Tobacco dependence is increasingly defined in terms of “nicotine addiction”.1 Whether smokers view themselves as addicted to nicotine and the role they attribute to nicotine is less clearly defined.2 Some smokers recognise the role of addiction in their continued smoking, while others may be reluctant to acknowledge their addiction for fear of expressing weak self-control and self-determination. Smokers may be ambivalent about their addiction: they may describe feeling trapped by their smoking, while insisting that whether or not to smoke is a free choice.3 In an Australian study, only a quarter of smokers agreed that they could quit anytime they want to, however 80% agreed that smokers who really want to quit will “just do it” and only 34% agreed that they were “too addicted to be able to quit” suggesting that most saw continuing to smoke as a choice.4 Smokers who believe that the health risks of smoking do not apply to them are less likely to make quit attempts.5
A 2017 systematic review found that most people agreed smoking was addictive, however adolescent smokers were less likely than adults to agree that they personally were addicted.2 Views on what addiction could be defined as, varied greatly. One commonly reported sign of addiction was a feeling of “need” or craving for cigarettes that was seen to differentiate addicted smokers from non-addicted smokers. Another aspect of addiction according to smokers was diminished control over smoking and difficulty in attempts to quit. However, smokers would often distance themselves from these symptoms of addiction, often using depersonalised terms.2
As smoking has become more stigmatised, young people who smoke in social situations may see themselves as ‘not real smokers’ and therefore not at risk of addiction6-9. This self-exempting or ‘optimistic bias’ may lead young people to experiment with smoking in the mistaken belief that they are less likely than others to become addicted.10-12 Young people have also been found to be optimistic about their ability to quit, prior to their smoking becoming problematic.13 In addition, adolescents express uncertainty about whether or not they are addicted to smoking, or the nature and strength of their addiction.2 These misconceptions are particularly dangerous in the light of evidence that over two-thirds of people who try one cigarette become daily smokers14 and that symptoms of nicotine dependence may develop after even sporadic smoking in adolescence;15—see Section 6.13.
The propensity among young smokers to believe that they are in control of their smoking has also been found in US and British adolescents.6, 16 In one US study, over half of adolescents believed they could smoke for a few years and then quit if they wanted to. A greater proportion of these adolescents also believed that most people who smoke for a few years become addicted and can’t stop.6 A study of the attitudes and beliefs of British teenage smokers aged 16–19 found that only 20% believed themselves to be addicted. A further 20% believed that they were not addicted, and the remainder categorised their smoking as a habit or a social behaviour over which they could exercise some degree of control.16 Younger children are more fearful than adolescents about addiction, but also have misconceptions about how quickly one can become addicted. In a study of Western Australian children aged 9–10, those who believed that they would become instantly addicted to smoking were less likely to intend to smoke than those who thought they would be able to smoke several cigarettes or smoke over a period of time before becoming addicted.17 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. Fear of addiction may be a more salient message in preventing uptake in young people than disease risk, which is a far more distant threat.
Whatever their perception of addiction, once addicted, most young18, 19 and adult smokers20 regret that they ever started smoking and wish to give up. Cessation is discussed in the following chapter.
Relevant news and research
For recent news items and research on this topic, click here.(Last updated March 2020)
1. Prochaska JJ and Benowitz NL. The past, present, and future of nicotine addiction therapy. Annu Rev Med, 2016; 67:467-86. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5117107/
2. Pfeffer D, Wigginton B, Gartner C, and Morphett K. Smokers' understandings of addiction to nicotine and tobacco: A systematic review and interpretive synthesis of quantitative and qualitative research. Nicotine Tob Res, 2017. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29059355
3. Carter S, Borland R, and Chapman S. Finding the strength to kill your best friend: Smokers talk about smoking and quitting. Sydney: Australian Smoking Cessation Consortium and GlaxoSmithKline Consumer Healthcare, 2001.
