Why smokers still smoke: It's the nicotine, stupid.

 

Dear Eyal Ert and Eldad Yechiam:

I read with great interest your Opinionator piece in the New York Times. Unfortunately, the Times’ website will not allow me to post a comment on your article, so I am emailing you directly, and also posting this reply on my blog

While I am sure there is some validity to your findings, I find your approach to the question rather naive. 

Your answer to the question of why people still smoke: smokers have poor self control. 

My answer to the question of why people still smoke: it’s the nicotine, stupid.

In the amounts consumed by typical habitual tobacco users, I’d argue that nicotine in and of itself is relatively benign. It is the means of delivery—the various forms of tobacco products consumed around the world—that introduce virtually all of the harm associated with nicotine use. 

In my opinion, the question is not, “Why do people still smoke?” The question is, “Why don’t public health authorities get real, pay attention to centuries of human behavior, and promote alternative means of nicotine consumption over cigarettes and other harm-inducing tobacco-based nicotine delivery methods?” (For instance, in Sweden, where the government has promoted the use of snus over smoking, men have the lowest incidence of lung cancer in Europe. While snus is a tobacco product, there is some evidence that it is less harmful than other forms of smokeless tobacco.)

Within 100 years of Europeans discovering the new world, tobacco was well on its way to establishing itself as a global commodity. To my knowledge, no society that has adopted tobacco use has ever later abandoned it. If you are aware of one, please correct me. 

And it’s not the tobacco that people like. It’s the nicotine it delivers. “Aha!” you may say, “But people don’t really like nicotine, they’re addicted to nicotine.” To which I might respond, “Bullshit.”

Have either of you ever smoked or used a tobacco product? If so, then you know that for the neophyte user, almost all means of tobacco consumption—cigarettes, hookahs, snuff, chewing tobacco, etc.—are noxious. It takes a while until new users no longer notice the noxiousness.  
Why do people put themselves through this unpleasantness to reach the point of addiction?

While I’m sure there are many, many factors, including cultural norms and peer pressure, one factor that shouldn’t be ignored is the neuropharmacological benefits nicotine provides. For lots of us, nicotine is a substance our brains love. And it’s not just that our brains love it—I’d submit that for lots of us, our brains work better on it. 

Some people try tobacco and never get hooked on it. Why? Because the benefit they feel from nicotine can’t override the unpleasantness of tobacco consumption. Do these people have better self control, or is it a matter of their brains not being wired to have an affinity for nicotine? I’d suggest it’s more often the latter. Or perhaps even some connection between the two. Maybe the differences in self-control your study highlights are really markers for the different ways our brains respond to nicotine. 

But it’s pretty damn clear after 500+ years of human experience with the drug that once a brain falls in love with nicotine, it doesn’t fall out of love with it easily, if ever.

Addressing the addictiveness of tobacco/nicotine while overlooking the benefits users receive from it and our species’ unbreakable, centuries-long association with it is, in my opinion, short-sighted and unproductive. 

We need to spend less time figuring out why smokers still smoke, and more time figuring out how to transition smokers to less harmful ways of consuming the nicotine their brains crave, like e-cigarettes or snus, or using nicotine gum as an ongoing delivery product instead of a cessation product.  

We need to recognize the reality that nicotine is a beneficial substance for a lot of people, and completely separate the issues of smoking—and the horrible health problems associated with it—and nicotine use.  

Sincerely,

Rich Malley
Total layperson, nicotine lover, e-cigarette user