“Dependence” and the danger of adopting the language of your oppressors

by Carl V Phillips

Vaping, smoking, and other tobacco product use are routinely described as “addictive”. As I have pointed out repeatedly, this is a very misleading characterization. (You might recall my major essay – years in the making – on this topic from earlier this year. If you missed it and are reading this, you will definitely want to go read it.) The two sentence summary of the headline point is: All ‘official’ definitions of “addiction” hinge on the behavior being highly disruptive to someone’s functioning – work, social, etc. But tobacco product use has no such effects, at least not for more than a minuscule fraction of consumers.

So the fallback position, in the event that someone recognizes the problem with that word, is to say that tobacco product use produces dependence. But this is barely more accurate and is equally misleading. For those who use these products or advocate for their acceptance, to use of either of these words is to make the rhetorically and psychologically dangerous mistake of adopting the language of one’s oppressors.

“Addiction” evokes the specter of destitute drug users who are entirely focused on getting their next fix, at huge cost to every other aspect of their lives. Use of this word is a calculated choice by Big Tobacco Control, to intentionally invoke that misleading picture. Before the last decade of the 20th century — back when tobacco controllers were honest decent people — they did not say, and often even explicitly denied, that tobacco products should be considered addictive.

But “dependence”, even though it is a technical term with a reasonably established definition, evokes much of the same specter. Technically the word means that someone experiences withdrawal symptoms when and if they cease the consumption. But what kind of symptoms and how strong are they? The dramatic specter is that of a heroin user in severe pain and gastrointestinal meltdown during withdrawal, or the heavy drinker suffering tremors and fever when “DT-ing”. The message contained in the word is that any payback from giving up a drug or other enjoyed consumption choice should be considered as dire as those horrible pains — which is to say, as good a reason for avoiding the choice.

Suffering some cost from ending longstanding pleasant practices is the norm in life, not the exception. We mourn, long, and miss. If we start implicitly conceding that any welfare loss that results from ceasing a rewarding behavior renders that behavior bad, we are implicitly endorsing the worst excesses of the “public health” political movement. There are a million good novels and other stories about love and loss, as well as less cliched combinations of benefiting from something and then suffering the backlash of its absence. This is the price we pay of the best parts of the human condition. Meanwhile, there are a million bad public health papers that implicitly recommend that we should restrict the human condition to shades of dull grey so that we never have to experience the cost of losing something. Before you fall into the trap of whose language you adopt, ask yourself whether you want to live a life as told in stories by Tolstoi, Hugo, George Jones, Gaiman, and various saints, or the stories told by some scolding public health puritans in their ham-handed Discussion sections.

The word “dependence” is not usually intended to include many of those losses I invoked in the previous paragraph, but the point remains that there being some negative effect of quitting is hardly a good reason for never starting. “Dependence” usually implies effects that are dramatic and distinct shortly after we stop “using”, and that are limited to the quasi-physical rather than thought-based (i.e., your body is messed up, or feels like it is, due to what is happening in your brain, rather than merely feeling a longing). Consider the well-known effects of giving up caffeine, or even just skipping it for a day: a splitting headache and difficulty focusing. Being bereft of one’s habitual nicotine also has a collection of these quasi-physical effects.

The two are not all that different from each other, so our lack of social condemnation of coffee must mean that creation of dependence alone — even in this narrow sense of the concept — is not a defining problem in itself. This is to say nothing of our celebration of countless other activities that bring us bouts of unhappiness when they end.

We accept the withdrawal effects for coffee as a simple legitimate cost-benefit calculation. If you choose to become a habitual coffee drinker then you will either need to go through a few days of payback when you quit, or just keep doing it forever. The latter is the preferred choice for most of us. But the dependence has approximately no influence on that choice. Yes, it is true that most of us “coffee addicts” (jk — see above) will occasionally put some effort into getting our “fix” on days when our routine is disrupted, perhaps drinking some swill that is barely palatable merely because of our dependence (i.e., primarily to avoid the withdrawal symptoms). But that is hardly specter-worthy stuff. It is just about a small cost for a day; we plan to resume drinking good coffee according to our routine as soon as it is convenient. The specter that is evoked by “dependence” is that it motivates substantial unfortunate choices.

