Last updated: February 2018
Suggested citation: Hall, W., Gartner, C., and Vittiglia, A. 6.14 Smokers’ attitudes to and beliefs about addiction. In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2018. Available from http://www.tobaccoinaustralia.org.au/chapter-6-addiction/6-14-smokers-attitudes-to-and-beliefs-about-addict
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.
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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.
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