Steven Yates has a Ph.D. in philosophy and recently received a master’s in health promotion and education.
Everyone knows that smoking is a risky business, health-wise. Cigarettes have been linked to many diseases and conditions, from lung cancer and heart problems on down. One of the first bits of advice a doctor gives a patient who smokes is to quit. Although not everyone suffers ill health from smoking—there are cases of people who chain-smoke for decades with few if any apparent health problems—the preponderance of the evidence is that cigarette smoking damages one’s health over the long run.
Does it follow from this that governments ought to declare war on smoking? Should those who manufacture and sell cigarettes to willing customers in an open market be sued for billions of dollars?
Before answering this question straightaway, let us make an obvious point. If smoking damages one’s health, then it does make sense to work at encouraging smokers to quit and to discourage teenagers from starting. How do we do this?
The first thing to note is that no one ever kicked the habit permanently who was forced to do so. This is equivalent to attacking the symptoms of a disease while leaving the disease’s causes untouched. Government-suppressed behaviors will simply go underground where their dangers actually increase, not decrease (the situation with illegal recreational drugs in America). Making smoking illegal is obviously not a live option, as it would provoke a mass rebellion: the Prohibition-era crime wave would look tame by comparison! But expanded government can use the legal system in other ways. The most popular at present is to file suit, ostensibly to cover the costs of treating smoking-related health problems. Hence the “tobacco war.”
If the aim of this “war” is less smoking, it is likely to fail.
The person who successfully quits must want to quit. No one can be forced to quit. Not really. Quitting smoking can be hard even for those who want to kick the habit. Many people try to quit many times. A number of approaches are currently used in smoking-cessation programs. The best involve carefully planned, systematic behavior-change efforts that make use of devices such as careful self-observation, diary-keeping, and so on. The would-be quitter may be asked to record the circumstances in which he smokes, or the moods that tempt him to smoke, the people he tends to be around, where he is when he smokes, and so on. The point is to understand as thoroughly as possible the situations that prompt him to smoke and then to address those situations. He may be encouraged to arrange new situations that don’t involve smoking, find new friends if all his friends smoke, avoid the establishments where he smokes. He may be told to get rid of ashtrays and all other visible reminders of his habit. There may be actions he can take that are incompatible with smoking and can substitute for it. He may be asked to record his successes in his journal and what led to them. If he lapses—as most who quit cigarette smoking will do from time to time—he may be asked to record as many details as he can remember of what prompted the lapse. Where was he? Who was he with? What was he thinking about? And so on. In this way people can learn to control their behaviors instead of allowing their behaviors to control them. To be sure, there are people who quit “cold turkey” and never look back. But this is not the norm. Millions of people have quit smoking once they learned the health risks. For most, the process was arduous and strewn with lapses into the old patterns of behavior.
People Are Different
What makes serious smoking-cessation efforts more complex is that what is needed for success differs somewhat from person to person, because people are different. A technique that works well for one person might be totally ineffective for someone else.
Moreover, while millions have quit, millions more have also started during the same period. Despite government-imposed warning labels on every cigarette pack, cigarettes continue to sell briskly. Despite age limits for legally purchasing cigarettes, they continue to fall into the hands of teenagers who want them, whether they believe it will make them more “adult,” more acceptable to their peers, or for whatever other reasons, which again vary from case to case. They aren’t thinking about the long-term health risks. Although everyone knows about these, they just aren’t a priority for everyone.
Many libertarians openly defend a person’s right to smoke if that is their informed choice. The challenge is to the unstated premise that if X is unhealthy behavior, then X ought to be fought by the government to the greatest extent possible, and banned if possible. Accepting this premise is what separates “health nazis” from genuine health promoters. The latter have some insight into human complexity. They know that many factors can motivate people to smoke, and that quitting is rarely a matter of sheer will power. They also recognize that laws, lawsuits, and top-down mandates have a poor track record.
All the science we have on smoking cessation points in a single direction: it must begin at the bottom—where the individual smoker is, in the situations the person actually confronts in life—and proceed upward. It must begin with the person’s sincere desire to quit and willingness to do, on a personal level, whatever it takes.
Force doesn’t work. It will only exacerbate the problem by encouraging resentment and rebellion, and not addressing those factors that lead people to smoke or doing what needs to be done for them to quit. Ironic as it sounds, the government’s war on smoking may well be a stumbling block to serious anti-smoking efforts.
The message (lest there be any doubt) is sound: don’t smoke! If you don’t smoke now, don’t start. If you do, consider quitting. But this message can’t be forced on anyone. It cannot be the basis of a workable and effective top-down policy. It is remarkable that the best findings in scientific health promotion are very much in line with the conclusions of those who believe that decisions, transactions, and so on, within society should be voluntary and not coerced.