Repeatedly, studies have found a large majority of smokers regret ever starting to smoke: 85% in this study, 90% in this four nation study. Each year, some 40% of smokers make an attempt to stop, with most relapsing within weeks.
Many fork out considerable money in pharmaceuticals along the way in the attempt to shake their smoking. Snake-oil, evidence-free quick-cure merchants advertising on telegraph poles for “laser therapy quitting” happily make up to A$500 from the more gullible.
With 12.8% of Australians aged 14 and over smoking daily, and 90% of these regretting they ever started, today just 1.28% are contented smokers. Recent evidence shows 55% of young smokers now approve of plain packaging with their ghoulish, unavoidable picture warnings. Can there be any product that enjoys less consumer satisfaction and customer loyalty?
One of the most common taunts pro-smokers hurl at tobacco control advocates with great relish is the claim they are enemies of pleasure: they just can’t stand the thought or sight of people taking pleasure from smoking. Perhaps they are right. Airport smoking rooms strike me as about the most fun and pleasure you could get. The queues of non-smokers you see waiting to get in just to experience it all pretty much clinch that argument.
The picture being painted here is of elegant smokers, hand gesturing and exhaling as in Richard Klein’s Cigarettes are sublime constantly pleasuring themselves in a way denied to non-smokers who have not woken up to the joys of nicotine.
But what is it that nicotine addicts like about pulling the chemical deep into their lungs some 90,000 times a year?
In 1994, the New York Times published the ratings of two of the USA’s most renowned addiction specialists, Neil Benowitz and Jack Henningfield, on the relative addictiveness of nicotine, caffeine, heroin, cocaine, alcohol and marijuana (cannabis). They rated each of these on a scale of one (most serious) to six (least serious).
Both rated nicotine higher in dependence than all the other drugs. By “dependence” they meant how difficult it is for the user to quit, the relapse rate, and the percentage of people who eventually become dependent.
Nicotine withdrawal also rated high (third behind the often discussed agonies of alcohol and heroin withdrawal). Both experts rated nicotine fourth behind cocaine, heroin and alcohol when it came to reinforcement (essentially, the pleasure given by the drug). But both rated nicotine last on intoxication, behind even caffeine.
Taking all this together, a picture emerges of nicotine dependent people regretful they started smoking, living in full knowledge of their high dependency, experiencing often unpleasant withdrawal symptoms when they have not been able to smoke for a while, and being relieved of this unpleasantness quickly when lighting up another cigarette.
Nicotine withdrawal symptoms include headache, nausea, constipation or diarrhoea, fatigue, drowsiness and insomnia, irritability, difficulty concentrating, anxiety, depressed mood, increased hunger and caloric intake and of course, constant tobacco cravings.
Smokers know from the earliest days of their addiction these feelings can disappear within a few seconds as the nicotine is rapidly transported from their lungs to their brains where dopamine is released and experienced as pleasurable.
Smokers often insist the pleasure from this release can somehow be experienced independently of the pleasures of the nicotine withdrawal symptoms rapidly dissipating.
So what is the “pleasure” being experienced here? When you have a toothache and this is relieved by a strong analgesic, your mood can quickly elevate as the codeine begins to work.
The argument that smoking and inhaling nicotine is “pleasurable” is a bit like saying being beaten up every day is something you want to continue with, because hey, it feels so good when the beating stops for a while.
Holiday periods like the upcoming Christmas break are time-honoured opportunities for smokers to make quit attempts. I used to smoke (in late school and to my mid 20s). I thought smoking was a great way to make a statement about myself that would impress those I cared to impress and irritate those I cared to irritate. But I always thought it tasted disgusting, was a stupid thing to continue and threatened to limit my early career opportunities.
I recall just drifting out of smoking, a pathway common to many ex-smokers. And like many smokers, I recall it being anything but difficult or torturous. This is one of the best kept secrets in tobacco control. While there are many smokers who struggle to quit and fail many times, there are many more who found the experience easier than they expected, sometimes far easier.
There are many more ex-smokers in Australia than smokers. The common narratives of quitting smoking ushering in the pleasures of tasting food and drink better, feeling physically better and of course the pleasure of having more disposable income can be compared with the supposed pleasures of smoking. Good luck if you are planning to quit. It’s the single most important thing you can do to improve your health.
Authors: Simon Chapman, Emeritus Professor in Public Health, University of Sydney