6.11 Smokers' attitudes to and beliefs about addiction
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While self-reported 'addiction' may provide a rationalisation for continuing to smoke and failed quit attempts, its implicit corollary is a denial of self-control and self-determination, concepts with which many people feel uncomfortable. Smokers' responses to addiction may therefore be ambivalent, and contradictory: it is not unusual for smokers to refer to a sense of entrapment in smoking, while also expressing the view that to smoke or not is a matter of free choice.70
Smokers and non-smokers alike strongly agree with the notion that tobacco use is addictive,71 but smokers are more likely to deny that they are themselves addicted to smoking, and to believe that they will find quitting easy, if they try. This effect is particularly marked in younger smokers.71-73 In research from the United States, 71% of adolescent smokers and 81% of adult smokers agreed with the statement that 'Most people who smoke for a few years become addicted and can't stop.' Significant proportions of smokers (60% of adolescents and 48% of adults) also agreed with the statement 'I could smoke for a few years and then quit if I wanted to.'71 This self-exempting or 'optimistic bias' may lead young people to experiment with smoking, because they believe themselves to be less likely to become addicted than others.71-73 These misconceptions are particularly dangerous in the light of research showing that even at low and sporadic levels of consumption during adolescence, symptoms of nicotine dependence may emerge41—see Section 6.7.
The adolescent propensity for expressing control over their smoking behaviour has also been demonstrated by British research. A study examining the attitudes and beliefs of a sample of teenage smokers aged 16–19 found that about 20% believed themselves to be addicted, a further 20% believed themselves not to be addicted, and that the remaining majority were ambivalent, tending rather to categorise their smoking as a habit or a social behaviour over which they could exercise some degree of control.74 This finding is supported by another British study showing that children perceive adult smoking as a response to a need to smoke in order to cope with everyday life, while maintaining that children who smoke do so for purely social reasons—to fit in with a social group, or to convey an image. Hence children are more likely to classify adult smoking as addictive behaviour, whereas smoking in their own age group is seen as discretionary and within the control of the individual.75
Younger children appear to be far more fearful about the prospect of addiction, but also to have misconceptions about its true nature. In a study of Western Australian children aged 9–10, children who expected that they would become addicted to smoking immediately upon trying it were less likely to intend experimenting with smoking than those who thought they would be able to smoke several cigarettes or over a short period of time before becoming addicted.76 Those who defined addiction as 'liking' or 'enjoying the taste of cigarettes' thought that as long as they didn't actually enjoy smoking, they would not become addicted. The authors of this study point out that fear of addiction may be a salient message for preventing uptake in young people, unlike health messages such as disease risk, which pose a far more distant threat.
Whatever their perception of addiction, once addicted, most young people50 and adults77 express regret at having started smoking and wish to give up. Cessation is discussed in Chapter 7.
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