What a drag: A brief look at cigarette smoking and nicotine dependence
Cigarette smoking among adults (i.e., those aged 18 years and over) has been a highly prevalent behaviour in Great Britain for decades but overall rates have significantly declined in recent times. Figures show that the highest recorded level of nicotine smoking among British males was in 1948 when four-fifths smoked (82%) although at that time only two-thirds smoked manufactured cigarettes (as the rest smoked pipes and/or cigars). The highest recorded level of nicotine smoking among British females was in the mid-1960s (45%) slightly higher than the prevalence rate of 41% in 1948.
A 2003 study by Dr. M. Jarvis in the journal Addiction reported that since 2000 the overall adult smoking rates in Great Britain had been declining by around 0.4% per year. More recently, the British prevalence rates of smoking remained constant at 21% between 2007 and 2009 (according to a 2013 report by Action on Smoking and Health [ASH]). According to the 2013 Office for National Statistics report, the most recent prevalence rate is 20% (21% of men and 19% of women). This equates to around 10 million British adult cigarette smokers. Smoking prevalence rates are highest in young adults. More specifically, in the 20-24 year age group, the prevalence rate of nicotine smoking is 30% in males and 28% in females. Only 1% of children are nicotine smokers at the age of 11 years. By the age of 15 years, 11% of children are regular smokers. As the 2013 ASH report noted:
“Since the mid 1970s cigarette consumption has fallen among both men and women. The overall reported number of cigarettes smoked per male and female smoker has changed little since the mid 1980s, averaging 13 cigarettes per smoker per day. As in previous years, men smoked slightly more per day on average than women and there was an association between consumption and socio-economic group. In 2011, smokers in manual occupations smoked an average of 14 cigarettes a day compared with 11 a day for those in managerial or professional groups… In 2011, 63% of smokers said they would like to stop smoking altogether. Other ways of measuring dependence include how difficult people would find it to go for a whole day without smoking and how soon they smoke after waking… In 2011, 60% of smokers said they would find it hard to go for a whole day without smoking. Eighty-one per cent of heavier smokers (20 or more a day) said they would find it difficult, compared to 32% of those smoking fewer than 10 cigarettes per day”.
Like drug addictions more generally, nicotine addiction is a complex combination of influences including genetic, pharmacological, psychological, social and environmental factors. In 2010, the US Surgeon General asserted that “there is no established consensus on criteria for diagnosing nicotine addiction” but that there are a number of symptoms can be viewed as addiction indicators such as:
- Drug use that is highly controlled or compulsive with psychoactive effects
- Stereotypical patterns of use
- Continued use despite harmful effects
- Relapse following abstinence accompanied by recurrent cravings.
A 2000 report by the Royal College of Physicians also noted that nicotine fulfils criteria for defining an addiction and states that:
“It is reasonable to conclude that nicotine delivered through tobacco smoke should be regarded as an addictive drug, and tobacco use as the means of self-administration…Cigarettes are highly efficient nicotine delivery devices and are as addictive as drugs such as heroin or cocaine.”
One of the key characteristics of drug addiction or dependence on a substance is the degree of compulsion experienced by the user. Since 1992, the British General Lifestyle Survey (which typically surveys around 15,000 adults from over 9000 households annually) has asked three questions relevant to nicotine dependence and addiction. The first is whether the person would like to stop smoking, the second is whether person would find it easy or difficult not to smoke for a whole day, and the third is how soon after waking up they smoke their first cigarette. Since 1992, there has been almost no change in any of the three measures.
The latest 2013 survey reported that 63% of smokers said they would like to stop smoking altogether and 60% felt it would be difficult for them to go a day without smoking. Four-fifths (81%) of heavy smokers (i.e., those smoking 20 or more cigarettes a day) said they would find it difficult to give up smoking compared to one-third (32%) of lighter smokers (i.e., those smoking less than 10 cigarettes a day). The average number of cigarettes smoked per day is 13, and 14% smoke a cigarette within five minutes of getting up in the morning, a figure that rises to 35% among heavy smokers who smoke more than 20 cigarettes a day. Research consistently shows that approximately two-thirds of smokers want to quit the behaviour yet the majority are unable to do so, which is also suggestive of a genuine addiction. Those that do try to quit smoking typically experience a wide range of withdrawal symptoms including craving for nicotine, irritability, anxiety, difficulty concentrating, restlessness, sleep disturbances, decreased heart rate, and increased appetite or weight gain.
Outside of Great Britain, tobacco and other drug use prevalence have been examined extensively among youth and adults. For example, by the Monitoring the Future research group in the U.S. (http://monitoringthefuture.org). They reported that daily (20 or more days in last 30 days) cigarette smoking varied from 11.4% among 18 year olds to 17% among 50 year olds. One may infer that daily cigarette smoking is addictive use, though several studies measure tobacco (nicotine) addiction specifically. Tobacco addiction (dependence) among older teenagers has been found to vary between 6% and 8%. Studies have found a prevalence rates of between 1.7% to 9.6% for tobacco addiction among college students.
