Cigarettes Are Not Addictive

About the time I was born, over half a century ago, there must have been a very hushed meeting, perhaps in Washington D.C. Prohibition had been a miserable failure, and there was probably a committee somewhere that had been forced to accept the fact that there would be untold numbers of American citizens falling to the evils of drink.

They had given up, these architects of a country free of alcohol--but it's too bad they weren't successful. For tens of thousands of years, humans did just fine without alcohol. On the other hand, we do not elect officials to tell us how to manage our personal lives.

Even though they gave up on the idea of eliminating alcohol, they could see a new danger on the horizon. Marijuana was a weed that grew with the enthusiasm of crabgrass, and, unlike the specialized refining necessary for alcohol, marijuana needed only to be picked and dried. There weren't the hybrid varieties of today, so in those times, one "reefer" had only the effect of a glass or two of wine. Nonetheless, this committee could see the potential of great problems if this weed was allowed to proliferate.

This committee, the names of whom have been lost in time, decided to take action--to nip this problem in the bud.

So they went to Hollywood and had a short film produced with the title, Reefer Madness. The film portrayed the reefer (marijuana) as an evil weed that will rob you of your sanity. It was even suggested in this film that the nicest person turned into a depraved sex fiend under the influence of this noxious substance.

These self-styled behavioral scientists felt that if they scared the hell out of the youth of America with the evils of the reefer, no one could ever consider risking their sanity or their very lives on such a temporary thrill.

Well, it didn't work!

The film was shown to millions of teenagers in the military and in colleges in the 40s and 50s, and the few who had tried marijuana knew it was an exaggeration. Even the majority that had no reefer experience got the word that the film was nothing more than a scare tactic, and they resented the attempt. After all, who likes to be lied to, regardless of the reason?

As a college student in the 50s and 60s, in some of my human behavior classes, we discussed the "necessary lie" concept and how, not only was it ineffective, it tended to backfire. We thought a technique like the Reefer Madness film would never be attempted again. What we didn't understand, however, was that every few years, the country gets a new crop of government officials who seldom learn from their predecessors' mistakes, and, in fact, tend to make the same mistakes all over again.

CIGARETTES ARE GOOD FOR ECONOMY
In 1964 the Surgeon General decided to make a strong statement against cigarette smoking. He said cigarettes cause cancer and emphysema. He said everyone who smoked should quit before it was too late.

It sounds like a reasonable position for any physician who has a mandate to protect the health for all Americans, but actually it was quite a risky position for this physician-turned-politician for the following reasons: Even in 1964 cigarettes brought in billions of dollars in taxes. It was one of the few easy to collect taxes, and one that few complained about paying.

The export of cigarettes, even in 1964, was critical for the balance of trade.Cigarette smokers were sick more than non-smokers, partially supporting the huge medical economy. Even in 1964 it was known that most cigarette smokers tended to die in their mid-60s, and this meant they didn't have years to draw from the already ailing social security fund--and this saved more billions. If you factor in the billions of advertising dollars, you will get an idea of the dependency the U.S. economy has on the tobacco industry. In fact, it was so important that tobacco farmers were given very special subsidies. These subsidies were not for the tobacco crop per se--they would not have given the same consideration for corn, wheat, or spinach.

Tobacco for cigarettes was needed to raise tax money and stimulate the economy in the ways I mentioned.

So, as Oliver Hardy said to Stan Laurel, "Here's another fine mess you got us into!" I don't envy the politician. It must be tough attempting to balance the good of the society against the good of the individual.

LOOKING FOR THE BIG BUCKS
Then, to complicate things even more, in 1965 the pharmaceutical companies got into the act. The upper management of these companies, with the mentality of the chemist, decided that there was a gold mine in this tobacco thing. Smokers must smoke cigarettes because the cigarette has some kind of chemical hold over them. They imagined the millions to be made if they found the "chemical villain" and then its antidote!

