Matt Yglesias

By Request: Smoking

Matthew Struhar asks:

As a former smoker, what steps do you think the Obama administration could take to help people trying to overcome addiction? Other than raising VATs on tobacco products, are there any interesting proposals out there to deter smoking and/or help people quit?

I don’t have many interesting ideas here. The main policy levers in use — taxes and restrictions on places wherein you can smoke — work pretty well, though it’s important not to kick the taxes up to a level that’s so high that you get tons of black market activity. One neglected aspect of this, I think, is the prospects for more rigorous enforcement of laws against giving/selling cigarettes to kids. Most smokers start earlier than 18 and the earlier you start the more deadly it is. I’m enough of a libertarian to think that what adult smokers choose to do with their money and their health should be mostly up to them, but it’s really worth squeezing the vise to try to prevent the emergence of the next generation of tobacco addicts.

Beyond that, this is a very vague policy idea, but clearly one problem with our health care system is that there’s more money to be made treating lung cancer or emphysema than there is persuading people to quit smoking even though the social value of preventing smoking-related illness is much greater than the value of treating it.

Last, since Obama himself is a smoker who’s been struggling with efforts to quit, I’ll observe that I think it would be good if more people talked seriously about tobacco addiction. There’s a lot of individual variation to this, but I’ve got it really bad and I’m sure I’m not the only one. I was out at a bar in Geneva back in November and people were allowed to smoke inside and generally being all European. I bummed a cigarette — my first one in almost two years. From that point, it took maybe 36 hours for me to return to a full-blown self-destructive pack-a-day habit. When you watch The Wire and see Bubbles quit heroin and then relapse you understand that he’s not going to shoot up just once. For me, at least, it’s just the same with cigarettes. When I got back to the states and resolved to re-quit, I found out that it’s a lot easier to stop after six days of heavy smoking than after ten years. But it’s not that easy, and didn’t spare me days of being depressed and irritable.

The effort to avoid smoking is often portrayed as a kind of quest to battle temptation — like the struggle to not eat too much chocolate cake and get fat. And for some people maybe it’s like that. But for a lot of people, it’s not like that at all. It’s a very serious addiction like hard drugs that just happens to come in a form that’s (sort of) socially acceptable and non-incapacitating.

Smoke ‘Em if You Got ‘Em

Via Ezra Klein, a chart of what happens to your body if you stop smoking right now

The idea here is to convince you that the benefits of quitting aren’t all long-term, that stopping will also improve your life in the short run. It’s a nice thought, but I don’t think it’s very accurate. Of course, people’s experiences of smoking are different. But I worry that it may actually be counterproductive for some people to gloss over the fact that if you spend ten years smoking a pack or more a day (like me!) and then decide to stop, it’ll really really suck. For example, they say that after 24 hours “your sense of taste and smell will return to a normal level.” That’s nice. But, again, if you haven’t been at a “normal” level for years, it’s actually quite unpleasant. And the idea that at 72 hours your “overall energy level will rise” is a fantasy. I’m sure there’s some technical sense in which that may be true, but I spent over a month feeling pereptually drowsy, confused, and un-motivated. The health reason to quit smoking really is “so that you don’t get cancer and die.” But it’s not fun.

The one real short-term benefit that I think I could claim is that not smoking means less pathetic addict behavior. I know lots of people who smoke regularly, but not all that heavily, and who don’t actually egage in that much pathetic addict behavior. Quitting might in some ways be harder for those folks. But I was thinking about this today as I read Spencer Ackerman write “It’s funny how sometimes you have power over something even after you’ve spent a long time telling yourself your self-control was gone.”

Looking back, it’s remarkable to me how much power being an addict had over me. Making plans about when I was going to have a chance to smoke, or have a chance to buy more cigarettes. Almost missing a connecting flight in Chicago that I knew was going to be a close call because I couldn’t miss the chance to run outside and smoke one even though that meant I would need to go back through the security checkpoint. Standing outside, under an umbrella, in a hurricane, smoking and being very upset at the wind interfering with the process. You think of smoking as “not so bad” an addiction to have, because the substance itself isn’t as debilitating as heroin or whatever. But it’s still true that, to a remarkable degree, my whole life was being shaped around the fact that I knew I would need to either regularly dose myself with nicotene or else experience various degrees of intense discomfort. It used to be, for example, that I could barely sit through a long movie at a theater.