Cigarette use down—but nicotine dependence holds steady

One image in particular sticks in my mind from my husband's days as a heavy smoker—him, huddled under the eaves at our back door, smoking an Old Gold cigarette as sheets of rain poured down. I remember thinking "He can't be enjoying that," and indeed he wasn't. But his need for a cigarette fix at that moment was stronger than any consideration for bodily comfort, so powerful is the sway of nicotine addiction.

Like President Obama and many other smokers, my husband struggled to give up his nicotine habit. He finally succeeded (10 years ago and counting), but quitting remains an elusive goal for many, despite public-awareness campaigns on the health risks of smoking, heavy taxation of cigarettes, and restrictions on smoking in public places. True, the number of smokers has dropped in recent decades with the help of such public health initiatives. But a new study finds that the ranks of heavy smokers has actually remained steady, suggesting that other approaches are necessary to help these smokers kick the habit.

Unlike previous research on smoking, the new study sought to separate occasional smokers from those with a true nicotine dependence. The researchers gathered information from a survey* of more than 40,000 adults on alcoholism and related conditions and addictions. As part of the survey, participants were asked questions about smoking, including more than 40 to gauge nicotine dependence.

To get a sense of how smoking patterns have changed over time, the researchers divided the participants into four groups based on age. (They excluded people over 55, as smoking-related deaths had likely reduced the number of smokers in this group.)

Smokers were defined as those who'd smoked 100 or more cigarettes. As expected, the older groups had more smokers than the younger groups, supporting the notion that public-awareness campaigns and other measures have kept some people from smoking. However, the number of current smokers deemed nicotine-dependent was nearly the same for all age groups, holding steady at around 20 percent of adults surveyed. This meant that while the overall number of smokers had dropped, the portion of smokers who were nicotine-dependent had actually risen.

What you need to know. Looking at different age groups doesn't provide a perfect measure of smoking changes over time, but these findings do suggest that more needs to be done to help hard-core smokers quit. Studies show that nicotine addiction can be as tough to treat as cocaine addiction. But while treatment programs for cocaine discourage heavy users from battling on their own, smokers are often left to fend for themselves. Indeed, insurance coverage for smoking programs is often limited and difficult to obtain. But the longer someone smokes, of course, the higher their risk of serious health problems. And this can cost the insurer (not to mention the individual) plenty.

—Sophie Ramsey, patient editor, BMJ Group

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