How addicted are you?

A little-known advantage of not smoking

In the NHS ‘Smokefree’ website there’s a section headed ‘Addiction test’. The purpose of this is to find out how dependent you are on nicotine.

The underlying concept, however, is wrong. If you’re addicted to nicotine that sufficiently defines your problem. The implication that there are degrees of addiction is unfounded and pointless. Another problem with this concept is that it’s discouraging and therefore counterproductive: an allegedly lightly addicted smoker may think there’s no need to quit (yet); and if someone is deemed heavily addicted this is likely to make her think it’s going to be too difficult to quit, so why go through the aggravation of trying?

How to decide your degree of addiction? The website uses the Fagerström Tolerance Questionnaire, developed by Karl-Olov Fagerström in 1991. Here are the questions with suggested answers from which you’re supposed to pick the ones that nearest apply to you:

  1. When you wake up in the morning, how soon do you smoke your first cigarette?
    Within 5 minutes
    6 to 30 minutes
    31 to 60 minutes
    After 60 minutes
  2. Do you find it difficult not to smoke in places like cinemas, buses or restaurants?
    Yes
    No
  3. Which cigarette would you hate to give up most?
    First in the morning
    Any other
  4. How many cigarettes do you smoke per day?
    10 or less (sic)
    11 – 20
    21 – 30
    31 or more
  5. Do you smoke more in the morning than during the rest of the day?
    No
    Yes
  6. If you are ill in bed, would you still smoke?
    No
    Yes

The problem with this questionnaire – apart from the illiteracy and wrong-headed underlying assumption that degrees of nicotine addiction exist – is that the criteria on which it is based are arbitrary.  Scoring is problematic too. On the NHS website the result is presented only as low, moderate or high addiction. The scoring system is 0 or 1 for yes/no questions, and 0 to 3 for multiple choice questions, but on what basis the score is converted to the descriptive result is not stated. More arbitrariness.

Suppose you truthfully answer the numbered questions thus:

      1. 1. After 60 minutes
      1. 2. No
      1. 3. I would hate to give up any except the first of the day
      1. 4. Ten cigarettes a day
      1. 5. No
      1. 6. No

So if you smoke your first cigarette sixty-one minutes or later after waking, you don’t find it difficult to refrain from smoking where it is forbidden (and how is ‘difficult’ defined?), and even if you smoke ten cigarettes per day, etc., then you would be regarded by the result of this questionnaire as being only lightly addicted. But whatever the supposed degree of addiction, a ten cigarette a day smoker still has a ten cigarette a day problem.

The simplistic thinking behind this approach is that someone who is ‘lightly addicted’ may be able to ditch tobacco just with the support of a counsellor, whereas for a ‘heavily addicted’ smoker, ‘cravings can hamper your quit attempts so you should use stop smoking medication to increase your chances of success.’ Note they say such a smoker should use stop smoking medication although this will only ‘increase [your] chances of success.’ It seems to be rather a chancy business.

On the contrary, in my experience heavy smokers may be easier to assist than light smokers. One middle-aged man getting through three packs a day, when asked why he smoked, put it like this: ‘I don’t enjoy it. It’s because I’m addicted.’ With my help he readily understood the mechanism of nicotine addiction and stopped there and then without cravings. On the other hand, those I sometimes find hard to help are young people smoking about five a day. They may have been pressed into coming by their parents, don’t really want to stop and believe their current relatively light smoking won’t harm them.

The concept of degrees of addiction should be abandoned. All smokers have the same problem: nicotine addiction, pure and simple. And the solution is the same for all of them: stop smoking.

How to do this is easier than one might think.

Text © Gabriel Symonds

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