CMAJ • February 27, 2007; 176 (5). doi:10.1503/cmaj.1060178.
© 2007 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Letters

Adolescent smoking

Paul R. Preston

Family Physician, North Bay, Ont.

It is disappointing to see articles such as the one by André Gervais and colleagues1 that are based on the old mantra that nicotine is very addictive and that it makes its victims "feel nauseated or ill" (as stated in the article), not to mention the airway burning and coughing it produces. Fundamentally, to be addictive a substance must give a pleasurable experience, not a noxious one. Gervais and colleagues report that mental addiction in adolescents sometimes occurs even before the initiation of smoking; this is more evidence that the primary forces of smoking addiction are psychosocial, not chemical. These kids are susceptible because of what smoking does for them socially and psychologically, not physically. This reality is absent from the article.

As a clinician, I commonly see smokers suddenly make up their minds to quit when there are no longer any psychological or social benefits to continuing smoking. They then experience no withdrawal symptoms, which is what one would expect when a noxious substance is removed. Similarly, I see many patients who do not experience any withdrawal symptoms over long hours spent in places where they cannot smoke, such as in their workplace, but they have cravings as soon as they are in an environment in which smoking is permitted.

It is the current bias to find a biological explanation for everything, but until we start recognizing the psychosocial factors that are the major forces behind smoking addiction, we will continue to disempower our patients and fail miserably in dealing with the greatest epidemic of preventable deaths in the history of humanity.

REFERENCE

  1. Gervais A, O'Loughlin J, Meshefedjian G, et al. Milestones in the natural course of onset of cigarette use among adolescents. CMAJ 2006;175(3):255-61.[Abstract/Free Full Text]




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