Happy World No Tobacco Day

Today is World No Tobacco Day – a fairly self-explanatory occasion. Presuming we want to eliminate tobacco smoking (although I don’t, personally), it’s worth having a quick think about who smokes and why.

Smoking is more prevalent among those below the poverty level than those above. Lifetime instances of major depression are twice as common amongst smokers than nonsmokers. Immigrants smoke more after moving to the US, to give another example. It is more common amongst people in high stress jobs, like nurses and carers. A pattern appears to be emerging.

These are patterns, moreover, which can be explained. For instance, it has been discovered that tobacco smoke contains an (as yet unidentified) chemical which acts as a monoamine oxidase inhibitor (or MAOI). In simple terms, important neurotransmitters like dopamine, serotonin, and norepinephrine are monoamines. Monoamine oxidase breaks down these chemicals, and tobacco smoke, by inhibiting the action of monoamine oxidase, increases their availability. Inhibited action of monoamine oxidase means more monoamines which means more serotonin, more dopamine, more norepinephrine. Cigarettes are a mild anti-depressant – that’s why the mentally ill smoke. Hence why this effect dramatically increases the motivation to self-administer nicotine in rats.

The flaw in anti-smoking advocacy is that it is heavily rooted in the behavioural model of medicine. There is a behaviour (smoking) which we wish to stop, so we seek to modify the behaviour without examining its causes. A more intelligent approach would take guidance from the biopsychosocial model of medicine – it would understand that behaviours are contextual, and if we wish to alter behaviour we most effectively and ethically do so by altering the context in which they occur. If smoking is more common among mentally ill, poor, and stressed individuals, is a byproduct of mental illness, stress, and poverty, it follows that a reduction in smoking would be a byproduct of tackling these more important issues.

So this World No Tobacco Day, ignore the World Health Organization and contribute to efforts to eradicate poverty or to mental health services.

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