MadSci Network: Medicine
Query:

Re: Why no addiction from cigarettes after 25 years of various exposure?

Date: Tue Sep 14 20:14:32 1999
Posted By: joshua rodefer, Research Fellow in Psychobiology & Lecturer
Area of science: Medicine
ID: 935417751.Me
Message:

Q: Why no addiction after 25 years of cigarettes?

A: You are a chipper.

Your astute observation - that there are people that go months 
between cigarettes, and do not ever seem to develop the 
characteristic symptoms of dependence or withdrawal - has 
only really been studied in the past decade.

Saul Shiffman, Ph.D., a psychologist at the University of 
Pittsburgh, was the scientist that first described chippers. 
Initially these persons were described as those who regularly 
smoke, but do not develop dependence. In one of the first 
studies on chippers, the group of smokers studied averaged 5 
cigarettes a day, but smoked less than 4 days per week - this 
is a LOT more than your report of going months between 
cigarettes.

There have been many hypotheses put forth to try to explain 
the behavior of chippers, including: differences in nicotine 
metabolism, smoking topography (how you take your puffs), 
psychological effects (mood, craving), feelings of stress, 
coping skills, and personality differences (to name but a 
few). Of all these, the only significant differences between 
regular smokers and chippers has been in the realm of 
personality. 

In one study, Kassel and colleagues (see reference below) 
found that the trait of sensation-seeking seemed to delineate 
groups of smokers better than any other criteria. 
Specifically, nonsmokers were characterized as more socially 
inhibited compared to chippers and regular smokers (a 
pack/day). This makes perfect sense given the very social 
nature of smoking. 

The other distinction they found was between regular smokers 
vs chippers and nonsmokers. Regular smokers were more 
impulsive and demonstrated less self-control than the other 
two groups. This also makes sense given that smokers would 
probably be described as addicted to, or dependent on, 
cigarettes. 

One of the easiest tests for nicotine dependence is asking a 
smoker which cigarette of the day would be most difficult to 
give up (see Jarvik et al, below). Heavy smokers frequently 
report that the first cigarette of the day when they wake up 
would be the most difficult (because they are beginning to 
experience nicotine withdrawal). Chippers and other light 
smokers report that the cigarette after dinner would be the 
most difficult (this is perhaps the most reinforcing for 
them).

So how many people are out there like you? That is a very good 
question. Some government estimates from the National 
Institute on Drug Abuse (NIDA) estimate that upwards of 90% of 
smokers are dependent (ie, relatively few chippers). However, 
there is some evidence to suggest that there are more social 
smokers and chippers than was previously thought.

One reason for this equivocal finding is relatively simple. 
Scientists may have been asking questions that are not precise 
enough. Up until recently, distinctions were often made 
between heavy (more than 20 cigs per day) and light (less than 20 
cigs per day) smokers. A second distinction was whether a person 
had smoked more or less than 100 cigarettes in their lifetime, and 
whether they were currently smoking. Seems like pretty crude 
distinctions, no?!

As you can probably figure out, there are LOTS of people that 
might be misclassified using those criteria. More recently, 
the Centers for Disease Control (CDC) started asking those who 
HAD smoked whether they still smoked regularly, less than once 
per day, or not at all. The middle category perhaps best 
describes a chipper. All of a sudden, there appeared to be 
many more chippers, and fewer hard-core smokers.

So all of this is good news in our war on drugs, right? 
Well, no. It is great that there are fewer heavy smokers than 
we thought before, however, smoking1s health risks do not fall 
along a continuum. There is no safe level of smoking. A really 
good example of this is the recent evidence surround the 
health risks of second-hand smoke. Once study has reported 
that the risk for cancer in light smoking (<10 cigs per day) 
women was the same as the risk for cancer in asbestos workers. 
Not reassuring. And there are PLENTY of studies showing that 
the combination of alcohol and tobacco potentiate the health 
risks of each drug alone (that is, 2 + 2 = 8 !! ). And since 
few people only smoke, or only drink alcohol, this is a very 
real health consideration.

So, although the jury is still out on all the health risks, it 
is very clear that we have a lot to learn about people like 
you. Most importantly because we have started to find evidence 
that there may be chippers for all drugs - cocaine chippers, 
heroin chippers, etc - and these individuals are obviously 
very different than the typical person who abuses illicit 
drugs. And if we have learned only one thing in the war on 
drugs, it is that different types of persons often require 
different types of treatment regimes (medication and/or 
psychotherapy) in order to kick their habit.

I hope this helps illuminate the issue for you. Thanks for the 
great question!
Cheers, 

Josh Rodefer, Ph.D.
Harvard Medical School
josh_rodefer@hms.harvard.edu


Selected references
You can access these and other articles by doing a MEDLINE 
search  PubMed is one site 
(www.ncbi.nlm.nih.gov/PubMed/medline.html) 
that I use frequently.
***************************
Jarvik, M, Killen, JD, Varady, A, Fortmann, SP (1993).
The favorite cigarette of the day.
Journal of Behavioral Medicine, vol 16, pp 413-422.

Kassel, JD, Shiffman, S, Gnys, M, Paty, J, Zettler-Segal, M 
(1994). Psychosocial and personality differences in chippers 
and regular smokers. Addictive Behaviors, vol 19, pp 565-575.

Shiffman, S (1989). Tobacco 3chippers2  individual 
differences in tobacco dependence. Psychopharmacology, vol 97, 
pp 539-547.

Shiffman, S, Fischer, LB, Zettler-Segal, M, Benowitz, NL 
(1990). Nicotine exposure among nondependent smokers.
Archives of General Psychiatry, vol 47, pp 333-336.

Shiffman, S, Paty, JA, Gnys, M, Kassel, JD, Elash, C. (1995).
Nicotine withdrawal in chippers and regular smokers: 
subjective and cognitive effects. Health Psychology, vol 14, 
pp 301-309.




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