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