A New Hat at Harvard, The Emerging Case Against Coffee, Private Baloney, and Other Matters. The Meaning of Addiction

(FORTUNE Magazine) – The headlines proclaim that Surgeon General C. Everett Koop says cigarettes are addictive. Is he right about that? Bold answer: It depends on what you mean by addiction. As you might expect, not everybody agrees on this critical matter. With the help of Nexis, we went searching in the American Journal of Psychiatry and instantly stumbled over a definition: Addiction is ''one of a multiplicity of obsessive involvements that can readily substitute for one another so long as they serve to evade a crucial conflict.'' Walking rapidly past that one, we next struck pay dirt in the Journal of the American Medical Association. There a panel of experts was labeling addiction ''a chronic disorder characterized by the compulsive use of a substance resulting in physical, psychological, or social harm to the user and continued use despite that harm.'' Is that what the Surgeon General means? Truth to tell, we are not sure; his report includes a dizzying number of formulations about addiction. But the following clunky sentence appears to be important: ''The central element among all forms of drug addiction is that the user's behavior is largely controlled . by a psychoactive substance (i.e., a substance that produces transient alterations in mood that are primarily mediated by effects in the brain).'' But wait. Surely it is an overstatement to say that cigarette smokers' behavior is ''largely controlled'' by nicotine. Most of the smokers we knew years ago have given it up, and those still puffing today manage to control themselves in elevators, theaters, churches, and aircraft. What the Surgeon General presumably means to say is that many smokers have trouble giving up the weed and also that smoking affects their mood somewhat. To be sure, if he said only that, somebody might point out that the same could be said about coffee drinking. Not everyone agrees with Koop about addiction. French radio recently carried a rather savage commentary on his document by Professor Albert Hirsch, author of a report on tobacco delivered to the French ministry of health last year and, in case you are wondering, a committed critic of the tobacco industry. ''It is always bad to fight an evil with misstatements or distortions of the truth,'' said Hirsch. He felt it absurd to compare tobacco to a hard drug that ''completely alters the personality of the subject . . .'' and said France ''should resist the kind of . . . witch-hunt that can be observed in some of the excesses of the anti-tobacco campaign in the United States.'' Will American public health big shots ever start talking along those lines? It would definitely be big news.