Psychology/Psychiatry

Is Smoking a Choice or an Addiction? Why Can't It Be Both?

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Michael Siegel notes a puzzling juxtaposition: Two days ago John Banzhaf, founder of Action on Smoking and Health, declared in a press release that smoking "is a choice rather than an addiction"; the following day, Altria CEO Michael E. Szymanczyk conceded in a presentation to shareholders that "tobacco use is addictive and it can be very difficult to quit." As Siegel notes, you'd expect the anti-smoking activist to emphasize the habit's addictiveness, since that is a basic premise of litigation that blames tobacco companies for smoking-related diseases—litigation that Banzhaf, a professor of law at George Washington University, has long promoted. And you'd expect the head of the nation's leading cigarette manufacturer to deny that smoking is addictive, which is precisely the position the tobacco companies took for decades while fending off lawsuits and regulations. What gives?

Banzhaf called smoking a choice in the process of arguing that it is legal for doctors to turn away smokers:

Although there is evidence that for many people smoking involves addiction, that addiction is to the drug nicotine, not to the act of smoking itself, which is a behavior. Because those who desire to quit smoking (e.g., for a medical procedure) can ingest nicotine from nicotine gum, nicotine patches, nicotine spray, nicotine inhalers, and e-cigarettes, their decision to ingest it by smoking rather than by using nicotine replacement products is a choice. Since it is a choice rather than an addiction, disease, or health status, it seems more legally justified to restrict access to medical care to smokers than to the obese.

Banzhaf has used a similar argument in defense of employers who refuse to hire smokers and insurers who charge them more. (By the way, I agree with him—on libertarian rather than anti-tobacco grounds—that doctors, employers, and insurers should be free to discriminate against smokers.) Szymanczyk, by contrast, was highlighting Altria's efforts to show it is breaking with its dishonest past and is now a good (or at least better) corporate citizen, which among other things involves discouraging people from consuming its products:

Because tobacco use is addictive and it can be very difficult to quit, our tobacco companies help connect adult tobacco consumers who have decided to quit with cessation information from public health authorities.

Siegel faults Banzhaf for his situational science:

Anti-smoking advocates seem to change the science on whether smoking is a choice or an addiction based on the issue of the day. If the issue is a lawsuit, then smoking is an addiction. If the issue is refusing to hire smokers, then smoking is a choice. If the issue is the FDA regulating nicotine, then smoking is an addiction. If the issue is denying medical care to smokers, then smoking suddenly becomes a choice again.

As I've noted before, an inconsistent view of smokers' moral culpability is typical of the anti-smoking movement, which treats them as victims when it's convenient (e.g., in advocating product liability suits and restrictions on advertising) and as villains when it's not (e.g., in advocating smoking bans or higher cigarette taxes). But I think Siegel and Banzhaf are wrong to insist on a choice/addiction dichotomy. Smoking, as a form of purposeful behavior, is always a choice, and it is often an addiction, meaning a strong attachment to something that provides pleasure or relieves stress. Pace Banzhaf, this addiction is not (or need not be) solely about the psychoactive effects of nicotine, as demonstrated by the low success rates of smokers who use nicotine replacement products to quit and by research finding that subjects hankering for a smoke can relieve their craving by puffing on denicotinized cigarettes. For people who develop the habit, smoking is a complex ritual with strong positive associations, only some of which can be explained by the nicotine. Furthermore, the fact that most people who try tobacco do not become regular users and the fact that former smokers outnumber smokers shows there is nothing inevitable or inescapable about the habit. The idea that nicotine (or any other drug) is pharmacologically irresistible, causing and maintaining addiction without regard to personality, tastes, preferences, and circumstances, is simply inconsistent with the way people who consume it actually behave.

Fortuitously, the same week a top tobacco executive and a prominent anti-smoking activist are disagreeing about whether smoking is a choice or an addiction, a leading addiction expert, Stanton Peele, is on the front page of The Fix, explaining that "addiction is not caused by substances" and that "most people recover naturally from addiction." Go here for Peele's Reason articles. Go here for my review of Jeffrey Schaler's book Addicion Is a Choice.

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  1. I dont’ care whether it is either or – or both as long as I continue to get my dividend checks from MO.

  2. In an effort to contribute in a mature fashion to a serious conversation, I would like to say that wanking it could also be considered to be one of these mixed-bags of addiction and choice.

    1. What about Laughter? I’ve heard that some people enjoy that too, but I just KNOW it’s unhealthy. Burns-calories-my-ass, it’s probably responsible for diabetes.

      1. it’s probably responsible for diabetes numerous studies have conclusively shown a link between laughter and diabetes.

        ftfm. (practicing for my dream of becomeing the Surgeon General someday…what, you have to be a doctor? Ok, President then.)

        1. I contracted herpes from laughing too much.

          1. I demand an immediate quarantine of all standup comedians, comedic writers, clowns, mimes, and especially the guy who does xkcd, until this epipandemic is under control.