The drug companies funded some of this search, and even the government (probably with mixed emotions) got into the act with grants. Even at the onset, it was hard for any biochemist with laboratory experience to believe that a highly poisonous and volatile alkaloid like nicotine would create any desirable effects. They nonetheless, searched in earnest.

In some experiments they tagged nicotine with an isotope so its progress could be followed through the body. They were disappointed to find that nicotine was excreted or isolated rapidly--exactly the same as with any toxic substance.

The scientists found no process within the body that used nicotine in a manner similar manner to, for example, heroin or caffeine. The heroin molecule forms a "key" that by accident fits the same "lock" as does endorphins. Endorphins cause a kind of high in which the body tends to ignore pain. Another example is caffeine, which gets into a biochemical "loop" and creates a stimulating effect.

The drug companies, sensing that huge profits were slipping from their grasp, frantically poked and prodded through the molecular structure of every part of the cigarette. Nothing that even resembled an addictive process could be found; and that holds true to this day.One company, in a kind of "feeding frenzy," even started marketing nicotinic acid as an antidote to nicotine. Nicotinic acid is niacin, a B vitamin, and has no relationship to nicotine other than the sound-alike name. The Federal Drug Administration quietly asked them to stop doing that under the truth-in-advertising regulations.

In the early 1980s, another company started selling the now-familiar nicotine gum. Imagine getting the consumer to fall for the idea of curing a phantom addiction by feeding the "addicted" person the same chemical! Can you imagine giving an alcoholic more alcohol to cure him? Would you consider more heroin for the heroin addict? The fact that physicians fell for this illogical concept represents the strong desire for a prescription they can write that will rescue their patients from a terrible health risk.

THERE THEY GO AGAIN!
In the 1980s under the Reagan administration, the Surgeon General was Dr. C. Everett Koop. Dr Koop was overweight and enjoyed a high fat diet. Even though the high fat diet kills more than three times as many people, Dr Koop decided to go after the cigarette industry. Dr. Koop's position, by the way, did not thrill many of President Reagan's advisors.

The first obstacle that was thrown in Dr. Koop's path was to deny him funding for his crusade. He was told that cigarette smoking was a habit, and there could be no funding for a habit. All the funds, he was told, were for addictions such as cocaine, marijuana, heroin, and the other illegal drugs.

Do you remember Dr. Koop's next move? That's when he came up with the statement "Cigarettes are more addictive than heroin."--the necessary lie concept revisited!

He and his advisors apparently believed that the end justified the means. Dr. Koop, as a surgeon, should have been especially conscious of the damage that could be done if a misdiagnosis was popularized. He should have remembered that the history of medicine is filled with tragedies caused by erroneous diagnoses.

WILL HYPNOTISM HELP?
In the 1940s I was drawn to an ad in my father's Outdoor Life magazine. "You can learn to hypnotize," it promised. I was intrigued. I wandered up and down the road that passed by our Oregon farm until I had collected $2 worth of soda bottles. A month later, I found a small book in the mailbox wrapped in a "plain brown wrapper" with the secrets of hypnosis. I read it over and over again. I practiced on any friend who would hold still long enough and developed some skill in what was then called parlor room hypnosis.

Twenty years later, leaving a career in forestry, I found my interest in hypnosis helped me write interesting term papers in my psychology and sociology courses. One of my professors, noting that I could hypnotize, asked me to assist him in a project which led to the submission of a paper in a professional journal about hypnotism.

This was about the time the original Surgeon General's report came out about the dangers of cigarette smoking. A few years pervious, the American Medical Association had given hypnotism a boost by accepting it as a useful tool for psychiatrists. This motivated some physicians to publish their findings about the use of hypnosis in their practice. A couple of well-known psychiatrists wrote with enthusiasm about the potential of using hypnosis for smoking elimination.

The stage was set. What a great way for a starving college student to earn some extra money! I posted some 3x5 cards on bulletin boards: "Quit Smoking With Hypnosis! Call 789-1234" ...and my phone rang off the hook! My method was simple; I would hypnotize my clients, tell them that cigarettes were "out of the question."

