Monday, June 8, 2009

Chippers, Smokers, & The Tipping Point

Last night I finished reading The Tipping Point by Malcolm Gladwell. I am not going to do a full review of the book, but I will say this - very interesting read, hard to put down, a fascinating look at the social psychological aspects of epidemics and trends. I loved it.

Unfortunately, I have already returned the book to the library so my discussion of the content is going to be without specific names, references, and page numbers. I apologize in advance for the inconvenience - I just didn't think about it. 

Smoking, and teen smoking in particular, is the main topic of the last chapter of the book. The main question posed by Gladwell (and many, many others) is this: Why, in the face of years and years of anti-smoking campaigns, higher-priced cigarettes, falling adult smoking rates, and tons of new health information about the negative effects of smoking has the teen smoking rate been increasing in ridiculous amounts?

***Disclaimer - this book was published in 2000, and I feel like teen smoking has declined since then (I could be wrong), but I still think this is a very interesting discussion.***

In an informal survey with a large but unrepresentative sample, Gladwell found a common theme among the responses given when people were asked about their first experience with smoking. He sums it up in a single word: sophistication. The respondents had come into contact with a person they saw as grown-up, mature, rebellious, independent - the very characteristics that most teenagers strive to exhibit. This person was a smoker. In some cases it was a parent. But it also could have been an exchange student, an older or admired peer, a person they had a crush on, etc. It doesn't really matter who. 

And Gladwell makes a very striking statement in response to this:

"It's not that smoking is cool. It's that smokers are cool."

The psychologist Hans Eysenck discovered what he calls "the smoker's personality type." Smokers tend to be very social, always in need of someone to talk to, rebellious, risk-taking, sensation-seeking, have a lot of friends, more honest with and about themselves, and in general care very little about what other people think of them. 

Think about those descriptors and then compare it in your mind with the average teen. Those are the characteristics they WANT to have if they don't have them already. In modeling themselves after an influential person in their life who has that personality, taking up smoking is a byproduct - much like choosing to dress like that person. 

I can personally attest to the truth behind this idea. The people in my life who were most like the kind of person I wanted to be as a teen - in short, badasses - were always smokers. My outgoing, outspoken, devil-may-care sarcastic mom, the girls at school that nobody fucked with, etc. The first time I smoked a cigarette I stole one from my mom's pack - it was a Misty Ultra-Light 100 menthol. Yuck. But I smoked it by myself to see what it was like. There was no peer pressure. I knew it was really bad for me (in fact, it turns out that most smokers overestimate the harm it causes, not underestimate), but none of that mattered. I got an awesome head rush even though it tasted gross. I liked the feel of smoking. I felt more grown up and definitely cooler, even though there was no one around to validate that feeling. 

Evidence suggests that whether or not you experience a head rush the first time you try a cigarette can predict whether or not you will take up the habit. A similar line of evidence suggests that there is a genetic predisposition for your body's ability to handle and process nicotine - if your body is good at it, you'll get a head rush. If it isn't, you'll just think it's gross. 

This is fascinating if you think about it, because it suggests that family lines of smokers has much more to do with genetics than with social modeling - without the genetics model, it is puzzling to realize that children of non-smokers are just as likely to smoke as children of parents who smoke and vice versa. My sister and I grew up in the same environment full of smokers - parents, grandparents, cousins, everyone. I became a smoker at age 12. My sister doesn't smoke and never has. She finds it disgusting. 

Now when a teen starts smoking, they are never regular, hardcore smokers. They are what has been termed "chippers" - people who smoke fewer than 5 cigarettes a day on average of about 4 days per week. There are a lot of adults in the world who never go beyond being a chipper. They often label themselves social smokers and are not by any means nicotine addicts. This brings about a new question: why do some people remain chippers and others move into the realm of addiction?

The foremost researcher on smoking (whose name I can't remember, dammit), estimates that the "tipping point" of nicotine addiction is a daily intake of (I think, could get the numbers wrong but it's irrelevant for the point) 5-6mg, which I think equals about 10 cigarettes per day. If you never cross that threshold, you will never become addicted to nicotine. You will remain a chipper. 

A couple of scientists (again, sorry) took this information and wrote an article suggesting that the tobacco companies be forced to lower the amount of nicotine in cigarettes to make it nearly impossible to intake the threshold amount in a given day, thereby reducing the likelihood that a person would become addicted. Gladwell thinks this is a good idea. 

I think it's a good idea, sort of. The reason I have reservations about this is because the existing smokers would be screwed. The actual health problem of smoking has nothing at all to do with nicotine (the patch doesn't give you cancer). It is about the shit that you are taking into your lungs in order to GET that nicotine. If cigarettes suddenly didn't contain enough nicotine to sustain your addiction, you'd just smoke more and more and more to try to get that "hit" you need. We'd be putting even more shit into our lungs to get the same amount of the drug. And you can't come up with a "hardened smoker" brand of cigarettes, because then teens will just want those instead. But I digress. 

