By Request: Smoking

Matthew Struhar asks:

As a former smoker, what steps do you think the Obama administration could take to help people trying to overcome addiction? Other than raising VATs on tobacco products, are there any interesting proposals out there to deter smoking and/or help people quit?

I don’t have many interesting ideas here. The main policy levers in use — taxes and restrictions on places wherein you can smoke — work pretty well, though it’s important not to kick the taxes up to a level that’s so high that you get tons of black market activity. One neglected aspect of this, I think, is the prospects for more rigorous enforcement of laws against giving/selling cigarettes to kids. Most smokers start earlier than 18 and the earlier you start the more deadly it is. I’m enough of a libertarian to think that what adult smokers choose to do with their money and their health should be mostly up to them, but it’s really worth squeezing the vise to try to prevent the emergence of the next generation of tobacco addicts.

Beyond that, this is a very vague policy idea, but clearly one problem with our health care system is that there’s more money to be made treating lung cancer or emphysema than there is persuading people to quit smoking even though the social value of preventing smoking-related illness is much greater than the value of treating it.

Last, since Obama himself is a smoker who’s been struggling with efforts to quit, I’ll observe that I think it would be good if more people talked seriously about tobacco addiction. There’s a lot of individual variation to this, but I’ve got it really bad and I’m sure I’m not the only one. I was out at a bar in Geneva back in November and people were allowed to smoke inside and generally being all European. I bummed a cigarette — my first one in almost two years. From that point, it took maybe 36 hours for me to return to a full-blown self-destructive pack-a-day habit. When you watch The Wire and see Bubbles quit heroin and then relapse you understand that he’s not going to shoot up just once. For me, at least, it’s just the same with cigarettes. When I got back to the states and resolved to re-quit, I found out that it’s a lot easier to stop after six days of heavy smoking than after ten years. But it’s not that easy, and didn’t spare me days of being depressed and irritable.

The effort to avoid smoking is often portrayed as a kind of quest to battle temptation — like the struggle to not eat too much chocolate cake and get fat. And for some people maybe it’s like that. But for a lot of people, it’s not like that at all. It’s a very serious addiction like hard drugs that just happens to come in a form that’s (sort of) socially acceptable and non-incapacitating.