It didn't work! So, next I told them that nicotine was a poison and if they continued to smoke they would get sick." That didn't work, either.

FIND OUT WHAT WORKS, AND DO IT
With sagging confidence, I discussed my failures with my mentor, the professor I mentioned earlier. "Are they getting hypnotized?" he asked. I was sure they were. "Then your problem must have to do with the suggestions you're giving," he counseled. He then gave me some advice that changed my life. "Talk to as many people as you can find who are successful and look for patterns. Then, talk to those who have failed, and again look for patterns." So, I kept two notebooks: one with "successful" notes and one with "failure" notes. At first, it seemed like a waste of time, but at last, some patterns started to emerge.

I learned about defense mechanisms that smokers use. I learned about the kind of commitment that smokers make, as they become nonsmokers. I learned of problems with obsessive thoughts. I learned that cigarettes had an interesting kind of value and for this, I coined the term assigned value. I learned that, if resisted, a strongly associated pattern could cause acute anxiety. I learned a lot of things about the architecture of the brain.

Now, 25 years later, I have revised and expanded my cigarette smoking program a dozen times.

COLLEGE EDUCATED SMOKING PROGRAMS
Nothing I learned in my private quest to help people quit smoking clashed with what I learned in my college classes. Another one of my favorite professors had been an engineering student before switching to physiology. He carried into his biochemistry classes quite a few engineering terms. One of his favorites was servomechanisms.

"In a machine with moving parts," he told us, "all moving parts influence and support the other in a kind of continuous loop, and this is called a servomechanism, and the human body works the same."

He would give us example after example; from the cyclic interaction of the heart/lung partnership; the digestive system, blood chemistry, and muscle function loop; or, the fascinating function called the Krebs cycle in which first, a glucose molecule and then a lipid/oxygen molecule is consumed in dual chemical loops, each releasing a spark of energy.

"The microscopic molecular loops," he told us "dovetail with the larger and larger loops until you end up with a functioning human machine."

ADDICTIONS AND SERVOMECHANISMS
When it came time to talk about addiction, he made his familiar series of semi-circles with an arrow pointing in the same direction, building into a blackboard-sized circle."If you have a chemical process that somehow feels good, or energizes a system, and that process is catalyzed (kick started) by a hormone, and then you introduce a molecule from the outside that just by chance has the shape to fit the same "lock" as does the endogenous (natural) hormone, you have the potential of a dangerous unbalancing of the servo-mechanistic process."

He went on to explain that the body fights to maintain its natural chemical balance--called homeostasis-by producing less of the natural hormone. Imagine what happens if the introduced (artificial) chemical is suddenly stopped. Since the balance is once again upset, a toxic condition called "withdrawal" is produced.

Sometimes a condition called "tolerance" also develops. This refers to the condition in which more and more of the externally introduced chemical is needed to cause the same effect.

So, if an underdose/overdose cycle is repeated again and again, you can end up with a real biological mess.

IS APPLE PIE ADDICTIVE?
As he was explaining all this to us, I remember one student asked if it was possible to get addicted to the apple pie that he loved so much.

"Don't get confused," or professor cautioned us, "by things that you associate with pleasure, such as taste, smell, mom's nurturing, and reward."

WHAT ABOUT HABITS?
He suggested we review Ivan Pavlov's experiments in which lab animals were conditioned to associate and respond to such unrelated things as food and the ringing of a bell.

"Addiction," he said, "has nothing to do with learning. Addiction operates on an electrochemical level. Habits and association are formed, showing a bell-shaped learning curve. Addictions, on the other hand, show no such learning curve, but are dose related."

Later, in our behavioral science labs, we discovered firsthand that you could condition humans, or any animal with a cerebellum, to respond to any signal with any association that had a component of either pain or pleasure.

So those of us who stayed awake in class ended up with a clear understanding of the difference between the biochemical process of addictions and the associated and ritualized learning process of the habit.

I've always been amazed at the political and special interest process that has created so much confusion about addiction versus habituation in the 1990s-when the facts were so logically and correctly delineated in the 1950s!