The acute pain of opioid withdrawal is enough, by itself, to keep some people coming back. They may have decided that they are better off no longer getting high in order to recover what they lose as a result of their drug use, and are unwavering in that. But they just cannot get through the intense acute negatives to get there. In the jargon of economics, they are stuck at an inferior equilibrium because of the short-term costs of transitioning to the new equilibrium. This is the specter that the technically-correct but fraught-with-connotations word, dependence, evokes.

We have therapies and reduced-risk maintenance drugs that make a huge difference in getting someone through opioid withdrawal (and also managing some of the less dramatic withdrawal effects that would otherwise continue for months or years). And, oh look, we have those for smoking/nicotine also. The thing is, the former are quite useful while the latter offer approximately no effect on smoking cessation. Did you ever stop to wonder why there is such a huge contrast?

The answer is pretty clear: Withdrawal is a trivial barrier to quitting smoking for most people. Smoking is not about dependence. It was never about dependence. Helping someone “get over the hump” to the new preferred equilibrium is seldom the issue it often is with opioids. The problem is that the new equilibrium is simply not preferred.

(I should pause to make clear that I am not implying that everyone has the same experiences and effects. There are always exceptions to what the majority experience, including some huge outliers. Indeed, the stereotypical scenarios are often far worse than the average experience. Anyone who makes blanket declarations about these behavioral issues (*cough* *tobacco controllers* *cough*) is demonstrating that they are clueless about them.)

When someone decides they want to give up coffee, they whine for a day about the headache and maybe take a Tylenol, and they grouse for a week about being groggy. But they just do it. Having decided they would be better off spending the rest of their life coffee-free, the dependence is not that big a deal.

Why they decided this is a complete mystery to me. I do not wonder how they endure the withdrawal or are willing to go through it — doing so is simply no big deal. No, the mystery to me is why anyone would choose to give up one of life’s great joys. That’s just nuts.

Ok, I will take that back. As noted, I recognize and respect heterogeneities, and realize someone might decide that continued coffee consumption causes them more harm than good. But you see my point: The reason that I and most people do not quit coffee is driven not by the withdrawal symptoms for a week, but being bereft of coffee for the ensuing years. We like it and want to keep doing it. For a large portion of the population, a day that includes consuming coffee is better — on net, after considering all costs — than one bereft of coffee. That is often not true for heroin.

This story about coffee is the same as the story for why most people keep smoking or using other tobacco products. A day with the consumption is better than a day without it. Yes, the first few days without it are worse than either of those. But that temporary extra cost is pretty trivial. For most people, having Tylenol or nicotine gum to “take the edge off” is not going to change the calculation about quitting (whereas methadone might). The real reason for not quitting is not the short-term extra-low welfare, but the continuing loss of welfare for all the time after that. Lots of smoking cessation attempts fail not during the withdrawal period, but months later. It boggles the mind that anyone can be aware of that fact and still think the failure to quit smoking has much to do with dependence.

No doubt you have seen the trope about “nicotine is more addictive than heroin” (by which they mean more dependence-producing). This is absurd at so many levels, not least because the people who say it cannot even offer a definition of addiction (or dependence), let alone a method of quantifying it to make a comparison. It is arguably even more absurd when you realize that this claim is not actually about quantifying addiction or dependence; it is a twisted interpretation of statistics for the success rate for self-declared quit attempts. Some such statistics suggest a larger portion of attempts are successful for heroin than for cigarettes. It is, of course, absurd to conclude this means it is less of a burden to go through heroin withdrawal. How stupid would someone have to be to believe that? What these statistics reflect is: (a) it is much easier to make an unserious quit attempt with smoking so that denominator is inflated and that, more importantly, (b) the motivation to be rid of the day-to-day effects of heroin is much stronger.

A stereotypical failed attempt to quit heroin involves the overwhelming discomfort of withdrawal dragging someone back. A typical failed attempt to quit smoking is saying (perhaps on the first day or perhaps a few months later), “this turned out to be a really bad time to quit, so I will just do it later — not a big deal.” This results in quips along the lines of “quitting smoking is easy — I’ve done it dozens of times.” No one says this about heroin.

(Aside: it actually is a bit of a bigger deal to delay quitting smoking than most people think. Just a few months delay poses as much risk as a lifetime of using a low-risk alternative.)

