Drug addiction.

Psychogenic dependence is the common denominator of all drug habits and the primary drive which leads to initiation and relapse to chronic drug use or abuse (25). Although a pharmacologic drive is necessary it does not need to be a strong one or to produce profound subjective effects in order that habituation to the use of the crude material becomes a pattern of life. Besides tobacco, the use of caffeine in coffee, tea, and cocoa is the best example in the American culture. Another example, the chewing of the betel morsel, exists on a world scale comparable to tobacco and involves several hundred million individuals of both sexes and of all races, classes, and religions (17). The morsel contains arecoline from the areca nut, an ingredient of the mixture. It is a very mild stimulant of the nervous system which is ordinarily no more detectable than nicotine subjectively. The morsel is chewed from morning to night, from infancy to death, and creates a craving more powerful than that for tobacco. As with tobacco, oral gratification plays an important role in this habit. Thus, correctly designating the chronic use of tobacco as habituation rather than addiction carries with it no implication that the habit may be broken easily. It does, however, carry an implication concerning the basic nature of the user and this distinction should be a clear one. It is generally accepted among psychiatrists that addiction to potent drugs is based upon serious personality defects from underlying psychologic or psychiatric disorders which may become manifest in other ways if the drugs are removed (32). Even the most energetic and emotional campaigner against smoking and nicotine could find little support for the view that all those who use tobacco,