Who smokes? And why?
Warner: If you look at the population that is at the poverty line or above it, about 18% of them are smokers. If you look at the population below the poverty line, it’s about 29%. If you look at college graduates, 7.5% of them smoke today. If you look at people with only 9 to 11 years of high school education it’s about 36% percent. If we go back to the time of the Surgeon General’s report…
Dubner: That, remember, was 1964.
Warner: …those numbers were very close to each other. So that’s a huge issue, is a socio-economic disparity. And then there is one we that have finally started to recognize and talk about in the field of tobacco control and it is very important — perhaps as many as 40 to 50 percent of all smokers have a concurrent mental health disability or morbidity and/or other substance-abuse problem. The cigarette industry has always liked to talk about smoking as being a rational choice of well-informed adults and yet we have this strong correlation between smoking and mental illness.
Dubner: So this opens up a whole other way to look at smoking – that it is, to some degree, self-medication, with side effects of course. Paul Newhouse is an m.d. who runs the Center for Cognitive Medicine at Vanderbilt. For 30 years, he’s been studying the effects of nicotine on the brain:
Newhouse: We jokingly say in our lab: You know, good drug, bad delivery system.
Dubner: Newhouse tells us that nicotine itself has a number of potentially positive characteristics.
Newhouse: It appears to activate a class of what we call receptors important for regulating a whole variety of brain functions. And so we think that nicotinic receptors are important for things like attention, for behavioral strategies, for what we call executive functioning, which is the ability to make decisions and evaluate information, we think it’s important for memory, and so that has kind of led us to thinking about what particular disorders might be helped by stimulating nicotinic receptors either with nicotine or with something else.
Dubner: So Newhouse and others in his field are exploring if nicotine therapy might be used to treat schizophrenia, Parkinson’s disease, or other maladies.
Newhouse: Things like memory loss disorders, Alzheimer’s disease, pre-Alzheimer’s disease, which is called mild cognitive impairment, we’ve looked at ADHD, attention deficit hyperactivity disorder. Other investigators have looked at things from Tourette’s Syndrome to anxiety disorders to depression. I think the full potential of nicotine and nicotinic drugs is really not even fully known yet.
Dubner: Newhouse does believe, however, that nicotine has medicinal effects, and that is why some smokers smoke.
Newhouse: If you look at heavy smokers you will find that many of them have mood disorders or anxiety disorders as well. The rates of psychological problems among heavy smokers these days are very high. And we think that one of the reasons they smoke is because it produces benefits to them. Maybe it improves their mood, maybe it stabilizes their anxiety, maybe it helps them pay attention or inhibit impulsiveness, etc.