Perhaps you recall Leslie Nielsen [correction: Lloyd Bridges] in Airplane, who comments that the dire stress of the day made it “the wrong week to stop smoking” (as he lights up). The joke comes when he reprises “the wrong week to stop” about sniffing glue and taking speed. It is funny because the first iteration, about smoking, is reasonable. If the cost of functioning better during an acute crisis is to delay smoking cessation for another week, then yeah, do that. But the idea of backsliding about stopping a devastating and (genuinely) addictive “hard drug” — one which is probably not exactly going to improve one’s crisis management like smoking would — is not so reasonable.

Of course, it is not just a matter of day-to-day welfare. Someone might like (on net) the daily effects of smoking while not liking the net lifetime effects (the latter, of course, include end-of-life diseases). This creates a challenging tradeoff, one that is absent for coffee: trading off short-term net benefits versus long-term costs. It is important to keep in mind that there is nothing at all unusual about this challenge. Many or most efforts to get people to change their behavior “for their own good” consists of trying to get them to do something that will make them better off over their lifecycle, even though it makes them worse off today. It is the whole “invest rather than consuming everything now” thing. (Indeed, there is a good case to be made that the only legitimate “for their own good” efforts are described by this, and the rest are just someone trying to impose their own preferences on others. But that is a topic for another day.) This is a challenge, but once again it has nothing to do with dependence.

No doubt some of you are now thinking, “but most smokers want to quit.” Really? Do they? That popular trope contains its own disproof: they smoke. All they have to do to quit is to not smoke; therefore, they pretty clearly do not want to quit. You might want to run a four-hour marathon, but are physically incapable no matter how hard you try. Avoiding smoking is not like that. It involves only the physical act of not lighting up, which is possible for anyone who chooses it.

That common utterance is not without meaning, however. (Well, sometimes it is without meaning. It is based on survey responses, many of which are genuinely meaningless –they are just the respondent dutifully reciting the only socially-acceptable answer to the question.) The trope means something, just not what it says. I believe that most often it means that someone wants to want to quit, even though they do not want to quit. (A “second-order preference” — for more, see this paper.) That story is clarified with the more intuitive observation, “they want to get the net benefits from smoking this year, but do not want the net costs from a lifetime of smoking; they thus would prefer to not have such a short-term preference, but they cannot override it despite recognizing it is contrary to their long-term interests.” Once again, however this has nothing to do with dependence.

I have observed at length (including in the previous link) that substitution of low-risk products is the perfect solution to exactly these challenges. If someone wants to want to quit, we should help them out by offering a substitute which keeps enough of the benefits that they really do want to quit. Their preferences then align with their second-order preferences, and also align with what they are “supposed” to do. Win-win-win. Happiness and health.

Pharmaceutical nicotine (NRT) works best for smoking cessation when someone discovers that they are satisfied using it every day as a substitute for smoking. It is approximately useless when used “on label” to merely overcome dependence, because dependence was never the real challenge. Long-term use can align someone’s preferences. Of course, using better products — vaping or snusing — works far better still.

Ah, but that is not “real” quitting because someone is still “addicted” or dependent. And herein we are back to the self-defeating danger of adopting the language of one’s oppressors. When you adopt their characterizations of the situation, even if for purposes of arguing about it, you have already lost. Falling into this trap is easy to do, and having done it it is difficult to avoid internalizing that you accept key premises of your own oppression. It happens to slaves, prisoners, hostages, the impoverished, and the otherwise discriminated against. It has happened to smokers over decades. And I have watched it happen to many vaping advocates quite rapidly. The concession of the absurd claim that smoking is somehow bad and/or happens merely because of dependence, and thus it is not mostly about normal preferences, concedes the legitimacy of a potent but absurd line of attack on vaping.

A common retort to the “not real quitting…you are still addicted/dependent” attack is that it is better to remain dependent than suffer the health effects of smoking. There is also the ongoing debate about the relative dependence-producing properties of different products. Such rhetoric effectively concedes that (a) dependence on nicotine or tobacco products is a problem in itself and (b) dependence is genuinely a substantial motivator in this context.

Point (b) is clearly false, as I have noted. I hope I have also already made the point, regarding (a), that facing some cost of withdrawal from a behavior is not necessarily a big deal, and certainly not an evil. It describes caffeine and countless other socially-accepted choices. If we extend beyond the quasi-physical aspects of dependence, it describes most everything that we like to do. If suffering a bit for giving something up is a problem that warrants condemning the behavior, then all pleasure is bad. You miss your kids when they are away. You are distracted by daydreaming about last week’s vacation. Unless we are talking about truly dire symptoms, “dependence” is just name-calling.