We have talked about the social factors that get teens to try smoking, the genetic factors that likely separate the continuing smokers from the experimenters, and the tipping point of developing a nicotine addiction. But what might separate the chippers from the chain-smokers? Why do chippers never feel the need to smoke more than 5 cigarettes per day?

The answer, research suggests, is mental illness. There is a significant correlation between smoking and depression. Alcoholics smoke at a rate something like 13 times the national rate. 90% of schizophrenics smoke. Nicotine is believed to act on dopamine and norepinephrine in the pre-frontal cortex, associated with pleasure. When the antidepressant bupropion (wellbutrin) was being tested, there were tons of reports coming in from patients saying "I no longer feel the need to smoke," or "I just don't like the taste of cigarettes anymore."

I can say from personal experience that wellbutrin does, in fact, have this effect. It's very logical - cigarettes are gross. They don't taste good. Just like how almost no one would drink if alchohol didn't provide desirable effects, if suddenly your cigarettes aren't doing anything for you, you're not going to want to smoke them anymore. It is believed that wellbutrin mimics the neurotransmitter effects of nicotine, that the increase in dopamine relieves the desire to smoke and the increase in norepinephrine reduces the withdrawal symptoms. 

It is probably a safe hypothesis to suggest that maybe those of us who become true smokers have a deficit in dopamine and norepinephrine in our brains that may or may not also result in depression. The chippers, on the other hand, probably have closer-to-normal levels and therefore simply enjoy the occasional increase. (This is just me talking now, this wasn't in the book.) When you combine this with the genetic component dealing with nicotine tolerance and processing as well as the social aspects, you can get a pretty clear picture of how a smoker becomes addicted and why others don't even smoke at all. 

I find all of this incredibly fascinating, particularly because nicotine doesn't have a conscious "high" associated with it, unlike all other drugs. I don't feel "good" when I smoke - I feel normal. When I am otherwise occupied with activities I find pleasurable, I don't feel the need to smoke. Yes, there is definitely a classically conditioned habit addiction in this for me as well - driving, for example, invokes a need to smoke. I used to believe that there was also an oral fixation thing going on, because I can distract myself from wanting to smoke by eating, which made sense given the typical weight gain that people experience when they quit. But now I'm thinking of it differently - eating is also a pleasurable activity, which is why there are food addictions. So maybe the reason eating tends to be a natural substitute is the neurotransmitter effects. Because if it was just an oral fixation, then drinking beverages and chewing gum would also work, but they don't. 

In a couple of weeks I will be seeing my doctor about quitting smoking and asking for an rx for wellbutrin because it has worked for me before. Now that I have a much better understanding about what is going on, I think I have a much better chance of successfully quitting. This topic and the new information that came along with it has given me a lot to think about. Expect me to post on this subject again sometime in the future. 


Comrade Physioprof said...

When I was in college, I could easily smoke a pack of cigarettes during a night of serious partying, and then not have another cigarette for days. Today, I have absolutely no desire to smoke, except when I am drinking alcohol. When I am drinking, I enjoy having a cigarette or two, but that it is.

scicurious said...

Very interesting ideas. I agree with you, lowering the amount of nicotine in a cigarette just wouldn't work. I think I need to read this book...

DuWayne Brayton said...

I'll check that one out too...Damn you for continually throwing more reading material at me!!!

As for the idiotic notion of lowering the amount of nicotine in cigarettes - that's just idiotic. While I am not averse to having the option of smokes with less nicotine, making it the rule would merely get people to smoke more - or possibly create a market for nicotine additives...

I have to say that I am now hovering around 3-5 a day and plan on cutting off entirely by the end of summer. Gave up on the quitters blog though - there was interest, but said interest didn't translate to actual posting...So it goes...

Anonymous said...

Actually, Phillip Morris in its plot to support FDA regulation of Cigarettes AND preserve their #1 market share wants to do exactly that -- so that smokers need to smoke more to reach the thresh hold dosage.

The other group not publicly supporting but with lots of money in the background are the Pharma companies: GlaxoSmithKline -- who by the way, holds the patent on Wellbutrin and Nicorette products.

Personally, I prefer a statistical increase in the chance of lung cancer to possible suicidal thoughts, but that's just me.

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Michael Barker said...

I started smoking at 19 mostly due to the fact of "cock-tailing" the left over joint in cigarettes. I started much later than my friends, who started in their mid-teens. They tended to be heavy smokers whilst most of the people who started late tend to be "chippers.

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