What's the Hook? Smoking Is More Than a Chemical Bond

By DeGranpre, Richard J. | Reason, January 1997 | Go to article overview

What's the Hook? Smoking Is More Than a Chemical Bond


DeGranpre, Richard J., Reason


During the presidential election campaign, Bill Clinton successfully cast Big Tobacco as a national enemy, with Bob Dole playing the role of collaborator by downplaying the addictiveness of nicotine. Meanwhile, the Food and Drug Administration has been asserting jurisdiction over cigarettes as "nicotine delivery devices," arguing that tobacco companies intend to hook their customers, just like schoolyard drug pushers. Hundreds of pending lawsuits, including class actions and cases filed by state governments, similarly allege a conspiracy to addict smokers. These developments represent important changes in our attitudes toward cigarettes. Though justified in the name of public health, the increasing emphasis on the enslaving power of nicotine may only make matters worse.

Understanding why requires careful consideration of the conventional wisdom about tobacco addiction, which recycles mistaken assumptions about illicit drugs. During the latter half of this century, the classical model of addiction, derived from observations of narcotic abuse, increasingly has been used to describe the cigarette habit. The classical model states that consumption of certain chemicals causes a physical dependence, either immediately or after prolonged use, characterized by withdrawal symptoms - symptoms that can be avoided or escaped only by further drug use. As Steven Hyman, director of the National Institute of Mental Health, opined recently in Science, "Repeated doses of addictive drugs - opiates, cocaine, and amphetamine - cause drug dependence and, afterward, withdrawal."

This cyclical model, in which the drug serves as both problem and solution, offers a simple, easy-to-grasp account of the addiction process, giving the concept great staying power in the public imagination. In the case of smoking, this view of addiction is central to the rationale for regulating tobacco and the concern that the cigarette companies have been doping their products with extra nicotine. But the classical model tends to conceal rather than elucidate the ultimate sources of addiction, and it is just as ill-suited to the cigarette habit as it has always been for understanding illicit drug use.

If a chemical compound can be addictive in the manner described by NIMH Director Hyman, we would expect anyone who regularly uses such a substance to become addicted. Yet only a minority of those who use illicit drugs - whether marijuana, cocaine, or heroin - ever develop a dependence on them. The prevalence of addiction, as defined by the American Psychiatric Association's Diagnostic and Statistical Manual, among users of alcohol and cocaine runs about 15 percent and 17 percent, respectively. Even in a sample of 79 regular crack users, Patricia Erickson and her colleagues at Toronto's Addiction Research Foundation found that only about 37 percent used the drug heavily (more than 100 times in their lives), and 67 percent had not used in the past month. A similar pattern holds for tobacco. In the 1994 National Household Survey on Drug Abuse, 73 percent of respondents reported smoking cigarettes at some time, but only about 29 percent reported smoking in the previous month, and not necessarily on a daily basis. Writing in the May/June Mother Jones, Jeffrey Klein manages to argue that nicotine enslaves its users and, at the same time, that Tobacco Inc. seeks to recruit young smokers to replace the 1.3 million Americans who quit each year. If nicotine is so relentlessly addictive, how can it be that 50 percent of all Americans who have ever smoked no longer do?

The classical model also suggests that the cigarette habit should be highly amenable to nicotine replacement therapy, such as the nicotine patch. Yet few of the tens of thousands of patch users have actually broken the habit (only about 10 percent to 15 percent succeed). In direct conflict with the classical model, most keep smoking while on the patch, continuing to consume the carcinogens in cigarette smoke while obtaining considerably higher blood levels of nicotine. …

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