Public versus Internal Conceptions of Addiction: An Analysis of Internal Philip Morris Documents

Abstract

Background

Tobacco addiction is a complex, multicomponent phenomenon stemming from nicotine’s pharmacology and the user’s biology, psychology, sociology, and environment. After decades of public denial, the tobacco industry now agrees with public health authorities that nicotine is addictive. In 2000, Philip Morris became the first major tobacco company to admit nicotine’s addictiveness. Evolving definitions of addiction have historically affected subsequent policymaking. This article examines how Philip Morris internally conceptualized addiction immediately before and after this announcement.

Methods and findings

We analyzed previously secret, internal Philip Morris documents made available as a result of litigation against the tobacco industry. We compared these documents to public company statements and found that Philip Morris’s move from public denial to public affirmation of nicotine’s addictiveness coincided with pressure on the industry from poor public approval ratings, the Master Settlement Agreement (MSA), the United States government’s filing of the Racketeer Influenced and Corrupt Organizations (RICO) suit, and the Institute of Medicine’s (IoM’s) endorsement of potentially reduced risk products. Philip Morris continued to research the causes of addiction through the 2000s in order to create successful potentially reduced exposure products (PREPs). While Philip Morris’s public statements reinforce the idea that nicotine’s pharmacology principally drives smoking addiction, company scientists framed addiction as the result of interconnected biological, social, psychological, and environmental determinants, with nicotine as but one component. Due to the fragmentary nature of the industry document database, we may have missed relevant information that could have affected our analysis.

Conclusions

Philip Morris’s research suggests that tobacco industry activity influences addiction treatment outcomes. Beyond nicotine’s pharmacology, the industry’s continued aggressive advertising, lobbying, and litigation against effective tobacco control policies promotes various nonpharmacological determinants of addiction. To help tobacco users quit, policy makers should increase attention on the social and environmental dimensions of addiction alongside traditional cessation efforts.

Author summary

Why was this study done?

• Tobacco companies publicly denied for decades that nicotine was addictive.
• In 2000, Philip Morris became the first tobacco company to publicly state that nicotine is addictive.
• Today, addiction is understood as a complex phenomenon resulting from both the pharmacology of the addictive substance and the user’s biology, psychology, social milieu, and environment.
• The tobacco industry avidly promotes new nicotine products, emphasizing that nicotine addiction is the key driver of smoking.
• Little is known about how tobacco companies internally understood addiction as they changed their public position.

What did the researchers do and find?

• We examined previously secret internal Philip Morris documents and public company statements and traced Philip Morris’s internal understanding of addiction from the mid-1990s until 2006.
• We found that Philip Morris’s shift from denying to affirming nicotine’s addictiveness was driven by public, regulatory, and legal pressures, not by a substantive change in scientific understanding.
• Philip Morris continued studying addiction through the 2000s to develop successful and potentially safer nicotine products.
• From the mid-1990s to at least 2006, Philip Morris’s internal models of addiction positioned psychological, social, and environmental factors as equally important to nicotine in driving cigarette use.

What do these findings mean?

• Philip Morris’s public embrace of nicotine as the main driver of addiction bolsters the case for tobacco harm reduction but likely does not accurately reflect the company’s internal understanding of addiction.
• Philip Morris has internally understood since at least 2006 that its actions (e.g., advertising, lobbying, and litigation) influence addiction by shaping users’ psychology, social milieu, and environment.
• Philip Morris’s public embrace of nicotine’s addictiveness currently works to redirect policy away from proven social and environmental interventions and toward the promotion of the industry’s potentially reduced harm products.
• To improve addiction outcomes, public health authorities should continue expanding and strengthening social and environmental restrictions on cigarette smoking.