Addicted to "Getting Normal"

"Who is likely to take up smoking at a time when its risks have been publicized as never before?" 

By Kathleen Cushman
Where tobacco is concerned, I seem to meet only two sorts of people these days: the self-righteous and the surly. People once smoked everywhere—casually, undefensively, invisibly—but smoking is now, in my circles at least, a public and provocative act, loaded with overtones. What a shame. For whether one sees smoking as sexy or merely macho, daring or stupidly risky, individualistic or compulsive, "this nothing activity, so slight it's hardly there" holds in it the seeds of a rich conversation that could change the way we think about addiction and human behavior.

In this complicated political and social climate, David Krogh's clearheaded exploration of who smokes and why comes as a relief and a stimulus (exactly the qualities, by the way, for which people turn to nicotine). Smoking: The Artificial Passion manages to lay out the current research on smoking without a trace of the condescension that infuriates the 50 million smokers who make up roughly a quarter of American adults. In fact, so intelligent, witty, and compassionate is his description of the nicotine addiction that I was still asking myself at book's end if Krogh, an editor and science writer who works for the University of California, might once himself have smoked.

I wouldn't be surprised, because—for reasons Krogh methodically explores—a lot of writers do smoke. One of the most appealing qualities of this substance—an acrid weed, after all, whose taste and harshness tobacco companies spend millions to disguise—is that it appears to enhance one's ability to concentrate and to process information over a prolonged period. Among those who sit at a typewriter hour after hour—as among factory workers and truck drivers and data processors—nicotine actually seems to improve job performance, returning them to normal from states as various as boredom, depression, anxiety, and stress. These positive effects are compounded by the physical routines of smoking—the tiny habitual acts of lighting up, dragging, stubbing out the butt—which substitute for distracting activities toward which the worker might otherwise wander. Unlike any other psychoactive drug except caffeine, tobacco commands a powerful and positive position in the workplace. But unlike caffeine (probably the world's most popular drug), nicotine is wildly addictive.

Moreover, as everybody knows by now, smoking kills you. David Krogh does not grind this point home with images of blackened lungs and weakened hearts; he merely reminds us that more Americans die daily from the effects of smoking than from any other drug, accident, or crime. His principal purpose, however, is to explore why people use nicotine—and from there he turns to the more encompassing and fascinating question of drug addiction itself. The urge to use tobacco, Krogh argues, is equal to the strongest of other substance addictions, partly because of the overwhelming number of behaviors smokers associate it with, and partly for complex neurobiological reasons that may link all drug addictions in the pleasurable effects they produce. In the end this book is as much about the ways psychology and biology combine to form addiction as it is about the particular "enslaving weed" itself.

People use "workplace drugs" like tobacco, Valium, and caffeine, Krogh says, not so much to induce an exotic sensation as to deal with the stresses and strains that make us less ourselves—not to get high, that is, but to "get normal." What is particularly startling about nicotine is its ability to moderate states of mind and body on both ends of the scale: it relaxes you if you're tense, mildly stimulates you if you're below par. Cigarettes are useful in other ways, too: they can signal erotic availability, hostility, or any number of other states one might want to advertise. Smoking keeps one's weight down, partly by increasing metabolic activity; smokers weigh about seven pounds less, on average, than nonsmokers. And it feels good, once you get used to it—not only the nicotine's physical effects but the sensual suck at the lips, the pleasurable scratch in the airways, the satisfying feel of something held in the fingers, "doing nothing while still doing something," as Krogh puts it. Who wouldn't get attached to such a drug, cheap and legal as it is? Who wouldn't mourn it like a lost love when the time comes to quit?