Moreover, the concession further concedes that the greater the benefit a behavioral choice (and thus the greater loss from giving it up), the worse the behavior must be.

I was inspired to write this by a tweet in which someone asserted that vapers are less dependent than smokers because e-cigarettes do not deliver the MAOIs — basically antidepressants — that are delivered by smoking (or snusing). This was presented as if it were an advantage of vaping. But if one of the benefits of smoking for someone is the MAOIs (or any of the other psychoactive chemicals that are absent from vaping, which are usually ignored because only nicotine and the MAOIs are well-understood), then losing them by switching to vaping is a cost, not a benefit. That does not mean that switching is a bad idea on net, of course. But losing this benefit is a downside, not an advantage. If someone is much more willing to give up vaping than they were to give up smoking, that could mean that there was something uniquely evil about smoking. But the more likely story (given that the supposed diabolical force remains unidentified) is that there was something better about smoking.

Having one or more advantages over vaping does not mean that smoking is a better choice on net, of course. But we should not allow what is good to be spun as a cost. Recall the Tolstoi-versus-puritans contrast. People smoke because they like to smoke. People vape because they like to vape. People are faux-“addicted” because they prefer to consume rather than not consume. When “dependence” is used to invoke a specter, but is really just used to mean “someone likes this aspect of the consumption choice and so is reluctant to give it up”, it is a backdoor way of denying that preferences and welfare matter. It implies that enjoying a behavior is bad, at least if some puritanical minority objects to the behavior based on their personal pique. Conforming to their language usage helps them cement that implication.

 

[Endnote: I would be remiss if I did not acknowledge that a very small number of tobacco controllers, those who consider themselves more sophisticated, argue that the dependence in question runs deeper. Note that this has nothing to do with the dominant rhetoric, and so does not change any of the above. But they argue that past nicotine use creates a deficit in terms the very benefits that it delivers, and withdrawal thus includes not only acute symptoms but being stuck with that deficit. That is, the claim is that nicotine product users experience improved focus, cognitive performance, calmness, etc. from consuming, but most or all of that is just getting them back to the level they would have been at had they never smoked or otherwise used nicotine products. They are running fast just to stand still. The claim here is that nicotine dependence is like someone’s dependence on a prosthetic foot: not only does withdrawal include immediate problems, but it also includes permanent disability because the product was filling in for an acquired loss of normal functioning.

I will assert, without going into detail here, that I have looked at what they cite as evidence for this “it is all just running to stand still” claim, and find it completely unconvincing. (You might not be surprised to learn that a lot of the problem is tobacco controllers failing to consider confounding.) Still, at least this assertion makes a defensible case that the “dependence” in question is genuinely something to really worry about, unlike the trivial effects the word usually refers to in this context. However, even if this were true, it could argue in favor only of not starting nicotine product use (or rather, it might argue in favor — there are tradeoffs). Once someone has already built up this supposed deficit, it would be a reason to keep smoking or using a substitute product, and to never become abstinent.]

 

 

 

12 responses to ““Dependence” and the danger of adopting the language of your oppressors

  1. Thanks so much for this article, Carl, though I fear the people that need to read it will reject it. Even with vapers, I often hear about how they’re addicted to nicotine and ought to stop, but…can’t. I think one thing people lose in this is that one of the reasons, one of the important ones, tobacco control calls smoking addictive is that the classical addict is seen as being controlled by his drug, and therefore unable to make rational decisions; the state and tobacco control must do it for him. It’s so discouraging.

    Does history not exist? The highest quit rates were in the late 1960s through the 1980s. Often ‘cold turkey’, and those folks were just fine. But perhaps that goes against the narrative.

    Still, we seem to be heading towards a puritanical world, pleasure = sin. I do not look forward.

    • Carl V Phillips

      There is no question that the reason some antis bark about “addiction” and “dependence” to try to fool someone (most often themselves) into thinking people need to be denied their human rights. I would add, they also want to make it ok to hurt smokers or other tobacco product users. If ~those people~ are merely pod people, after all, then there is no harm in making them unhappy and stealing their pennies. Indeed, it is better to do that to them because maybe their slavers will go away if we do!

