Saturday, 23 February 2013

Carl Phillips on addiction

Carl Phillips has recently written a series of essential posts at Anti-THR Lies (THR= Tobacco Harm Reduction) about the ANTZ (anti-nicotine and tobacco zealots). Carl's writing has something that many academics lack: clarity and insight. I recommend you read them all...

“…but they are still addicted!”

“…but they are still addicted!” (part two)

What is addiction?

What is addiction? (part two)

The mirror-image delusion

Some highlights...

On anti-smoking ideologues who suspect everyone is a paid shill, including e-cigarette and snus users who say that reduced harms products helped them quit (from ANTZ and the mirror-image delusion).

Most of the ANTZ would never take the time to do anything they were not being paid for, and are themselves often doing the bidding of their paymasters. For many, their delusions make them incapable of understanding that consumers and the rest of us who are genuinely concerned with public health do not behave that way.

Similarly, on the subject of their apparently sincere (?) belief that all the evidence that displeases them must be corrupt...

ANTZ do not hesitate to corrupt scientific inquiry, lie about scientific results, and otherwise produce stinking pools of junk- and pseudo-science, and so they assume that their opponents have the same lack of concern about good science and ethics.

I was particularly impressed by Carl's discussion of the claim that most smokers want to quit which nicely expresses my own thoughts on the matter...

It is commonly claimed that most smokers want to quit. The surveys that support this are actually quite suspect, since smokers know that they are supposed to say that, and thus often just give that answer as cheap talk. But while this explains a large portion of the responses, there are definitely some people who sincerely assert that they want to not smoke, even as their actions show that they are choosing to smoke. But what can this obvious contradiction possibly mean? It almost certainly means, in most cases, that their second-order preference is to be someone who wants to not smoke, even though the reality is that they are someone who really wants to smoke.

This is an important point. It is often said that 70 per cent (or more) of smokers want to quit. As Carl says, the surveys are questionable and there is a big difference between stated preferences and revealed preferences.

Aside from the fact that only a small fraction of smokers actually quit smoking each year, only around 30 per cent of them even attempt to quit smoking each year. The high failure rate of those who attempt to quit can plausibly be cited as proof of "addiction", but the fact that at least half of the smokers who claim to want to quit don't make even one attempt to do so suggests that their stated preference is not their true preference.

As Carl points out, what these smokers are really saying is they wish they enjoyed not smoking as much as they enjoyed smoking. This does not preclude the possibility of genuine physiological addiction, but the fact that many smokers resume smoking after a long period of absence, when physical cravings are a distant memory, strongly suggests that people smoke because (whisper it) they enjoy it.

There is nothing horrible, or even the slightest bit unusual, about this second-order preference pattern. We all have countless preferences for different preferences. I would prefer to like going to the gym as much as I like playing computer games, and I would prefer to like unsweetened iced tea as much as I like Coke.

Public health campaigners assume that it is their job to force people away from their revealed, first-order preferences towards their stated, second-order preferences. If people say they want to eat more healthily or quit smoking but fail to do so, the campaigners blame the retail environment, or the industry, or the government for failing to "make healthy choices easier".

But the campaigners cannot make the second-order preferences more appealing or more enjoyable. They can only make the first-order preference more expensive, or less attractive or—the nuclear option—illegal.

Notice that I do not want diminish my enjoyment of computer games to the point that I prefer the gym; I want to raise my enjoyment of gym-going to that of computer games. If there were an action that accomplished that, making gym attendance better without diminishing the value of any alternative, there would be no question that this was an improvement in the world. But, of course, for most actions, particularly those where there is profit to be had by improving quality, there is no such magical cost-free improvement that no one has bothered to implement. You can sweeten and flavor the iced tea, but only at the cost of making it nutritionally about the same as Coke. My gym options are much nicer than the university weight rooms I frequented for a few decades, thanks to the wonders of the free market, but those wonders are still not enough to change the fact that staying home is nicer still, and there is no reason to expect magical further improvement.

Many anti-smoking efforts can be characterized as attempts to cause people’s preferences to align with their second-order preferences. But this is done by lowering the net benefits of smoking until quitting is the preferred option. That is ethically justified if (and those of us who believe in individual liberty would argue, only if) those who are affected genuinely want an external actor to do that to them, and they understand that the action is not going to make being abstinent as good as smoking, but is going to make smoking as bad as being abstinent. So, a drug like Chantix that makes someone not want to smoke is fine (ignoring, in this analysis, the side effects), so long as someone understands that it probably will not make the experience during long-term abstinence as enjoyable/productive/etc. as life when they smoked, but is merely going to lower the benefits of smoking in the short run to help achieve a new habit of abstinence that is in line with the second-order preference that the individual cannot bring herself to act upon.

...When the ANTZ defend policies that make smoking more costly and less pleasant with language like “helping smokers quit”, a standard response is that this is utter crap: Intentionally inflicting pain on someone to try to modify their behavior is called “torture”, not “help”, and it violates all accepted modern Western rules of ethical behavior.

...When the ANTZ claim that torture is help, they are invoking the implicit (and clearly false) claim that everyone affected by the torture has second-order preferences for quitting, and also invoking the implicit (and clearly false) claim that they want someone to use force to align their preferences with their second-order preferences by inflicting torture until quitting is preferable to smoking. In addition, the ANTZ are making the implicit (and clearly false) claim that all of these smokers who want to be forced really understand that when they are abstinent they are likely to be less happy/productive/etc. compared to when they were smoking.

Do go read all the rest.


nisakiman said...

This is a most excellent analysis by Carl. Probably the best description of the 'smoker's dilemma' that I've read. At the end of the day, smokers don't not quit because they are 'addicts'. They don't quit because they don't want to.

Any addiction is surmountable. Even real addictions (like heroin), as opposed to 'habits', which I class smoking as. I speak as one who is intimately familiar with 'real' addiction. If the actual desire to quit is there, then doing so is not an impossible outcome. It is quite achievable.

I long ago gave up wanting to give up smoking. I've done so a couple of times for periods of a year or more, but realised that the possible downsides were heavily outweighed by the pleasure I get from it.

Yes, good call by Carl.

Karl Fasbracke said...

I recently found a document by Dipl.-Hdl. Ernst-Günther Krause, an ANTZ executive, where he tries to make their own volunteers make friends with the professional ANTZ. In particular, he asked for some understanding, that the pros
- have to obey orders from their superiors
- get paid
- are financially dependend on their organization
- are sometimes smokers themselves

More about that on my blog

RdM said...

Search out and read
A Critique of Nicotine Addiction

Also, see and study (old, now?)& note

Just for starters

Let's also not forget essays at

Particularly, of those, Gio Batta Gori's

(and his other works there)

Associate with ... ?