THIS WORD "ADDICTION"
The World Health Organization, in the mid-sixties, decided that the line between chemical and psychological needs were not well enough understood to continue using some current definitions.

When it was decided to downplay the concept of a physical relationship to certain drugs within the body's biochemistry, it caused a lot of confusion. Once the idea of a physical and psychological mix was added to the concept of addiction, it almost turned into a non-word. The terms habituation, obsession, and compulsion started to lose specific meaning as well. On the surface, that might sound okay, but clear and distinct meanings of terms are essential for an accurate diagnosis.

Also, just as important, the public tends to hang on to the older meanings of words for at least a generation.

Since that time there have been many breakthroughs in the understanding of the action of some chemicals on the nervous system. Opiates, for example have been found to be a molecular cousin to the endorphins that cause a natural high. Opiates (such as heroin) are not intrinsically evil; they are simply a biological probability. Think of them as a key that coincidentally just happens to fit someone else's lock.

DEFINITION OF TERMS

ADDICTION: Most people, when they hear the word, "addiction," think of a chemical that the body will quickly learn to "like" and "need." The "person on the street" thinks of an addict as someone who is out of control with a chemical "need" or "want." It is thought that if the chemical is stopped, the addict will experience physical pain and mental anguish.

Since the general public thinks of the meaning of "addiction" this way, then a psychotherapist must respond to this general understanding. Otherwise, the term "addiction" actually becomes damaging to the psycho- therapeutic process.

We actually need a term like "addiction" as defined above, for chemicals such as heroin, morphine, cocaine, Valium, and even caffeine. Without this denotation of the term, it's difficult to explain the difference between, for example, the use of alcohol, opiates, and cigarettes.

HABITUATION: To most people, the word habit has a much "fluffier" meaning than the word "addiction." Often, when you hear the word "habit," it is preceded by words such as "only" or "just"…"It's just a habit" or "It's only a habit."

In neurological terms, however, habits are among the most powerful of human behaviors. They are programmed (through repetition and association) into a part of the brain called the cerebellum until becoming almost as automatic as breathing.

The cerebellum operates below the cerebral part of the brain, so habits need not be part of a conscious thought. You can thing about a habit, and thinking can trigger a habit, but thinking is not necessary for a habit to function.

Pushing on the brake pedal to slow or stop your car is an example of a life-or-death kind of habit. Imagine that you were forced to drive a car with a hand brake rather than a foot brake. You would find driving extremely irritating. After just a couple of minutes of driving, you would notice very definite feelings of nervousness. If you continued, however, in a surprisingly short time, a new habit response would form, and you would be comfortable with the use of a hand brake.

In any good smoking cessation program, at least 20% of the instruction time must be spent on the function of habits and habituation. As soon as the smoker understands how habits are associated, formed, disassociated, and extinguished, he or she is much closer to becoming a non-smoker.

OBSESSION: Obsession means that you can't seem to stop thinking about something. Advertising people are skilled at inventing jingles that have an "endless tape" quality to the mind. As these clever rhyming messages play away in the brain, it produces the effect of hearing the same commercial over and over again.

Even in the most severe loss, the normal grieving period is from three weeks to three months. However, because of the human tendency to be obsessive, it is not unusual to extend this period into years, decades, or even a lifetime. In simple terms, when we are thinking obsessively, we are thinking in circles.

Obsessions play only a minor role in the routine of cigarette smoking, but play a major role in quitting process.

COMPULSION: When obsessive thoughts are acted out, you have a compulsion. Compulsive events are almost always over-reactions. For example, if you can think of nothing else but that half-gallon of ice cream in the freezer, and then finally give in to eat the whole thing, you have eaten compulsively.

This is one reason that when smokers quit and re-start multiple times, they generally smoke more--or at least, think more about smoking-then if they would have made no attempts. When smokers understand that there must be obsessive thoughts before a compulsive act can exist, they gain critical insight.