In a 2004 issue of the Archives of General Psychiatry, Dr. Jon Grant and colleagues found a prevalence of 12.8% for tobacco addiction among a U.S. national sample of adults. A few years later in a 2009 issue of the American Journal of Public Health, Dr. R.D. Goodwin and colleagues found a prevalence of 21.6% and 17.8% for tobacco addiction among a U.S. national sample of male and female adults, respectively. It appears that daily smoking demonstrates about the same level of prevalence as direct measures of dependence, particularly among adults.
In a 2011 study that I carried out with Dr. Steve Sussman and Nadra Lisha, we estimated that past year nicotine dependence prevalence in the general adult population of the U.S. as being approximately 15%. A different summary of research on the epidemiology of drug dependence has shown that of all people who initiate cigarette use, almost one-third become addicted smokers (32%), a figure that is much higher addiction rate than for users of heroin (23%), cocaine (17%), alcohol (15%) or cannabis (9%).
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
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Action on Smoking and Health (2013). Smoking statistics: Who smokes and how much. London: Action on Smoking and Health.
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Grant, B.F., Hasin, D.S., Chou, P., Stinson, F.S., & Dawson, D.A. (2004a). Nicotine dependence and psychiatric disorders in the United States. Archives of General Psychiatry, 61, 1107-1115.
Information Centre for Health and Social Care (2011). Smoking drinking and drug use among young people in England in 2011. London: Information Centre for Health and Social Care.
Jarvis, M. (2003). Monitoring cigarette smoking prevalence in Britain in a timely fashion. Addiction, 98, 1569-1574.
Office for National Statistics (2012). The 2010 General Lifestyle Survey. London: Office for National Statistics.
Office for National Statistics (2013). The 2011 General Lifestyle Survey. London: Office for National Statistics.
Sussman, S., Lisha, N. & Griffiths, M.D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professions, 34, 3-56.
Wald, N. & Nicolaides-Bouman, A. (1991). UK Smoking Statistics (2nd edition). Oxford: Oxford University Press.
Elasticity of demand: Can bungee jumping be addictive?
“Aaaaaaaggggggghhhhhhh” – or something like it – was the sound I made as I jumped from 300 foot above the River Thames with a piece of elastic tied round my ankles in my one and only bungee-jump. Was I brave? No. Insane? No (although others may take issue). Stupid? Possibly. Was I doing it for a bet? No. To raise money for a charity? No. To have a story to tell the grandchildren? No (but I will have). At the end of the day, I really don’t know what possessed me to take that jump. But I did it. I have about a hundred eyewitnesses, the certificate, the photos, and of course the video of my jump (“Drastic Elastic”).
So how did it all come about? Well, it was one of those spur of the moment things. I was with my partner and some of her friends all of whom had congregated at Battersea Power Station to see one of their long-standing friends do a bungee-jump. The bungee-jump at Battersea as I later found out is the highest in the UK but as I sat drinking bottled lager on the riverside boat bar all I was wondering was why the bloody hell is he going to do it? He had a few weeks to think about it. Thankfully when it came to my jump, I had about half an hour for it to sink in. The only bottle I really had was the one I had been holding full of lager.
Before I went on my jump, a couple of radio journalists went up to do a report. A couple of my colleagues have suggested that it was only the presence of the broadcast media that got me to jump. One jumper who came down while I was waiting described it as the worst experience of his life. What a time to tell me! What’s more, the person before me chickened out when she got to the top. I must admit than when I was finally hoisted up to that birds-eye view over London, I did momentarily think there was still time to change my mind. The forms that I signed before going up were certainly food for thought. There is a phrase in the small print that basically says that in the event of my death or serious injury that I do not hold the UK Bungee Club personally responsible.
As the crane slowly ascended to the jump point my heart got a little faster but I was still looking forward to it. The crane suddenly stopped. The door of the cage opened and there I was standing over the Thames. In three seconds time I would be making my oscillating descent downwards. One of the guys in the crane said he would count to three and then tap me on the shoulder which was my cue to jump. The other guy was holding the camcorder recording my every grimace.
“One. Two. Three. Jump”. I dived off the cage’s platform and hurtled towards my friends in the boat below. I bounced up and down for about half a minute before I realised it was nearly over. The rush I got from the whole experience hit me straight after the jump rather than during it. The term “adrenaline junkie” has now passed into everyday usage and although my main research area concentrates on very specific types of risky behaviour (e.g., gambling) and others perceive me to be someone who generally takes risks, I would be the first to admit that bungee jumping is not something that has ever been one of my lifelong desires.
It is therefore something of an irony that one of my ex-PhD students (Dr. Michael Larkin) did his research on the relationship between addiction and identity and interviewed bungee-jumpers about their experiences and whether they view their high-risk behaviour as addictive (research that we eventually published in the Journal of Community and Applied Social Psychology). I also realize that if I was interviewing myself about my experiences of bungee jumping I’d be hard pressed to give any kind of rational explanation of why I did it.
