Commentary: Why Do Smokers Still Smoke?

This October marks the centennial anniversary of America’s “public health enemy number one”: cigarettes. One-hundred years ago, R.J. Reynolds introduced the first modern cigarette, marking the beginning of a new social, economic and health climate in the United States. As smoking evolved from a fashionable accessory to what we now understand as deadly addiction, at least 43 million Americans still smoke, despite its negative health, social and economic impact.

So why do smokers still smoke?

As the science around smoking continues to grow, we know that there is no silver bullet to quitting. Those of us who have struggled to quit ourselves or who have worked with smokers can tell you that it’s a complex and powerful addiction – from a behavioral, physical and mental perspective. The nicotine in cigarettes changes the chemistry of a smoker’s brain, creating physical dependence. Coupled with the behavioral and social aspects of smoking, it can seem next to impossible for a smoker to quit.

A recent commentary in The New York Times offered a theory as to “Why Smokers Still Smoke.” The authors – two researchers – conducted experiments revolving around a card game to determine how smokers and nonsmokers respond to risk-taking. In a modified version of the “Iowa gambling task,” the researchers asked smokers and nonsmokers to choose the most attractive financial scenario between two options. They found that smokers were more likely than nonsmokers to choose the option that brought short-term financial success, despite the fact that the same option brought long-term financial disaster. Through this data, researchers surmised that smokers are less likely to delay satisfaction and less likely to focus on long-term benefit. Or simply – smokers had less self-control than nonsmokers.

In the commentary, the two researchers themselves say their findings are “admittedly nuanced.” And that “it is not risk taking per se that drives smokers’ risky behavior; it’s a weakness for activities that are profitable most of the time yet hazardous eventually.” They offer that if it is indeed true that smokers have less self-control – that knowledge can then be used to tailor strategies to discourage smoking and help smokers quit.

While the study might have been well-intended, I must raise a cautionary flag. The study was small – just 100 people, both smokers and nonsmokers. If this sounds like hair-splitting, it’s not. Rather, my bigger issue with studies of this nature is that a limited finding can often lead to a wider misperception. Smokers in this country are ostracized enough; as a former smoker who struggled to quit for 25 years – I know firsthand. Weak-willed, selfish, unhealthy, irresponsible – I’ve heard these descriptions and they’re still widely used today to label smokers.

Labeling does not help, nor does oversimplifying a problem that continues to plague more than 43 million Americans today.

While I doubt my two fellow researchers intended to add another label to the vernacular describing smokers, articles of this kind are often boiled down or dissected and the larger points or meanings are lost. Having poor self-control is another new label that could potentially be attached to smokers. I sincerely hope that is not the case. Could it be, that once addicted, smokers reframe their life expectancy and therefore act rationally in valuing the short term over the far less certain “long term” which they believe they may not live to see?

Cheryl G. Healton, DrPH
President and CEO

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    Ben House

    October 21, 2013 at 11:58 PM

    The conclusion that the test subjects did not delay gratification, that they lacked a sense of future in their planning does not in itself lead to conclusions of will power. A sense of fore-shortened future is found in other populations, notably trauma survivors. Others do not see themselves as getting old or do not want to live that long so smoking and other risk taking are not calculated with the same weight as those who do plan on growing old.
    I see bad science drawing a weak will power conclusion from a data that only supports short sightedness. I believe some risk takers would assert they have very strong will power and that it was the researchers that were short sighted.

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    Elaine Keller

    October 18, 2013 at 1:12 PM

    Several million of us who used to smoke were finally able to stop destroying our lungs, CV systems, and cells when we switched to an electronic cigarette. For me it has been over 4-1/2 years smoke free. E-cigarettes provide the nicotine that smokers want without exposing them to the harmful tar, CO, particulates, and thousands of chemicals found in smoke that are the cause of smoking-related diseases.

    It boggles my mind that the tobacco control world is coming out so strongly in opposition to a product that is 99% less hazardous than continued smoking. This is not a new idea. But until now, there was no product that could provide smokers with both low-risk nicotine delivery and a substitute for the visual and kinesthetic effects of smoking. As for why we continued to crave nicotine…

    “It appears increasingly probable that some smokers may experience very long-term, perhaps lifelong, disruption of brain function, mood and/or cognitive ability following smoking cessation. Such individuals may require similarly long-term treatment support or nicotine maintenance, and this may account for the sustained use of nicotine medications by some ex-smokers, many of whom report that their use is to enable them to maintain [smoking] abstinence.” Royal College of Physicians, Harm Reduction in Nicotine Addiction: Helping People Who Can’t Quit.

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    steve castleman

    October 16, 2013 at 11:18 AM

    Evidence shows that drug addiction causes the orbitofrontal cortex, the locus of self-control, to wither and weaken. Thus, the emotional need for relief from craving for an addictive drug can overcome the rational exercise of a weakened self-control system. It’s true that addicts lack willpower, but that’s the result of addiction, not necessarily it’s cause.

    steve castleman

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