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Keywords:

  • Cessation;
  • policy;
  • tobacco control

West and colleagues [1] propose that the serious and life-threatening illnesses associated with smoking necessitate a tobacco control strategy in which cessation assistance has a role. I am in agreement. The fact that most people are able to quit without assistance does not necessarily mean that smoking cessation services are either unnecessary or unhelpful. I do, however, take issue with the bold assertion that believing in addiction does not dissuade people from making quit attempts, and may even make these more likely. This claim is based on a recent study [2], which found that the single-item measure ‘I am addicted to smoking cigarettes’ was associated weakly (odds ratio approximately 1.2) with quit attempts in the past year. This finding contrasts markedly with a considerable amount of research suggesting consistently that belief in the addictive properties of cigarettes makes quitting more difficult (e.g. [3]), that ‘non-addicted’ smoking (chipping) is associated with a lessened belief in nicotine's addictiveness [4] and that one of the most commonly cited reasons for smoking is addiction (e.g. [5,6]).

Encouraging smokers to believe that they are addicted might be beneficial if it persuaded more people to make (aided) quit attempts; however, this is not supported by the literature. A series of studies [7–9] indicate that smokers who describe themselves as addicted use this label as an explanation that enables them to deny their capacity to quit, allowing them to take refuge from widely held anti-smoking beliefs causing them dissonance [10]. In this way, the connotations of addiction may provide people with a functional explanation pertaining to diminished responsibility for engaging in undesirable behaviour [11,12]. Another study [13] found that smokers who saw themselves as addicted expressed weaker intentions to stop smoking and had much lower expectations regarding their perceived ability to do so. Abstaining, in contrast, was found at follow-up to be associated with respondents describing themselves as less addicted a year previously and cessation attempts were related strongly to respondents' previously declared intentions to make quit attempts. Respondents who had tried unsuccessfully to stop smoking showed a slight decrease in self-attributed addiction when change scores were considered compared to those who had made no quit attempts. This is contrary to what might have been expected had smokers made defensive attributions in a post-hoc rationalization of their failure to quit. In this study, smokers who regarded themselves as addicted thus appeared pessimistic concerning their chances of giving up yet did not seem to use addiction as an explanation rationalizing their failure to do. This work therefore indicates that the belief in addiction may dissuade individuals from trying to quit and may encourage them to see cessation attempts as a futile endeavour (see also [14,15]).

With this in mind, I would urge that West's [2] finding is interpreted in the context of the evidence cited above pointing in precisely the opposite direction. In view of research indicating that smokers overestimate the likelihood of their stopping in the future [16], that they are unaware of cessation methods and underestimate their effectiveness [17], I respectfully suggest a more nuanced approach to tobacco control and smoking cessation. We should not divorce individuals from the roots of their own behaviour by promoting the self-handicapping idea of addiction when delivering cessation support (see [18]). Rather, we should encourage individuals to take responsibility for their own decisions and behaviour and make this a key feature of cessation assistance and tobacco control policies and practice.

Declaration of interests

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  2. Declaration of interests
  3. References

D.H. has received funding from Cancer Research UK as well as travel funds and hospitality from smoking cessation organizations. He was also paid an honorarium for speaking at the FRESH Smoke Free Northeast Conference. He has obtained financial support from the following other sources: AERC, ESRC, Glasgow Centre for Population Health, NHS, Preston City Council, Scottish Government and the Joseph Rowntree Foundation.

References

  1. Top of page
  2. Declaration of interests
  3. References