We have changed our views of smoking - and definition of addiction - within recent memory. Yet we are just as sure that what we believe today (nicotine is addictive) was engraved by God on stone tablets, is proven by PET Scans, and to burn at the stake people who disagee, as we used to laugh at people who said smoking was addictive.
The Stanton Peele Addiction Website, February 5, 2010. This blog post also appeared on Stanton's Addiction in Society blog at PsychologyToday.com.
Smoking and Addiction - Fad and Fashion
My views on nicotine addiction don't fit any known template. Except my own. And, oh, the facts. And to show how mainstream, how core, my views are, I‘ll refer in this post to only U.S. Government publications for data.
I. 1964 Surgeon General's Report - Smoking Not Addictive
The 1964 SGR - Smoking and Health - told us that smoking causes cancer. The headlines were blared around the world. Really anti-tobacco, right? So, surely they nailed smoking as addictive? No! SGR 1964 specifically detailed how nicotine was not addictive. Like coffee, it was habituating. I was the first to call smoking addictive - in 1975 - in Love and Addiction.
How the heck could the pharmacologists in SGR 64 not know smoking is addictive? Everybody knows smoking is addictive. It's in the brain! The answer is: because, comparing smokers with heroin addicts, they found that smokers weren't psychopathic outsiders, they didn't use a drug to escape life through a debilitating intoxication, and - 1964 SGR announced - cessation didn't cause withdrawal!
II. 1988 SGR Nicotine Addiction - Addiction Changes!
A quarter century later, the people who brought you Smoking and Health were forced to come back with - dum-de-dum - Nicotine Addiction. It took these distinguished pharmacologists 600+ pages to explain that they were wrong in 1964 - smoking was addictive.
SGR 88 came to this realization by changing the definition and image of addiction. You didn't have to be an underworld figure - stealing money in order to purchase a street drug - to be addicted. You didn't have to climb the walls like Frank Sinatra in The Man With The Golden Arm (which even most heroin addicts don't do) to prove you were undergoing withdrawal. And, because cocaine had recently been redefined as addictive, the definition had shifted from withdrawal to your need for the psychotropic effects of the substance - if it elevated your spirit, and you came to depend on this mood change to get through life, then you were addicted.
III. Is Caffeine Addictive?
What if they discovered coffee caused cancer? Some people would quit without a thought. Some people would quit reluctantly. Some people would panic and use any means to continue drinking the devilish brew and resist any pressure to quit. Can you imagine the government and public health creating increasingly dire portraits of coffee's addictiveness, as people kept drinking this cancerous substance?
(Note: This post is not about coffee being addictive.)
IV. Excommunicating Those With The "Wrong" Ideas About Addiction
In 2002, the editors of the prestigious international journal, Addiction, wrote an extraordinary editorial about a 2000 book by two pharmacologists which claimed that nicotine was not addictive. The editorial - pointing out that the men had received some initial funding from the tobacco industry (the book itself was not financed by tobacco interests) - assailed the researchers and their conclusion as dishonest and immoral.
As with the Catholic Church, if you believe something now ruled to be heresy, you are in danger of excommunication, if not being burned at the stake!
(Note: I say these actions by Addiction's editors are reprehensible, even though I view smoking as addictive.)
V. Those Who Continue To Smoke Are Not More Addicted
Neuroscientists explain that people continue to smoke because they are too addicted to halt. This is why TV ads promote various pharmaceuticals to enable the truly addicted to quit. In some cases, people use these as alternative nicotine-delivery systems - I know a woman who has chewed Nicorettes for decades. This is harm reduction. I support harm reduction. Nicorettes are less unhealthy than smoking (as is snuff).
But research has proven it's untrue that continuing smokers are more addicted than quitters. People can quit addictions at any point. And, even after decades of heavy marketing of smoking cessation aids, most smokers disregard the ads and still quit on their own.
The National Cancer Institute released a 2002 compendium report, Those Who Continue To Smoke, about smokers who hadn't quit since everyone learned that smoking causes cancer. None of the researchers found that continuing smokers were more addicted. In fact, older smokers who were more dependent were more likely to quit! Why? Let's think. As you age, being a heavy smoker makes you reflect more on your mortality and you are more anxious to live.
VI. Poor People Smoke More
Sorry, scientists, addiction reads income tax returns. Neuroscientists' theories are completely incapable of dealing with this. Yet, science has to take this truth into account, which is hard to do in a PET Scan. And the only people less able to deal with poorer people smoking more is tobacco companies, since they like to portray smokers as libertarians who have consciously chosen to smoke as a part of the good life.
Okay. Prominent, well-off people smoke (although more often than average cigars). But most cigarette smokers are part of the American underclass, even though people in all social classes are equally likely to have smoked in their lives. Even as the cost of smoking rises, poorer, less educated people more often continue smoking.
The National Survey on Drug Use and Health shows that people who don't graduate high school smoke cigarettes at 2.5 times the rate of college grads. This proves addiction is not something that occurs in the laboratory, but in the context of people's whole lives.
Figure 4.6 Past Month Tobacco Use among Adults Aged 18 or Older, by Education - 2008 National Survey on Drug Use and Health