18. Addiction vs. Intelligence

March 27, 2016

Even in people who are purported to be very smart, addiction trumps intelligence.

A few months ago I was chagrined to find an announcement for a periodic gatherings at a local cigar shop in a local Mensa publication called Much Ado About Mensa (MAAM).

I can’t locate the exact words of the response I received from the then editor, but it was to the effect of, ‘if a member wants to announce an event we publish it, which does not imply approval or endorsement’.  Kind of a First Amendment argument, I suppose, though it did not relieve my concern about the apparent endorsement and actual “enabling” of an event that contravenes common sense and the goals of national public health policies.  What follows, for what it may be worth to others,  is the letter I had sent to the editor of the Mensa newsletter:

Nicotine Addiction

For nearly 25 years I was a nicotine addict. Happily that ended for me forty years ago. In those days no one but the tobacco companies realized that the reason people used nicotine was because it is more quickly and powerfully addicting than heroin. And of course they weren’t telling. Most people referred to smoking as a “habit”, and the companies used the euphemism “adult pastime”.   While at the same time, of course, aiming their marketing at children and teens.

When I was in college in the early ’50s, marketing representatives of the tobacco companies flooded campuses with pretty girls handing out little packages of four cigarettes. The girls would extoll the “taste” of the brands they were pushing and encourage kids (along with many other entering students I was 16) to try it for themselves. What the companies had already discovered on an empirical basis, that science finally established only many decades later, was that it takes the nicotine from merely four cigarettes to light up the brain’s nucleus accumbens with dopamine, in a repeated pattern that establishes a very strong need to have a fifth such experience.

Once started, it takes most people several decades to stop using nicotine, if they ever do, short of dying. This despite modern awareness of the severe adverse consequences to health and life itself. (Persistent use despite serious adverse consequence, by the way, is one of the features that defines an addiction.)

As it happens, a cigar or pipe full of tobacco delivers about eight times the nicotine found in a cigarette. And nicotine is easily absorbed through intact skin. There is a famous case of a worker in a plant making nicotine garden spray, for roses, who fell from her stool in a seizure. When no cause could be found she returned to work, only to fall again from her seat at work with another convulsion. It was determined that spilled nicotine spray had puddled on the contoured seat of her stool and saturated the seat of her work clothes. Enough was absorbed through the skin of her buttocks to cause the seizures, and enough had remained in her clothing to cause their repetition.

Inhaled nicotine is absorbed instantly into the blood in the lungs, and reaches the brain in about seven seconds. Many smokers know that it is better to take the first morning drag sitting on the edge of the bed, because a few seconds later a wave of mild vertigo passes through them. While some cigar and pipe smokers think they are safe because they rarely inhale, they absorb the same amount of nicotine through the mucosa of the mouth and nasopharynx as inhalers do through their lungs.

Even ignorant as I was of these matters, after attending my first autopsy in medical school in the 1960’s, and seeing the lungs of that smoker, I quit smoking for a few years. Then, when I was a surgical resident, my intern’s wife had a baby and after a protest I allowed myself to be talked into smoking an “It’s a Girl!” cigar. Still ignorant of the quantity required to re-initiate an addiction, I didn’t want to be impolite. After a month of suppressing an urge to smoke a second cigar, I went to the hospital gift shop and bought one for myself.   Over the course of a few weeks it ramped up to two or three cigars a day, then when I intentionally left the cigars behind on a family camping trip, in a moment of stress, grabbed my wife’s cigarettes and was off to another eight years of smoking a pack a day.

At twenty puffs per cigarette and twenty cigarettes per pack, that’s four hundred fairly evenly spaced intravenous jolts of nicotine to the brain per day. Just what the addicted brain ordered! However, since finally quitting for good in 1976 I have avoided 5,840,000 of those little nicotine jolts to the brain. And at today’s prices in New York City, I have avoided paying out $204,000.00 for them.

The taste of  sugared and flavored tobacco may be mildly pleasant, for the first fews puffs. After which. considered dispassionately, it is more fairly  described as painful and unpleasant. Regarding another oft-advertised benefit, nicotine is only “calming” to a nicotine addict, in whom it relieves the agitation of actual or impending withdrawal. The non-addict, who lacks the agitation of nicotine withdrawal every half hour, therefore doesn’t have need for, nor benefit from, the “calming” effect nicotine.

I am not a doctor who believes that others have to do as I do, or even follow my advice. Initially, it is for each to decide what he or she wants to do about nicotine… with the understanding, of course, that within a very short term of usage, addiction robs us of that rational choice.

Nevertheless I am bemused to find the following announcement in various event schedules and in the MAAM:

“Wed Nov 11 — 7:00 PM to ?  UP IN SMOKE  Fox Cigar Bar has a little of everything and A LOT of some things! C’mon down and enjoy stimulating conversation and the huge walk-in cigar humidor and a liquor selection that would make even the most finicky drinker do the happy dance. Flexible end time. Every 2nd Wednesday of the month. AE – Adult Event, S – Smoking OK indoors, WA – Wheelchair Access. … No RSVP required. Public event.”

And in the MAAM blog, I read a lead article about the new Fox Cigar in Scottsdale, with a huge picture. This goes beyond individual choice. This constitutes organizational behavior and support for the coordinated use of an addicting and dangerous drug with no redeeming social value whatever. This is a position worthy of reconsideration, and consultation with the membership.

[Following 28 years of Board Certified Family Practice, I returned to a three-year state hospital residency that resulted in board certifications in General and Addiction Psychiatry. I worked in that capacity, as a state hospital forensic psychiatrist, until my retirement at the beginning of the millennium.]

In the end, the Mensa publication continued to run the ad and my words were wasted on the editor and the local governing body.  But perhaps you will find them useful.  (Smiley face.)