      That is probably a lot of it. And it is a particularly good reason why adopting the language of one’s oppressors is a bad idea.

      Any yes, I have heard plenty about people reading and rejecting this. Except it is probably really “people laying eyes on each of the words in order and rejecting it”, which I don’t really count as reading. “I read the thesis statement and disagree with it based on my unexamined priors, so I will not even try to process the rest of it” is not reading. I have no great skill at educating people who do not seek to be educated. I am good at educating people who want knowledge, but breaking through to those who resistant to learning — that is the skill of a good 8th grade teacher or a leader of a popular revolution, not my skill set. I can say “she is abusing you and is not going to stop; leave her!” as well as the next guy, but I am not much better than average in getting it to stick.

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  3. Sadly it is true that the “A” word has been weaponized by tobacco control orthodoxy and internalized even by those opposing this orthodoxy. How can we address this?

    I had a long correspondence with an Argentinian vaper who constantly whined in social networks about the “A” curse because he tried very hard to stop vaping and kept failing. He had quit smoking 3 years ago a 20 years 2 packs a day habit thanks to vaping, so he was very supportive of vaping, but nevertheless he wanted to be also free from it. I asked him why would he want to “be free” of something he has enjoyed for the past 3 years and has caused him no health problems and would probably cause minimal problems in the long term. He said he didn’t want to be an “A” person (long term risks didn’t bother him). The exchange continued at length. I asked him if he would like to be free from coffee or beer, I also argued that those throwing him the “A” word as a curse lacked any scientific ground, that it was just puritan BS. He noticed the contradictions but did not yield, in the end he simply cut the exchange by saying “I just want to stop vaping, it is my personal choice, full stop”. I know he doesn’t want to stop vaping and that he, like many other vapers, has internalized the BS and gratuitous guilt associated with the “A” word. But, sadly, it is hard to overcome this when the assault is so intense and is coming from all fronts.

    • Carl V Phillips

      I wonder if he would like to be free from needing to frequently sleep and eat. I know I would.

      This story is classic “adopt the views of one’s oppressors” stuff. He presumably could not even tell you what he meant by “addiction” when he used it, other that it being some vague thing about wanting to do it. But he does not want his oppressors looking down on him, and the thought they were dominated his view to such an extent that he will hurt himself to try to impress them. (And, of course, he will find himself disappointed that they are not impressed.) It is so much like the behavior of downtrodden people of particular races/SESs/genders/whatever that it baffles me that some people cannot see the parallels. I suppose the problem is that they do not look around to recognize that this happens with downtrodden demographic groups, so they do not even realizing their are paralleling what gets everyone recognizes as Stockholm Syndrome when it happens on a micro level.

      I really don’t know how to stop it. If everyone were like me, it would be sufficient to point this out and tell them to think through what they are doing to themselves (by choosing to allow others to do it to them). [Narrator: “Everyone is not like Carl.”]

      I am open to suggestions for how to reach people with this message more effectively. But the fact that you could not pull it off even one-on-one shows just how difficult it is.

  4. “someone asserted that vapers are less dependent than smokers because e-cigarettes do not deliver the MAOIs — basically antidepressants — that are delivered by smoking (or snusing)”
    Hmm.. I wonder who you might be referring to? (Spoken as someone who has tweeted similar things, but is not sure they’re on even the radar of such luminaries as the post author.)
    One thing I wish is that each article ended with ’20 word takeaways’ (or some such rot for a ‘sound byte’). Those would make it easier, at least, to slot the takeaways into Tweets.
    But then, maybe I should just link the article itself and thereafter mute whoever I was responding to – going on about the addictive potential of nicotine. 🤷

    Sidebar: I’ve often wondered if a adding dash of WTA’s to e-liquid would ‘hit the spot’ for some smokers who otherwise would not make the transition.. 🤔

    • Carl V Phillips

      I am pretty sure it wasn’t you. (I started this post and wrote that passage several weeks ago, and I do read you on Twitter, so I am not 100% sure. But I don’t think so.)

      I understand the value in soundbites. But as I think I have noted many times before, I also have my concerns about them — they usually get something wrong. I quite like Frank Baeyens’s (@FBaeyens) approach of quoting a good passage from something, with a link (though I wish he would tag me so I could always see and RT it!). It does not send the message that the passage is an adequate summary of the thesis, or of anything, but it offers a soundbite.