4. Balmford J and Borland R. What does it mean to want to quit? Drug and Alcohol Review, 2008; 27:21-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18034378
5. Borland R, Yong HH, Balmford J, Fong GT, Zanna MP, et al. Do risk-minimizing beliefs about smoking inhibit quitting? Findings from the international tobacco control (itc) four-country survey. Preventive Medicine, 2009; 49(2−3):219−23. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19573553
6. Nichtera M, Nichtera M, Carkoglub A, Lloyd-Richardsonc E, and the Tobacco Etiology Research Network (TERN). Smoking and drinking among college students: “It’s a package deal”. Drug and Alcohol Dependence, 2010; 106:16-20. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19758771
7. Berg CJ, Lust KA, Sanem JR, Kirch MA, Rudie M, et al. Smoker self-identification versus recent smoking among college students. American Journal of Preventive Medicine, 2009; 36(4):333−6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19201148
8. Waters K, Harris K, Hall S, Nazir N, and Waigandt A. Characteristics of social smoking among college students Journal of American College Health, 2007; 55(3):133−9 Available from: http://www.ncbi.nlm.nih.gov/pubmed/17175899
9. Morley KI, Hall WD, Hausdorf K, and Owen N. 'Occasional' and 'social' smokers: Potential target groups for smoking cessation campaigns? Australian and New Zealand Journal of Public Health, 2006; 30(6):550-4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17209271
10. Arnett J. Optimistic bias in adolescent and adult smokers and nonsmokers. Addictive Behaviors, 2000; 25(4):625–32. Available from: https://www.ncbi.nlm.nih.gov/pubmed/10972456
11. Halpern-Felsher B, Biehl M, Kropp R, and Rubinstein M. Perceived risks and benefits of smoking: Differences among adolescents with different smoking experiences and intentions. Preventive Medicine, 2004; 39(3):559−67. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15313096
12. Weinstein N, Slovic P, and Gibson G. Accuracy and optimism in smokers' beliefs about quitting. Nicotine and Tobacco Research, 2004; 6 (suppl. 3):S375−80. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15799601
13. Mantler T. A systematic review of smoking youths’ perceptions of addiction and health risks associated with smoking: Utilizing the framework of the health belief model. Addiction Research & Theory, 2013; 21(4):306-17. Available from: https://doi.org/10.3109/16066359.2012.727505
14. Birge M, Duffy S, Miler JA, and Hajek P. What proportion of people who try one cigarette become daily smokers? A meta-analysis of representative surveys. Nicotine & Tobacco Research, 2017:ntx243. Available from: http://dx.doi.org/10.1093/ntr/ntx243
15. DiFranza JR, Savageau JA, Rigotti NA, Fletcher K, Ockene JK, et al. Development of symptoms of tobacco dependence in youths: 30 month follow up data from the DANDY study. Tobacco Control, 2002; 11(3):228–35. Available from: http://tc.bmjjournals.com/cgi/content/abstract/11/3/228
16. Amos A, Wiltshire S, Haw S, and McNeill A. Ambivalence and uncertainty: Experiences of and attitudes towards addiction and smoking cessation in the mid-to-late teens. Health Education Research, 2006; 21(2):181−91. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16107488
17. Wang C, Henley N, and Donovan R. Exploring children's conceptions of smoking addiction. Health Education Research, 2004; 19(6):626−34. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15199004
18. US Department of Health and Human Services. Preventing tobacco use among young people: A report of the surgeon general. Atlanta, Georgia: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1994. Available from: https://www.ncbi.nlm.nih.gov/pubmed/8154552.
19. Giovino GA and Barker DC. The national youth smoking cessation survey: 2003-2005, 2013, Inter-university Consortium for Political and Social Research: Ann Arbor, MI. Available from: https://www.icpsr.umich.edu/icpsrweb/HMCA/studies/34275.
20. Fong G, Hammond D, Laux F, Zanna M, Cummings K, et al. The near-universal experience of regret among smokers in four countries: Findings from the international tobacco control policy evaluation survey. Nicotine and Tobacco Research, 2004; 6(3):S341–51. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15799597