You're at a party and all of a sudden, the unmistakable whiff of cigarette smoke hits you from the direction of one of your friends, who's just stepped out for some "fresh air." "I didn't know you smoke," you exclaim in surprise. She rushes to deny the allegation. "Oh no, I don't," she explains. "I just have one or two when I'm out drinking. Really, I'm just a social smoker."
It's a common enough scenario. We all know smokers who "don't smoke." Are these people in denial, lying, or just too embarrassed to admit to what a habit that society is finding increasingly undesirable? The answer is none of the above. They honestly don't realize that they may be as addicted to smoking as is the chain smoker. What's worse, they also don't realize that with time, they can easily slide down the slippery slope to chain smoking, with all the health problems that go with this unfortunate habit. You can help protect your friends-or if you see yourself in this scenario-you can start now to protect yourself.
According to the Centers for Disease Control and Prevention, as of 2008 approximately 443,000 deaths in the U.S. were linked to cigarette smoking. The chronic disease of emphysema is almost always caused by cigarette smoking, which increases the actions of an enzyme that destroys the tissue of the tiny air sacs in the lung. Cigarette smokers are also more likely to develop heart disease, hypertension, stroke, Alzheimer's disease, and a host of other serious chronic, if not fatal, conditions. Smoking can even cause your skin to wrinkle prematurely.
According to Dr. Joseph DiFranza, a medical researcher at the University of Massachusetts Medical School, social smokers: 1. smoke fewer than 5 cigarettes a day; 2. don't feel the need to smoke every day; and 3. feel they can control their urge to smoke. However, he qualifies this definition by noting that true social smokers rarely exist. They may smoke infrequently, and have only one or two at a time, but they're not in control of their smoking.
Social smokers think they can control their smoking because they may go for one, two, three or even seven days without smoking. However, what's really happening is that over that period of time, however long it is, their craving for nicotine continues to build until they can no longer resist the urge. They're forced to light up, whether it is a cigarette they've borrowed or one they bought from a pack they've hoarded for weeks. DiFranza believes this "loss of autonomy" is the key to understanding what happens to convert a social smoker to an addicted smoker.
Having one or two cigarettes a week may not seem to be that harmful. People who think they're social smokers console themselves with the knowledge that most of the studies on smoking's effects involve the heavy, one-pack-a-day, variety. Unfortunately, many (if not most) social smokers experience a continuing decrease in their latency periods. Their original latency may be a week or longer, but the more they smoke, the shorter the latency period becomes.
Why can't social smokers maintain their once-a-week habit? It's because the brain rapidly becomes sensitized to nicotine's effects; specifically, nicotine stimulates an increase in the density of dendrites in brain regions involved in addiction. Even one cigarette can start the process. Teens are particularly sensitive to nicotine's effects on the brain. DiFranza found that for 10% of the adolescents he studied, it only took 2 days after having their first cigarette for them to feel the urge for another. The more they smoked, the faster their autonomy declined. In fact, teens who smoked 2 cigarettes a week at the age of 12 were 174 times more likely to be heavy smokers as adults. Teenage girls are particularly vulnerable to the cumulative effects of early smoking.
Still think you're just a social smoker? You can test yourself (or a loved one) with this Hooked on Nicotine Checklist:
1. Have you ever tried to quit, but couldn't?
2. Do you smoke now because it is really hard to quit?
3. Have you ever felt like you were addicted to tobacco?
4. Do you ever have strong cravings to smoke?
5. Have you ever felt like you really needed a cigarette?
6. Is it hard to keep from smoking in places where you are not supposed to?
When you haven't smoked for a while do you...
7. find it hard to concentrate?
8. feel more irritablble?
9. feel a strong need or urge to smoke?
10 feel nervous, restless or anxious?
Any one symptom on this checklist indicates that you've started to become addicted.
The DiFranza team believes that nicotine addiction develops in stages. At first, smokers show no withdrawal symptoms. In the second stage , called "wanting," the smoker has a mild desire to smoke, but isn't preoccupied. In the third stage, "craving," the smoker has a tough time putting aside the thought of a cigarette. By the last stage, "needing," the smoker feels that he or she can't function normally without the cigarette. Smokers in the last stage smoke, on average, almost 14 cigarettes per day. However, if their latency is short enough (21 minutes), they may get up to 2 packs per day. Smokers may not realize they're addicted until they reach the third or fourth stage; at that point, they can't go for even one day without a smoke.
You might imagine that the nondaily smokers have an easier time quitting than the daily smokers, but they relapse just as readily as their heavier smoking counterparts-a shockingly high 90% for both groups.
If you still believe in the myth of the social smoker, I hope I've convinced you otherwise. The first step toward change, however, is to acknowledge that if you smoke at all, the brain can change, and you can become addicted.
What steps are available to you? Check out these three helpful resources:
1.The University of Massachusetts "Hooked on Nicotine Checklist (HONC)" website. Here you'll find further details on the research I've described including technical information on the HONC.
2. Centers for Disease Prevention and Control (CDC)"Quitting Smoking" website.The CDC is an excellent resource for information about smoking and tobacco use as well as advice on how to quit,
It's not easy to quit once you've established an addiction, but unless you recognize the dangers of so-called social smoking, you'll never be motivated to try.
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Copyright Susan Krauss Whitbourne, Ph.D. 2011