      As for the issue of needing to mute over this, yeah. Notice that every comment and reply here is about people who resist this message. That whole “luminary” status insulates me from some of that. Occasionally some total newbie will try to “educate” me about something they are adamantly wrong about (or, more often, something where they are basically right but do not understand that the nuances of what I wrote are not fundamentally contrary to their simpler belief). But those who are a bit up from newbie figure out that this is not appropriate.

      I will talk all day to someone who is not resistant to learning. Or even someone who genuinely wants to learn even though they are inherently resistant. But I have no patience for dealing with someone whose worldview is dominated by “I believe X; since I know X is true, that means I must be right; so I will just ignore or scoff at anyone who tries to tell me X is wrong.” I just walk away if it is someone of no particular consequence (yes, I would be a bad social worker). I keep on it for a while if it is someone who is a bit of an opinion leader, because I consider educating the opinion leaders to be my most useful mission. But even then I eventually give up. What’s the point, right?

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  6. Dnison Penndragon

    As someone with a borderline addiction to (or should I say dependence on?) “being that guy” I feel the need to point out that it was not Leslie Nielsen who spoke those lines in Airplane!, it was Lloyd Bridges.

    Aside from that, great article!

  7. Interesting. For a while I endorsed the “dependence” definition of what happens to many smokers, likening it to a strong habituation that is difficult to quit because of subsequent yearnings to continue the behavior after stopping. I considered it “psychologically” dependence-inducing, rather than physical, but I can see now this too vague and doesn’t make sense when considering attempts at smoking abstinence often fail weeks or even months after one has initially stopped. It makes a medical issue out of a universal aspect of humanity, and in vague terms that are almost as indefensible as common perceptions of “addiction”.

    I also vaguely recall a USSG report from the 70s referring to tobacco use as a strong habituation rather than addiction or even dependence per se, quite like coffee. I think smoking is also in a unique spot because of how short nicotine’s half-life is; if smoking could induce stimulation for hours rather than 30-45 minutes at most, and most people only smoked a few cigarettes a day like a few cups of coffee, the health risks would be vastly lower (though likely still higher than coffee), and I wonder what our view of smoking would be like then. Pack-a-day smokers would be unheard off, and even half-pack would be considered on the extreme end of nicotine consumption.

    I’m also happy to see you point out how ridiculous the assertion nicotine is “more addictive” than heroin because people apparently make more quit attempts for smoking than they do heroin. It doesn’t seem that difficult to me to deduce the obvious difference between these two substances and why it’s absurd to compare them in this way: the stakes of quitting heroin are much more dire and motivating than cigarettes on any given day. Average heroin user wouldn’t wish opium withdrawal on their worst enemies.

    >Many or most efforts to get people to change their behavior “for their own good” consists of trying to get them to do something that will make them better off over their lifecycle, even though it makes them worse off today. It is the whole “invest rather than consuming everything now” thing. (Indeed, there is a good case to be made that the only legitimate “for their own good” efforts are described by this, and the rest are just someone trying to impose their own preferences on others…)

    Indeed, I’ve heard this argument before. It’s by far the strongest argument I’ve seen in favor of paternalistic, even coercive measures against smoking, including widespread bans and taxation – smokers commit an injustice against their future selves by accumulative risk of disease for a person who may very well go on to regret smoking
    all those years, and that in light of this, a decision to smoke *now* is a necessarily foolish and irrational one that can never possibly take into full account the risks of continuing the behavior because they appear so far off from the present. In a nutshell, smoking is always a poor investment because of the incalculable risk to any individual’s future self (because stats tell us nothing about each individual person’s own risk of disease), thus an irrational decision, and any measures to push people toward quitting or never starting are justified. As you might have imagined or already know, this argument was posed in detail by an economist.

