The Role of the Addictive Process as a Key Step in Causation of All Tobacco-Related Diseases

Two circumstances—the fact that cigarette smoking is the single largest preventable cause of disease and death in the country1and the rapid development of a new body of knowledge concerning the addictive process—combine to provide an unparalleled opportunity for American medicine to fulfill its primary responsibility—"the reduction of suffering and death."2 The magnificent neuroadaptability of our species at times becomes dangerous and expensive. We can, unfortunately, come to accept familiar and well-known situations as givens, a part of the landscape. As a result of this adaptability, we frequently overlook important factors that have become so familiar they have lost their saliency. Applied to cigarette smoking, we need to see relative burdens of mortality and morbidity more clearly again, as for the first time. The 350,000 excess deaths per year attributable to cigarette smoking constitute more than all other drug and alcohol abuse deaths combined, seven times more than