Pubdate: Thu, 14 May 1998
Source: Seattle-Times (WA)
Contact:  http://seattletimes.com/
Author:  John Schwartz and Leef Smith, The Washington Post

CASUAL SMOKERS COMPLICATE ADDICTION THEORIES

Peter Dubose Jr. hates smoking - just ask him.

"I think it's foul," says Dubose, a 28-year-old marketing manager from
Bethesda, Md. "It's disgusting."

So why is he smoking that cigarette? "I can't understand my own actions,"
he says, except to say he feels a powerful hankering for a smoke whenever
he's in a bar. He buys a pack - he doesn't want to bum from friends - but
"I throw the cigarettes away the next morning. The next time, I buy another
pack."

Dubose is a "social smoker," the sort of person many folks have trouble
believing exists. After all, tobacco experts and public-health advocates
have asserted for more than a decade that nicotine is at least as addictive
as cocaine and heroin, and that kind of addiction is commonly seen as an
icy death-grip that never lets you go.

In fact, according to official government statistics in recent years, there
are plenty of occasional smokers. David Mendez, an assistant professor of
public health at the University of Michigan, was analyzing smoking
statistics from surveys conducted for the federal Centers for Disease
Control and Prevention with his computer last spring when he noticed that
the percentage of people who said they smoke, but not on a daily basis,
made up 18 percent of the country's estimated 45 million smokers. "I had no
idea of what to expect," Mendez said, "but my impression was that it would
have been in the range of 5, 6, 7, 10 percent at most. No more than that. I
was surprised."

The Nature Of Addiction

The notion that there are so many smokers who can take it or leave it
raises questions about the nature of addiction and suggests to some
researchers that U.S. smoking patterns could be shifting.

The new data emerged from a change in the way the CDC collects information
about smoking. Before 1992, the National Health Interview Survey asked
people whether they had ever smoked 100 cigarettes in their lives and
whether they still smoked at the time of the survey.

In 1992, the CDC made a more subtle distinction in the second question,
asking whether those who had smoked still smoked regularly, less than once
a day or not at all.

"It's like we developed a new microscope or something so we could see
things we'd never seen before," said Gary Giovino, the chief epidemiologist
for the CDC's Office on Smoking and Health.

Because the new question has been used only since 1992, those statistics
cannot show whether occasional smokers constitute a growing trend.

But some researchers think that is the case.

Changing attitudes toward smoking do appear to be driving smokers to light
up less often, said Kenneth Warner, a researcher at the University of
Michigan School of Public Health. "Many of them have decided they're not
going to stand out on the window ledge in the dead of winter."

Social Behavior

Some younger people - who make up a large percentage of the
sometime-smoking crowd, according to CDC estimates - could be seeing
smoking not a "daily behavior but a social behavior you did with friends,
as drinking," Warner said.

That's certainly when Monique Apter, 31, lights up. "I smoke when I drink,"
she says, puffing away at an Arlington, Va., bar. "I'm not really a smoker.
I just like having something in my mouth."

Over by the pool tables at the same bar, Walter Teal, 35, has a cigarette
dangling rakishly from his lips as he sets up a bank shot. He could work
his way through half a pack whenever he was out with friends. But he began
to worry the habit might hurt his chances of meeting an ardently nonsmoking
Ms. Right, so he quit earlier this year.

Every woman he has dated since then is a social smoker.

So he is smoking again. "If you haven't smoked and then kiss someone who is
smoking, it's `yuck!' The best way to beat that is to have a cigarette," he
said, adding: "People will think up all kinds of excuses for a cig, won't
they?"

To understand how a supposedly addictive substance could have so many users
who can walk away, it is important to look at addiction - as the term is
used within the scientific community.

No substance, apparently, addicts everyone. Even among those who become
addicted, the amount of discomfort that accompanies quitting varies from
person to person. Ten percent to 15 percent of heroin and cocaine users,
for example, can simply drop their habit, never seeming to become addicted.
Only about 15 percent of those who drink alcohol become addicted. People
addicted to heroin and, later, scientists studying them, called these
non-addicts "chippers."

Saul Shiffman, a psychologist at the University of Pittsburgh, first
applied the notion of chipping to smokers in the late 1980s. "I was
estimating about 5 percent, but it was a very crude estimate," Shiffman
said. "Whether it has risen or I was just too conservative, I don't know -
since it really was a guess more than data." The fact that some people are
not addicted does not diminish the hold of addiction on the rest of the
smokers, Shiffman said. "We've got to realize that the stranglehold is real
- - but it's not universal."

Teal and his fellow chippers aside, however, nicotine consistently ranks as
one of the toughest addictions to break. Seventy percent of smokers tell
pollsters they would like to quit but have been unable to do so. According
to a 1995 CDC survey comparing tobacco's physiological pull with that of
illegal drugs, cigarette smokers were more than twice as likely as users of
marijuana, cocaine or alcohol to report being unable to cut down.

Although Warner notes "there's no threshold under which there's no risk" of
getting lung cancer, heart disease or any of the other myriad ailments
linked to the tobacco habit and recommends that any smoker try to quit, he
acknowledges the risk associated with smoking a cigarette every day or so
"is minimal compared to someone who smokes 30 cigarettes a day."

`There's No Safe Level'

Public-health officials bristle at the thought that anyone might cautiously
recommend reducing the habit as opposed to kicking it outright. "Any
tobacco use increases the risk above no tobacco use," said Donald Sharp, a
medical epidemiologist at the CDC's Office on Smoking and Health. "That's
our take-home message: There's no safe level of tobacco use."

How much risk occasional smokers face - or the effect of social smoking on
the estimated $50 billion in smoking-related health costs - remains
unclear. No study has examined the risk of smoking a few cigarettes a day
or less, Sharp said, because the number of smokers with such light smoking
habits was thought to be too small to provide reliable data.

So in studies, occasional smokers are lumped in with people who smoke 10
cigarettes or fewer each day. At that level, a male smoker's risk of
getting lung cancer is 80 percent higher than a male nonsmoker's. For
reasons not yet fully understood, a female smoker's lung cancer risk is
higher, about five times the risk for smoking 10 or fewer cigarettes each
day compared with the cancer risk for nonsmokers. The average smoker bears
a 23-fold increase in cancer risk, and heavy smokers can increase their
risk by 50 times or more.

David Burns, a professor of medicine at the University of California at San
Diego who has studied the effects of low-level smoking and secondhand
cigarette smoke, said a person who picks up a cigarette only a few times a
year would certainly have a risk "too small to be biologically meaningful."

But he noted the fivefold risk for women who smoke 10 cigarettes a day or
fewer was roughly equivalent to the risk of cancer for asbestos workers.
"Do you know anybody who would say, `I just spray asbestos without any
protection once or twice a week. It's not really a problem for me.' "

- ---