    Putting aside the epidemiology that shows life expectancy loss doesn’t significantly increase until one continues smoking into middle age (assuming a starting age of around 15 and a pack-a-day habit), I have two problems with this argument. First, it seems much too reductive and unspecific for a behavior as complex as smoking. Second, I’m not sure I buy the idea of a “future self” I should consider an entity in and of itself, like a separate person whose rights and desires I should consider as much as my own in the present. Certainly, the average person must operate as if there is a future self to work toward – this is how we motivate ourselves to work hard at tasks not necessarily enjoyable in the present, but are expected to provide net positive pay off in the future. But we aren’t clairvoyants. Anything can happen between now and five minutes, or hours, or days, or weeks, or years, or decades. Can this not be included in a risk/reward calculation? Look at the extent to which the risks of smoking are currently exaggerated – still, over a billion people choose to do it. In spite of taxation and bans, dozens of millions of people in the U.S. continue to smoke. The natural conclusion to this argument seems to me that we should just throw away veneer of “gently” pushing smokers toward cessation and jump to firing squads and straitjackets – when we shove human beings into a cold utilitarian calculus like aforementioned economist uses, treating them like automatons, why should there be a limit to the measures we use to make smokers quit? Suffice it to say, I’m sure Duterte would love this argument and agree wholeheartedly.

    The remaining smokers of today, after decades of inundation by media and govt about the health risks, are all necessarily condemned as irrational and stupid by this logic. But who’s to say so much about so many people? And there is still a lot of information we could provide to smokers that might convince them to cut down on smoking or switch to different brands or any other harm reduction measure they would voluntarily take with such info, without necessarily quitting smoking. (For the sake of his argument I’m pretending low-risk products don’t exist, in which case the obvious choice is to promote them as widely as possible and subsidize them – would be cheaper, more humane than continuing to punish smokers).

    My future self doesn’t exist. I can pretend it does for the sake of functioning, but it’s ultimately an illusion. If someone with lung cancer at 70 goes on to regret smoking their whole life, and further wishes they had been beaten down and chastised for the decision like a child so they might have been convinced to stop, I’ll have a difficult time accepting that my rights should be stepped on for the regrettable decision-making of others. I know what I’m doing when I choose to smoke tobacco – but then, I have precise knowledge of the risks that most smokers don’t. There is room for harm reduction before we should ever consider going to such extreme measures, but tobacco control won’t let that happen. I wonder what that economist would say if he knew the extent to which the scientific literature on tobacco is poisoned by ideology, corruption, and greed – and not from the tobacco companies.

    • Carl V Phillips

      Hi, Robert. Thanks for the comment.

      Stepping through a few replies to it….

      You are right about the original SG language. Only later did those reports pivot to churning propaganda. There is an interesting contrast between the ups-and-downs from smoking vs. coffee. I will add, without analyzing the implications, that snus is much more similar to coffee.

      The future selves thing is, of course, largely due to the great Thomas Schelling, one of my mentors. He specifically applied it to smoking, an inspiration for a lot of his analysis due to his personal struggle with it. I tend to strongly support the usefulness of the concept.

      You point out that there is a lot of uncertainty. That does not invalidate the conceptualization. This, as well as other factors, mean it is not necessarily wrong for someone to cost their future self something to provide benefit now. We do it constantly, after all — every act of non-survival consumption. The uncertainty aspect (as well as the “more desperate needs right now” aspect) shine a light on some of the most absurd cluelessness/evil of tobacco controllers: soldiers in combat should be forced to give up nicotine products; we should focus on forcing quitting by the most downtrodden and desperate people in the world. Just because there is a future self, and that perhaps external cool thinkers might better protect him than the current person occupying his future body, does not justify just any intervention. Schelling (nor anyone else who thinks seriously about this) never suggested that any act to benefit future selves is justified. Someone can make a rational decision to consume now and hurt their future self, including smoking.

      The point is that they are a legitimate object of concern that we KNOW the current self does not always look out for, so PERHAPS we should consider intervening and it is not prima facie inappropriate. We know the distinction among the interests of “selves” is real. To take Schelling’s simplest example of it: The self at 10pm sets the alarm early, out of consideration for the interests of the self that will exist at 8am. The self at 6:30am turns off the alarm because he wants to sleep later, thus getting to work late and creating problems for the later-that-day self.

      Needless to say that I agree that someone who seems generally capable of doing the whole lifecycle calculation should be allowed to make their choice. But there are a lot of people who get pulled out of some behavior they were choosing and expected to keep choosing, and are incredibly thankful for that. I am talking immediately. Regretting past consumption choices at 70 because you would rather have more consumption then is a red herring, as you suggest. Of course the future self would love to rob from his past self (now long gone) to have more then. That does not mean the choice was bad in the first place.

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