Give Dole a Break


Ever since Bob Dole suggested that tobacco is not addictive for everyone, journalists and anti-smoking activists have been reacting as if he had declared that the earth is flat. But while the Republican candidate for President spoke somewhat loosely, the gist of his comments on smoking is so obviously true that it is hard to see what all the fuss is about.

In a visit to Kentucky on June 13, Mr. Dole said: "To some people, smoking is addictive. To others, they can take it or leave it." He made a related point in an interview with Peter Jennings of ABC News on June 27. "My own nonscientific view is that it's a habit," Mr. Dole said. "Some people who have tried it can quit easily. Others don't quit. So I guess it's addictive to some and not to others."

It's easy to quibble with these remarks by noting, as Mr. Dole's critics have done repeatedly, that most experts consider tobacco addictive. In his 1988 report on smoking, Dr. C. Everett Koop, then the Surgeon General, cited three "primary criteria" for addiction: highly controlled or compulsive use, psychoactive effects and drug-reinforced behavior. He also listed seven "additional criteria": pleasant effects, stereotypic patterns of use, recurrent drug cravings, use despite harm, tolerance, physical dependence, and relapse following abstinence.

All of these things are familiar to smokers, so by this standard tobacco is addictive. But Mr. Dole's common-sensical formulation reflects an important truth that Dr. Koop's definition obscures: Addiction is a pattern of behavior, not merely a chemical reaction; it resides in a person's relationship with a substance, not in the substance itself. People who try drugs that are generally considered addictive—nicotine, caffeine, alcohol, heroin, barbiturates—do not necessarily become regular users, and many regular users cut back or stop.

As Mr. Dole noted, many people who try cigarettes never become regular smokers, and many regular smokers quit, some easily and some (like Mr. Dole himself) with great difficulty. In the 1994 National Household Survey on Drug Abuse, 73 percent of respondents said they had tried smoking. But only 29 percent said they had smoked in the previous month, not necessarily on a daily basis.

There are more than 44 million former smokers in this country, and most of them—about 90 percent, according to the Centers for Disease Control and Prevention—gave up the habit on their own without formal treatment, usually quitting cold turkey. On the other hand, some 46 million Americans still smoke, despite the availability of nicotine gum and patches. If all they were after was a nicotine fix, their choice would be hard to understand, given the hazards of smoking.

Such a reductionist view of smoking, implicit in Food and Drug Administration Commissioner David Kessler's definition of cigarettes as "nicotine delivery devices," also fails to explain why so many who quit start again after withdrawal symptoms are long gone. Clearly, smoking served an important function—relieving boredom, soothing anxiety, aiding concentration, warding off loneliness—and they missed it. We can call this behavior addiction, but that's a label, not an explanation.

In the end, all the talk about addiction boils down to a point recognized for hundreds of years: Smoking can be a difficult habit to break. To deny this would be absurd, but that is not what Mr. Dole did. He simply noted that smoking is neither irresistible nor inescapable—a message tobacco's opponents should welcome.

This article appeared in the July 12, 1996 edition of TheNew York Times.