“… being a smoker is not a matter of free choice; they’re gripped by an addiction fuelled by the tobacco industry and they need support to give up
Deborah Arnott, Head of ASH

The first and most important issue to raise is the one which is least often discussed in polite company, namely the fundamental question as to why someone should choose to smoke in the first place, and then continue to smoke, despite the risks of doing so. Maybe, just perhaps, smokers like smoking?

This is fundamental to the question of “tobacco control” as control is only required if consumers are acting in an entirely irrational manner, causing harm to themselves and (in the next logical development of the argument) harm to others. This, it is implicitly argued, is because tobacco is “addictive”, and customers are lured into smoking through aggressive marketing by “Big Tobacco” as the comment from Deborah Arnott above suggests.

This has been eloquently described as the “theory of demonic possession” whereby the individual’s responsibility for their actions has been subverted by some greater (and inherently, therefore, evil) force. The implication of this theory is that any intervention can be justified in the name of “public health” including punitive taxation; ever increasing regulation of both the product and the ways in which consumers use the product; and outright stigmatisation of the consumer by “denormalisation”.

Figure 3: Government-mandated commentary on smokers

For this characterisation of smokers to be true we would have to believe that there was no personal choice being exercised and that smokers derive absolutely no utility (in an economic sense, i.e. “pleasure”) from smoking at all. The obvious fallacy of the argument is that, despite everything, millions of people around the world continue to smoke in knowledge and therefore acceptance of the apparent risks. A rational view must be that smokers have accepted the potential risks of their habit, and borne the obvious financial cost imposed on them for maintaining in their habit, because they “value” smoking – for the taste, the sensation, the stimulation, the relaxation, the conviviality or for whatever other reason or combination of reasons.

On a personal level we may not see that trade off in the same way as we ourselves have either chosen not to smoke or to cease smoking. But then people may well disagree with our personal life choices, each of which themselves may come with their own costs, risks and pay backs.

Figure 4: Risk of a “healthy” commute in London
Source: R. Maile, courtesy of an altercation with a Boris bike which was in the wrong place, Feb 2016

The counter to this is, inevitably, the survey data which suggest that the vast majority of smokers want to give up and/or wish they had never started. But then asked if you think you really should lose some weight, drink less, eat more healthily and give more to charity you would probably agree with all of those sentiments, especially if asked by an interviewer who catches you on the High Street. Each is within your gift if, that is, you want to forego that chocolate cake, not finish that bottle of claret (and open a second), eat more kale (really?) and hand over more cash to every worthy cause that asks. Each of these would, however, require a reduction in utility (pleasure) in the short term which may not be balanced by the promised benefit in terms of increased longevity in the very long term.

We discuss the question of “Addiction” more fully below, but at this point we make a number of points.

  • There is no accepted medical or scientific definition of “addiction”
  • There are more ex-smokers in the UK and the US as current smokers
  • Until 1988 the Surgeon General did not regard nicotine as “addictive”, rather it was an “habituation”
  • Even when declaring nicotine to be “addictive” in 1988, the view of the then Surgeon General was that ”For many smokers, a genuine desire to quit and, if necessary, persistent and repeated attempts to quit may be all that is necessary

Quitting smoking may well be difficult for many, we do not doubt that, but it is not impossible (as many millions of people have proven) and it is certainly not life-threatening. The “addictive” properties of nicotine (using the word in the sense of common, current parlance) are only one part of the reason for smoking and are, in many ways, no different to the “addictive” qualities of caffeine. And no-one judges you for drinking coffee.