Friday, December 13, 2013

Don't Blame the Cigarette Smokers

All too often anyone who smokes cigarettes is seen as endangering not only their own life, but those around them in the transmission of second and third-hand smoke. Small children fall prey to the dangers created by cigarette smoke and the cry is that smokers are a scourge on humanity. I don't believe they are and I do think we need to rethink where the fault lies, why people smoke and who are the groups that smoke heaviest.

No one is a natural born smoker. They have to be cajoled and teased and victimized by peer pressure and seductive ads that seem to promise status, attractiveness and maturity. Who smokes? Why, of course, it's an adult thing so kids want to be just like their adult role models and cigarettes become a part of the package.  And learning to smoke isn't easy. You have to learn to tolerate that burning sensation in your throat, the vomiting that can be brought on, dizziness and forget about the high cost of buying these little sticks.

I'm not going to go into why you shouldn't smoke. I just want to point out a few reasons that people (adults in particular) smoke in the first place. They may have started smoking in their teens, but what is the mechanism that keeps them sucking at cigarettes and, aside from the need to be part of your peer group, what other things could be acting on smokers?

Forget about the cigarette taxes that were supposed to curb smoking. Spending $7.50 or more for a pack just means you need to find the money, not stop smoking. Whether you have to ask others to give you cigarettes, steal them from someone or even buy tax-stamp-free packs of cigarettes, a smoker finds a way. The tax stamps, in fact, have created a highly lucrative underground economy that moves cigarettes all over the country and probably the world. The sellers include everyone from street toughs to elderly housewives trying to make a little money for their household expenses and medications.

I won't go into the current actions of cigarette companies against countries that have tried to limit smoking by their citizens, Namibia, for example has been targeted. If you'd like to read about that, go to the article in The New York Times.  You'll get the information on the industry that helps kill five million people a year worldwide.

Why do people smoke aside from what I've just mentioned with regard to role models and peer pressure? It's not difficult to explain because it's really straight forward and scare tactics (disturbing TV PSAs or graphic posters of diseased lungs) don't work well for one reason; smoking is biological.

What is one thing that you find among people in every country of the world, especially during times of economic difficulty, food insecurity or war? It's anxiety and stress and these are situations where smoking cigarettes can help because it is a natural anxiolytic (anti-anxiety substance). Natural is supposed to be good for you, isn't it? In this instance, it's anything but good, but it does help with the anxiety. How it does this is also simple.

Nicotine is a substance that the body has already readied itself to utilize and it has nicotinic receptors.  Just like medications have specific receptors to get the job done, nicotine receptors do, too.  Not only do they respond to nicotine, but they help us remember things, maintain focus and function. Wonderful stuff, but when the nicotine is introduced by cigarettes, other unnatural reactions begin. The smoker doesn't care because they are getting immediate relief and that keeps them smoking.

At any social function that permits it, look around and see who's smoking. They are usually the people who need to feed that craving for nicotine that develops and to tamp down the anxiety that comes when they don't.  In fact, nicotine withdrawal has been dubbed worse than withdrawing from heroin and we know how difficult it can be to kick the heroin habit.

Smokers, therefore, are victims of their habit and their anxiety and they deserve help in many ways and one of them is in learning how to handle anxiety while they wean off cigarettes. If the CBT component is missing, how effective can any smoking cessation be? Patches alone can't do it and neither can chewing gum. In fact, I've seen articles that indicate that the gum can actually keep the craving going and the person begins to chew more and more gum.

Fired Up: A shrink's musings