Large-scale research in the area of young people and risk-taking has tended to focus on ‘risk-takers’. This term clearly situates the ‘risky-ness’ within a particular kind of person, and captures only the negative aspect of such behaviours (i.e., risk). In our published research, Dr. Larkin and I purposefully used the term ‘risky-but-rewarding activities’ for two reasons. Firstly, the term situates ‘risky-ness’ within activities, rather than the persons engaging in them, and secondly, it captures both the positive and negative aspects of such activities (i.e., risk and reward).
In one of our studies, we used semi-structured interviews to explore the experiences and understandings of two small groups of participants engaging in either dangerous sports (i.e., bungee jumpers) or recreational drug use (i.e., Ecstasy users). We chose these two particular activities because they provided an opportunity to explore an interesting psychological question – how do individuals evaluate and understand the relationship between risk and pleasure?
All participants had what can best be described as ‘non-problematic’ relationships with their respective activities (i.e. they did not consider themselves as ‘addicted’. Furthermore, all of the participants in our study claimed they made informed and educated decisions about the risks involved in their respective activities – even though there were variations in each individual’s appraisal of how great this risk might actually be, and of how well-informed they were.
We found both similarities and differences between the bungee-jumpers and the Ecstasy users. Initiation into bungee jumping was presented as the consequence of an active, rational decision. Perhaps this was possible for the bungee-jumpers, in contrast to the ecstasy users, because they had fewer reservations to overcome. We also reported that there seemed to be no expectation of unknown, long-term risk associated with bungee jumping (as opposed to Ecstasy use). Secondly, bungee jumping does not represent an analogous ‘boundary point’ between relatively minor involvement, and more serious involvement, in dangerous sports, in the way that Ecstasy use and amphetamine use may do within general drug-taking activities. Thus, we can see that ‘contextual decisions’ may have a psychological function for the user, as a means of overcoming reservations (through denial of agency), and a discursive function for the speaker, as a means of rationalizing a ‘risky shift.’ However, even though bungee jumpers did not utilize this strategy, they still presented their activities as participatory, and acknowledged that social elements contributed to the rewards of the activity, and carried out a considerable amount of identity work in the interviews, which collectively suggests that (like Ecstasy-use) participation grants access to an identity, and gives the user a voice within a particular sub-culture.
We also found that first experiences of bungee jumping and Ecstasy-use were often ambivalent, and sometimes even unpleasant. This ambivalence was generally reported as leading to a stage of ‘learning to like it.’ This might be considered a key process in moving from initiation to maintaining use. Our analysis of the data sought to illuminate something of what it means to take risks for pleasure in our culture. From this process, a number of insights have emerged.
Firstly, it seemed that initiation into a risk-taking activity may require numerous strategies in order to overcome one’s own reservations, and also to accommodate perceived disapproval from others. These strategies include momentary denials of agency (such as the construction of ‘contextual decisions’ rather than ‘rational decisions’), emphasis on the value of ‘inclusion’ for maintaining friendship and cultural identity, the use of anticipated regret as a rationale for accepting possible consequences, and emphasis on the intrinsic value of collecting a broad range of experiences.
Secondly, while initiation may involve some denial of agency, once the person is initiated, and it perhaps becomes evident that the activity can be maintained relatively safely (costs; managing risks) and satisfactorily (learning to like it; learning to control it), then engagement in the activity becomes more rationalized. This involves the acquisition of information about the risks involved, espousing certain practices in response to those risks, and explaining accidents in terms of inappropriate engagement in the activity. In these ways, short-term risks can be managed and accepted as appropriate to the pleasure received.
One interesting feature of the accounts we collected is their positive, appetitive and wilful orientation toward risk. Our participants articulated a relationship with risk that allowed us to see it as a source of pleasure and reward, cultural identity and social participation, but also perhaps as a means of expressing resistance to conventional constraints. Risk-taking was not exactly ‘normal’ for our participants. Its very abnormality was part of its transgressive allure, but at the same time it was mediated by attempts to adopt safe practices, and as such it cannot be understood simply as negativistic action either. Instead, it makes more sense to understand the value of these transgressive acts in terms of access granted to both desirable identities and modified mood states. Whatever future research uncovers, I will always have my bungee jumping certificate that takes pride of place in my office and reads:
“This certifies that in a brief moment of bravado, Dr. Mark Griffiths being of sound mind did of their own choice leap from a 300ft platform. When they launched themselves into space their only touch with reality was a bungee cord attached to their ankles. This courageous person has hereby encountered “The Ultimate Adrenalin Experience”. Lesser beings should now show the respect and admiration due to the intrepid Bungee Jumper, who has undertaken to accept their fame with some restraint and modesty”
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
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Larkin, M. (2002). Understandings and experiences: A post-constructionist cultural psychology of addiction and recovery in the 12-step tradition. Unpublished PhD. thesis, Nottingham Trent University.
Larkin, M., & Griffiths, M.D. (2002). Experiences of addiction and recovery: The case for subjective accounts. Addiction Research and Theory, 10, 281–311.
Larkin, M. & Griffiths, M.D. (2004). Dangerous sports and recreational drug-use: Rationalising and contextualising risk. Journal of Community and Applied Social Psychology, 14, 215-232.
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