Nicotine addiction, maurice seevers, and the first surgeon general report on cigarette smoking and health: Conflicting terms and interests

Objective: This study assessed the role of Maurice Seev-ers in delaying the United States Surgeon General Reports’ judgment that nicotine use is a drug addiction and examined the use of addiction, as applied to nicotine (smoking), from the 1930s to 2013. Method: In this narrative review, Truth Tobacco Industry Documents were searched using names of those involved in the 1964 Surgeon General Report; key staff of the American Tobacco Company; and the terms addiction, addictive, dependence, habituation, and habit. Use of “addiction” to smoking was also examined in selected works from 1938 to 2013. Re-sults: Seevers had consulted for the cigarette industry and had been a long-standing advocate for judging nicotine use a drug habituation. He was primarily responsible for cigarettes being judged not addictive in 1964, over objections of other committee members. According to selec- tion rules, he should have been ineligible for committee membership. At the time, multiple sources supported calling smoking an addiction. By the 1980s, “nicotine dependence” or “addiction” became officially accepted. Conclusions: One expert with financial and intellectual conflicts of interest delayed official judgments that nicotine was addictive. Selection rules for expert committees should be designed to minimize conflicts of interest and should be followed. Although heavy nicotine use may now be classified variously as a tobacco use disorder, addiction, or dependence, depending on the source or audience, “drug habituation” no longer has any currency. The terms used to communicate with the public are important in dealing with the individual and public health costs of tobacco use.