DAMAGING MISCONCEPTIONS
It's irritating for me to deal with the fact that most of those I treat for cigarette smoking elimination are under the delusion that they are addicted (in a chemical sense) to cigarettes.

The treatment for addiction is far different than the treatment for habituation. Many of the symptoms sensed from a neurological withdrawal of a powerfully associated habit pattern will, on the surface, seem the same as those of an addiction withdrawal. These symptoms are, nonetheless, different and, therefore, the treatment must also be different.

Because of this, almost 25% of The Weisbrod Cigarette Smoking Elimination Workbook needs to be devoted to undoing the misinformation that those we should have been able to trust foisted upon us.

ADDICTION IS A FOUR-LETTER WORD
As you might have guessed by now, "addiction" has fallen off my "favorite word" list forever. My old professor who defined the scientific meaning of addiction died years ago, but he must turn in his grave when he hears that some believe that are sugar addicts, jogging addicts, sex addicts, work addicts, stress addicts, travel addicts, exercise addicts, car addicts, thrill addicts, and even addiction addicts!

In fact, it's gotten to the point that we no longer have to take responsibility for excesses of any kind. Just blame it on addiction!

I even know of some psychologists and psychiatrists who have bought into this addiction mania. I sometimes wonder if they got their training from the National Inquirer.

And now, the overall effect is that even the newer psychological tests are defining addiction and habituation as synonymous. So what does it all mean? The word "addiction" is worse than useless.

My suggestion would be to consider the cause of pain or undesirable behavior at its root cause. That means that you might have to start on a physiological basis, and then link that understanding with basic knowledge of human behavior. Let me give you an idea or two.

First of all, we consciously motivate either to gain pleasure or to avoid pain. The cigarette smoker does not smoke, for example, because it tastes good or feels good, but because it is associated with other things that in some way feel good. If this pleasure association continues with the cigarette, the smoker will smoke feeling that smoking somehow increases pleasure. This happens in direct relationship to the development of an association with pleasure.

Those who have never smoked a cigarette can quickly verify with a first choking puff that there is no intrinsic pleasure in drawing cigarette smoke into the lungs. The smoker, however, learns to develop the illusion that causes an artificial pleasure sensation.

BUT WHY IS IT SO HARD TO QUIT?
Quitting smoking is difficult because, when the pleasure-associated ritual is resisted, a painful stress reaction occurs. And guess what the immediate relief for that pain is? You guessed it--another cigarette. My old professor might have called it a conditioned servomechanism.

Understanding the process, however, gives the smoker the power to intervene and distract himself or herself just long enough for the urge to dissipate. As Dr. Pavlov discovered 70 years ago, if an urge is ignored just a few times, it will start to disappear. Unrecognized urges, however, cannot be ignored and therefore won't dissipate. Worse, unrecognized urges that are resisted become obsessions.

So, herein lies the only effective approach to therapy for cigarette smoking. The best method of eliminating the cigarette smoking behavior is to teach the smoker about the function of conditioned responses, help them recognize the blocks, and enable them to diagnose and cope with their own stress reaction symptoms. If done correctly, the major discomfort will be over in three days. If knowledge is lacking, if the smoker thinks that he or she is addicted, obsession can layer on top of obsessions until the compulsion to smoke "just that one cigarette" becomes unbearable.

About 20% of the smoking population seems to understand what I've been talking about on almost an instinctual level. Without any outside help, they become non-smokers with little difficulty. The rest (80%) need training to become non-smokers. I talk about the "spontaneous remission" effect frequently in my workbook until the smoker loses the idea that there are some with more will power, or who are less addicted, and exchange that idea with the knowledge that it's simply a matter of doing it right!

TO BECOME A NON-SMOKER
The only way to become a non-smoker is to understand exactly what cigarette smoking behavior is and what it is not. Once the mechanics of cigarette smoking behavior is understood, a smoker can follow the formula all smokers use to become non-smokers, whether they get it from me or find it on their own.

Good luck!
Carl Weisbrod, PhD
December 1990