            1. (thank god I’m not that funny, *whew*)

          2. I contracted “laughing” from hearing that you got herpes.

    2. interesting because it is considered cancer prophylactic, and the other, an actuation

  3. Writing something that is both mildly interesting and makes sense is apparently not a choice for Sullum.

    1. If you have to be addicted to something, writing things that are both interesting and make sense is a good thing to be addicted to.

    2. Apparently it’s not a choice for Max, either.

  4. it is an addiction for some but not all but the first time you opt to smoke, it is volition

  5. Is using heartburn pills a choice or an addiction?
    Is taking insulin a choice or an addiction?
    Is playing video games a choice or an addiction?
    Is the statist mindset a choice or an addiction?

    1. Is taking insulin a choice or an addiction?

      For people in chronic, unfixable, pain, I see this as equivalent. The diabetic is reliant on insulin to keep them from dying. The pain patient is reliant on the painkillers to keep from being in pain.

      /preaching-to-the-choir-mode-off

      As for the statist control-freak addiction….CMON SCIENCE, where’s the drugs that fix that, huh smart guys?!

  6. Man, people really love false dichotomies, don’t they? Aren’t all addictions entered into by choice (even if the choice is based on inadequate information)? And does anyone kick an addiction without choosing to do so? There really isn’t any opposition or mutual exclusivity between addiction and choice.

  7. Is eating food you enjoy an addiction too?

    Maybe we need to amend the bill of rights with something to protect our right to smoke and eat good food the liberals pretend not too like. After all, “Mooshelle” Obama loves feeding her kids ribs while fighting childhood obesity!

    http://libertarians4freedom.blogspot.com/

  8. Smoking is a rational choice. Do you want to enjoy 60 years of your meager existence, or do you want to suffer through 80 years.

    1. Selecting the non-suffering option is now a Federal Crime.

  9. The way I’ve quit many times, last month being the most recent, was to tell myself that nicotine detracts from the enjoyment of my other vices.

  10. I once thought that I could replace cigarettes with nicotine gum until one day I was standing there chewing the gum and smoking a cigarette going “what’s wrong with this picture?”

    1. I’m reminded of a character Glenyth Paltrow (sp?) played who was smoking in order to help her end her addiction to nicotine gum, which she had taken up in order to quit smoking.

    2. I had a professor in college who chewed nicotine gum, but had never smoked. I thought that was interesting.

  11. “Since (smoking) is a choice rather than an addiction, disease, or health status, it seems more legally justified to restrict access to medical care to smokers than to the obese.”

    By that logic, being obese must be a choice as well, since one can choose to get their nutrition from salads and healthier foods or from Twinkies and Big Macs, right?

  12. The idea that nicotine (or any other drug) is pharmacologically irresistible, causing and maintaining addiction without regard to personality, tastes, preferences, and circumstances, is simply inconsistent with the way people who consume it actually behave.

    “You know Billy, what worries me is how your mother is going to take this.”

  13. The idea that nicotine (or any other drug) is pharmacologically irresistible, causing and maintaining addiction without regard to personality, tastes, preferences, and circumstances, is simply inconsistent with the way people who consume it actually behave.

    Who are you going to believe, the experts or reality?

  14. $$$ – cigarettes are still the cheapest and quickest way to a nicotine fix.

    Besides, gum chewers are just gross. 🙂

  15. Let’s see, first it’s a choice, and then you can’t quit, so it’s an addiction? No, that can’t be.

  16. Since it is a choice rather than an addiction, disease, or health status, it seems more legally justified to restrict access to medical care to smokers than to the obese.

    Wait, is Banzhaf saying obesity is not a choice?

    Another thing I think is funny was how the movie Cold Turkey was premised on a town’s not being able to quit smoking was considered a p.r. coup for a cigaret maker, while their success in quitting was considered to be a p.r. failure by the cigaret maker.

  17. It’s definately a choice AND an addiction for me..

  18. What would a smoker say?

    Smokers who want to quit most likely want to call it an addiction. Those who don’t want to quit will likely call it a choice.

    The goal is to end smoking-related illness; we should tailor quit smoking messages and regulations to whatever works best to help people quit, irregardless of what smoking “is”.

  19. Smoking is an addiction, not a true choice. Over 90% of smokers began smoking while they were teens or preteens, and therefore, incapable of making a rational or legal decision or “choice” to start smoking.

    But, once they made that foolish choice and continued to smoke, they became addicted to nicotine.

    Your description of addiction, meaning a strong attachment to something that provides pleasure or relieves stress, isn’t true too.

    A smoker only gains pleasure or stress relief from smoking only because they are relieving the withdrawal cravings from not getting a nicotine fix. I believe that you will not find one teenager or preteen who said they received pleasure from a cigarette the first time they smoked one.

  20. Really? Wish I had known that smoking was a CHOICE the entire 30 years I smoked. Perhaps then the umpteen times I tried to quite using NRTs would have worked. LOL I did finally give up cigarettes for electric cigarettes but….

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