There is no U.S. cigarette pack addiction warning label. Canada's required label reads, "WARNING - cigarettes are highly addictive - studies have shown that tobacco can be harder to quit than heroin or cocaine." Until now, even Canadian youth have had little guidance as to what "highly addictive" actually meant. But not anymore.
(Charleston, SC) May 13, 2005 -- A new study published in the June edition of the Journal of Pediatric Psychology surveyed 15,000 Chicago 6th to 10th grade students. It found that 86.8% of students who were daily nicotine smokers were chemically dependent under Diagnostic and Statistical Manual for Mental Disorders, 4th Edition standards (DSM-IV).
The study's primary author was Dr. Denise Kandel with the Department of Psychiatry of Columbia University. As might be expected, Dr. Kandel found that dependency rates increased as the number of daily cigarettes smoked increased.
But a finding that's likely raising eyebrows is the revelation that among student ever-smokers that 17% smoking less than one cigarette per day, and another 13% smoking just one per day, were found dependent under DSM-IV standards.
DSM-IV criteria are intended to assess full-blown dependency, not the time of first symptom onset. They tell us when critical pathways within a smoker's brain have already been physically desensitized to nicotine's presence, and when returning home often begins to come with a hefty crave and anxiety price tag.
The seven DSM-IV standards focus upon: (1) tolerance to the effects of nicotine and a gradual need for more; (2) withdrawal symptoms when attempting to diminish intake or quit; (3) using larger amounts over a longer period of time than intended; (4) impaired control as evidenced by a persistent desire or unsuccessful attempts to cut down or control use; (5) substantial time spent obtaining, using and recovering from nicotine's effects; (6) trading or reducing social, occupational, or recreational opportunities in order to permit nicotine use; and (7) continuing to use nicotine despite knowing the serious physical and psychological problems that using tobacco causes.
As with adults, students meeting any 3 of the 7 DSM-IV dependency criteria were declared dependent. Dr. Kandel found that among nicotine dependent students that the top three symptoms noted were tolerance (86%), withdrawal (87%) and impaired control (89%).
Dr. Kandel's finding of dependency in 17% of students smoking less than one cigarette per day is consistent with an earlier study by Dr. Joseph R. DiFranza published in 2000 in Tobacco Control. Dr. DiFranza found that among students exhibiting at least one dependency symptom, 62% had experienced their first symptom before becoming daily smokers.
How quickly can a young first-time smoker experience that first symptom of addiction? For obvious ethical reasons, there will likely never be a "real-time" study which daily follows a group of youth and documents the arrival of that first warning-sign of imminent loss of autonomy.
In fact, Dr. Kandel's study only surveyed and assessed student recollections once, and Dr. DiFranza surveyed them three times per school year. But how accurate are symptom onset dates pulled from memories that are months or even years old?
An informal online smoking initiation survey at WhyQuit.com - a free quitting forum - demonstrates poor recall regarding dependency symptom onset in established adult smokers and ex-smokers. In contrast, it also raises serious concerns if the memories of those claiming recall are accurate.
WhyQuit's survey asked smokers and ex-smokers, "when you first started smoking, how many cigarettes did you smoke before you sensed your brain issue an urge or crave command to smoke again?"
A whopping 59% claimed that they could not remember. But of the 41% who assert they could, 29% said they experienced their first crave by their 3rd cigarette, and an additional 9% between their 4th and 6th.
When asked how long they smoked before feeling that first urge or crave to smoke again, 54% couldn't remember. Among those who could, 21% indicated that their first crave to smoke arrived within 2 days of starting to smoke, and another 16% said it happened on the 3rd or 4th day after starting.
The tobacco industry isn't just following youth dependency initiation studies, a 16-page Philip Morris brochure entitled "Raising Kids Who Don't Smoke - Peer pressure & smoking," restates their results in a manner that almost seems to reassure youth that they have substantial time to experiment with smoking before getting hooked.
While citing Dr. DiFranza's 2000 study, Philip Morris - the largest U.S. cigarette company with a 50% market share and the maker of Marlboro - tells a mother that she should teach her daughter that "it's possible to become addicted after only a few weeks of smoking" (see right side of PDF page 7 of 9).
The actual quote from Dr. DiFranza's study reads, "the first symptoms of nicotine dependence can appear within days to weeks of the onset of occasional use, often before the onset of daily smoking."
Why would Philip Morris choose to teach parents to teach their children that they can safely smoke for "a few weeks" without getting addicted, when the very study cited in its brochure asserts that youth could begin losing their freedom and autonomy within "only a few days?"
Dr. Kandel's finding of dependency in 60% of students smoking 5 or fewer cigarettes per day shatters the myth that light smokers consuming less than 5 mg. of nicotine daily are not addicted (the average smoker retains roughly 1mg. of nicotine per cigarette). Yes, being a little bit addicted is like being a little bit pregnant.
Dr. Kandel's findings may also raise concerns regarding the practice of using up to 3mg. of nicotine as a placebo patch masking agent in nicotine replacement therapy studies, and lesser amounts in placebo nicotine gum.
WhyQuit.com's online survey -- which appears to have attracted a group of primarily long-term smokers/ex-smokers who averaged roughly a pack a day -- asks, "if you could go back in time and have a second chance, would you again take that first puff of nicotine?" To date, 93% have replied "absolutely not."
Intelligent students may want to ignore Philip Morris addiction lessons. Instead, they may want to look at smoking that very first cigarette as though it might very well compel them to give Philip Morris a portion of their hard earned money, every day, for the remainder of a significantly shortened life.
Just one rule to avoiding a never-ending need to replenish constantly falling blood-serum nicotine levels in order to avoid sensing withdrawal ... no nicotine today, Never Take That First Puff, Dip or Chew!