Krogh answers these questions by sorting through the studies of who smokes, when they start, and what happens when they try to stop. Although smoking is steadily on the decline in the United States (from 40 percent of adults in 1964 to 27 percent today), it remains fairly constant across age groups and impervious to economic and emotional changes. Most smokers start in adolescence or young adulthood, work up to a tolerance level of about a pack a day, and hold that pattern for years or even a lifetime. Seventy-five percent of quitters relapse within a year, the same rate as for heroin addicts and alcoholics. The figures hold so steady, Krogh reminds us, because nicotine creates a physical dependence; smokers who cut down on the number of cigarettes with compensate by increasing the number of drags they take on each. (Many smokers of "low-tar, low-nicotine" cigarettes habitually block the air holes in the filters, intensifying the nicotine they get to the point that they might as well be smoking Camels.) Withdrawal symptoms are intense and immediate, and even when the hardest first few days are over, the ex-smoker faces years of intermittent cravings to smoke. Obviously, the most effective line of attack against smoking in our society is to persuade people not to start.

Who is likely to take up smoking, then, at a time when its risks have been publicized as never before? Adolescent girls do in large numbers, egged on by sexy ads showing long-legged slim women smoking long, slim cigarettes. (Later they won't quit, Krogh points out, because they think they'll put on weight: this makes cigarettes a feminist issue.) Baseball players (and those who admire and imitate them) don't smoke so much as chew; Krogh speculates that the nicotine sharpens their visual reflexes, and toys with the notion that tobacco in baseball should perhaps be banned, as steroids are in football. Anyone who thrives on risk might be drawn to cigarettes: studies show that smokers are more impulsive, less likely to wear seat belts, more likely to believe that chance controls what happens to them. Schizophrenics and the clinically depressed are especially likely to be smokers—perhaps because they can so subtly and precisely regulate their moods with nicotine, Krogh suggests, making it a form of self-medication. Finally, smokers are likely to be extroverts; they need extra stimulus and sensation to feel good, and they don't mind the element of public display built into smoking. All these things may change swiftly, the author notes—extroverts don't thrive on social stigma—and, of course, they vary from person to person, from situation to situation. So far, Krogh concludes, to attempt a characteristic profile of a smoker is a futile exercise, and neither personality nor genes have yet been shown to determine whether or not one will start to smoke in the first place.

Once smoking becomes central to one's life, Krogh argues, it is more a compulsive behavior than a disease. Substances like nicotine and alcohol are biologically addictive, he says, but "if drug addiction requires a kind of agreement between self and substance, then individuals bring at least as much to drugs as drugs bring to individuals." If this is true, then smoking and other addictive behaviors can be controlled—and here we realize that although Krogh is sympathetic to smokers and other addicts, he believes we have a responsibility to help them stop. But this is tricky, and politically sensitive. Alcoholism, for instance, is widely perceived as a disease to which certain people are especially susceptible, and narcotics in general are viewed as a kind of irreversible poison in whose thrall addicts are helpless. If heavy drinking, drug use, and smoking are simply ways that people choose to moderate the stresses in their lives, might we best fight their debilitating effects by addressing the stresses themselves: poverty, crime, the absence of competence or joy? Not in the case of tobacco, Krogh concludes; smokers does themselves only because life has come to seem dreary without nicotine. Tobacco teaches us that the primary weapon in any arsenal against addiction must be biological agents (from methadone to nicotine gum) to satisfy the craving. Behavioral factors can form the rear guard of the attack—not through coercive suppression, Krogh argues, but through education and in some cases the possibility of a better life. Our approach must be complex and subtle, because the enemy is nothing less than human desire.

The best thing about this book is its unpretentious, literate, and accessible style. David Krogh follows a scientific path into the subject of smoking, but he knows how to explain complicated biological and psychological concepts and experiments in engaging ways. Where studies conflict, he describes the problems clearly and weighs them with care. Krogh's scorn for the power politics of the tobacco lobby is a quiet undertone here, running beneath the scientific evidence he sets out and the human implications of those facts. He makes sensible critical suggestions—starting with more funding for research—for government action against nicotine and other addictive drugs. Most important, throughout this book he conveys both empathy for the adversity that the smoker faces and an unruffled conviction that something can be done about it. (Three fourths of all smokers say they want to stop, and an appendix to the book offers strategies for quitting.) Krogh's elegant unpacking of the smoking habit returns the subject to a plane on which the surly and the self-righteous may actually enjoy each other again.

This article available online at:

http://www.theatlantic.com/magazine/archive/1991/10/addicted-to-getting-normal/376344/