Smoking guns...

by Geoff Hart

Previously published as: Hart, G.J. 1988. Smoking guns... Canadian Forest Service, Sault Ste. Marie, Ont. Staff Newsletter, June:12–14.

We all know that smoking cigarettes is bad for us, and some of us have known this for decades. By known, I mean to say that the evidence collected in medical studies of smokers has become progressively more frightening. If you smoke, you are aware of this, whether or not you have chosen to do anything about it. After all, we all know of exceptions to the rules. My great uncle Ben smoked at least a pack of cigarettes every day of his life from the age of 15 to the day he died (of a stroke, seemingly not smoking related) at the age of 85. He chose to continue smoking, although he was one of the smartest people I've ever had the pleasure to meet, and it didn't seem to affect him. But lest this make you feel more confident about your own chances or those of a loved one, you should know that another family member died of lung cancer before reaching the comparatively young age of 50 years.

Because this sort of thing is so familiar, I won't belabor the point. However, the Surgeon General of the United States, Everett Koop, recently released a report on smoking that levels another "smoking gun" (this is the lawyer's jargon for unmistakable evidence) at the tobacco industry. You may have heard this report already on the news—you know, the one that claims that smokers are drug addicts? If not, this probably will come as a surprise to you, and if you've been looking for another excuse to quit, this is a pretty good one. According to the statistics that the Surgeon General presented, addiction to cigarettes (more specifically, to the nicotine in tobacco smoke) is every bit as powerful as the addiction to heroin. This may seem to be a pretty wild claim, but the numbers bear him out:

The relapse rate among smokers who have quit (i.e., the number that start smoking again) is 75%—almost exactly the same as the relapse rate for heroin addicts. In fact, one rehabilitated heroin addict who also smoked claimed that his heroin habit was the easier of the two to overcome.
Smoking is now implicated in the deaths of 350,000 Americans each year—nearly three times the toll collected by alcoholism (125,000+) and the use of heroin (6,000+) combined.

If you've tried to quit, or know someone who has tried, you already know how difficult it is. My sister and my mother have both tried to quit smoking, with a bit of help from the rest of the family: Mom succeeded (though it took a lot of cigarettes flushed down the toilet to make our point), but Sis is still going strong (she lives in her own apartment, and is beyond our reach). My family has a 50% success rate, far above the American average, but it is not a particularly satisfactory tally despite this. When I've been sufficiently annoyed by a smoker, I've been tempted to allow rage to dictate an explanation for this: that smokers are all spineless wretches who haven't got the will to quit. I don't really believe this, but it does get me over being quite so pissed off (a false sense of superiority will do that sometimes). The new addiction information helps me to resist my "dark urge", and I can now understand on an emotional as well as an intellectual level why so many people continue to smoke despite knowing the risks.

Part of the insidious nature of smoking lies in the properties of nicotine itself. Because it is inhaled, nicotine reaches the brain in half the time taken by an injected drug such as heroin, and one third the time of an ingested drug such as alcohol. However, unlike many other drugs, nicotine isn't retained in the body for any great length of time. This means that nicotine levels must be renewed constantly to keep the same level of intoxication, and this is why people chain-smoke: fast relief, but an equally fast fading of the effect. Some people are literally taking a few hundred hits of their drug each day (i.e., the number of puffs per cigarette times the number of cigarettes), which makes the addiction that much more powerful.

There's an interesting sidelight on addiction that is not commonly known, and it concerns the persistence of the addiction response. It is commonly and incorrectly believed that having an occasional puff after you've quit is harmless. The truth of the matter is that addiction is a biological matter and not just a mental one. For some time after you've quit, indeed, often for a lifetime in the case of many drugs, your body remembers that it was once addicted. In some cases, as with alcohol, the body adapts to the addiction in such a way as to facilitate the response to the drug: a recovered alcoholic is advised to never again have a drink, even a small one, because their body is so prone to relapse into its old addictive habit. While this is known for alcohol, it is not yet demonstrated for nicotine, although the statistics on relapse rates offer some evidence for this.

A related factor concerns the relationship between use of the drug and the pleasure it provides. Some rather barbaric studies were performed on rats that had electrodes inserted into the pleasure centers of their brains. In layman's terms, the pleasure center is a region of cells that, when stimulated electrically, causes great pleasure for the rat. (I believe that this effect was originally discovered by Canadian neurosurgeon Wilder Penfield, while conducting surgery on some of his human patients, but don't quote me on this. In any event, human brains have similar structures.) What was discovered in the study with rats was that when the rats discovered they could induce pleasure in themselves by pressing a button or performing some other learned behavior, they did so continually. Most rats continued to press the buttons to give themselves a jolt to the exclusion of eating or any other activity, and most died as a result. Although humans are certainly different from rats (with a few notable exceptions), the existence of a comparable brain area indicates the potential for similar effects in addicted individuals.

Since the addiction problem is a result of nicotine alone, simply switching to "smokeless tobacco" will reduce the risk of lung cancer, but it avoids the real issue: addiction. Admitting that you're addicted (and I don't mean just agreeing with a critic—admitting means understanding and accepting the truth) is not easy. It may be the hardest thing you'll ever do, since it means facing the truth about yourself and accepting some of the social stigma of being called an addict. By the way, those who use chewing tobacco have an equally real and equally frightening alternative to contemplate: cancer of the mouth and tongue. The evidence against chewing tobacco is every bit as good as that against cigarettes, if not stronger.

If you're not at all worried about smoking, either for yourself or for a family member, then you're fooling yourself. If you want to quit, then the Surgeon General's report gives you good reason to expect that you'll have a hard time doing so. However, a comforting statistic came out of this report, one that should give you a bit of self-confidence. The study revealed that virtually all of the programs to help smokers quit are equally effective (or ineffective, considering the 25% success rate)—but what was most interesting was that those who quit successfully had one thing that the others lacked: unequivocal, long-term, face-to-face support and assistance from doctors, family members and from smokers who had quit. Talk to your loved ones and get started now. It'll be a long haul, but it will be worth it.