as a function of what was then labeled as the "addictive personality,” a designation that implied that addiction resulted from underlying psychiatric disturbances rather than from the addictive properties of the substances themselves. However, the addictive personality construct, increasingly identified with psychoanalytic psychiatry, fell into disfavor. Meanwhile, as a result of the discovery of the brain’s natural opiates in the 1980s, addiction became understood in the context of the interaction of brain mechanisms with the actions of addictive substances. By the late 1980s many neuroscientists argued that exogenous addictive substances, including nicotine, altered brain chemistry and architecture in permanent ways. For many addiction experts, these putative brain alterations explained the high rate of smoking cessation failures. This paradigm was enshrined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), beginning with the 3rd revision in 1987. In subsequent DSM revisions, addictive behaviors, including smoking, were reclassified as distinct categories of psychiatric disease (e. g., Nicotine Dependence, 305.10). As a result of this increased attention to the action of nicotine on the brains of smokers, the role of nicotine as self-medication for some underlying psychiatric conditions has been obscured.

12th Annual Meeting of the International Society for the History of the Neurosciences   (ISHN)
Los Angeles, California, USA, 19-23 June 2007