Tuesday 27 December 2016

The Much-Ignored Pleasure Of Smoking

There is a report out today from the Centre for Substance Use Research (CSUR) in Glasgow which should be compulsory reading for anyone and everyone in the tobacco control industry. Sadly, it will be largely ignored.

Entitled "The Pleasure of Smoking", the report canvasses the views of 583 'confirmed' smokers; that is, smokers who enjoy smoking and are mostly resistant to demands to quit. Lead author Neil McKegany explains why this research should be heeded in the Executive Summary.
This research has provided considerable detailed information on the way in which smoking is viewed by a group of confirmed smokers. This is a group whose opinions are rarely articulated. The implications of these findings from a smoking cessation perspective are significant because there is a clear gulf between the way smoking is typically viewed as a negative, somewhat reprehensible behaviour, and how the smokers themselves saw their smoking as a source of pleasure, a choice rather than an addiction. Whilst it might be objected that "Smokers would say that, wouldn't they?", if stop smoking services are going to succeed in engaging with those smokers who continue to smoke in the face of the extensive efforts aimed at encouraging smoking cessation they are going to have to be prepared to engage with smokers on the terms upon which those individuals view their own behaviour. This includes being willing to recognise the pleasurable elements of smoking. 

There are two things to observe about that introduction. Firstly, tobacco control has never been remotely interested in articulating the views of smokers, instead they have sought every avenue by which they can ensure the views of smokers are silenced or ignored.

Secondly, if any tobacco controller were to admit that smokers derive pleasure from smoking rather than merely being addicted, they would experience an avalanche of abuse and threats from their colleagues who are driven solely by the need to actively denormalise smoking and cast smokers as third class citizens incapable of rational independent thought. The report points out how such vile behaviour from tobacco control would never be tolerated in any other policy area.
In other contexts we recoil at the suggestion of excluding individuals from social gatherings on the basis of their gender, race, religion or sexual identity and yet we positively embrace the notion of excluding smokers from gatherings in enclosed public places. The increasing marginalisation of smokers means that we are less and less inclined to ask them about their views on smoking or their views on the evidence of smoking harm, of addiction, and their interest in changing their behaviour. As a result we understand less and less about the experience of smoking as seen through the eyes of smokers themselves. 
Yep. Those who wish smokers to quit have never been prepared to "engage with smokers" at all, a tactic that vapers might recognise too. It is why tobacco controllers have never, and will never, understand smokers or other users of nicotine. Simply because they don't want to.

Denormalisation has been a stated tactic of tobacco control for many years now, they are quite open about it. Ignoring smokers is just one facet of that approach. Considering this is an attitude endemic within the anti-smoking industry, it is no surprise that the smokers surveyed by CSUR find nothing of any interest when they come into contact with the "well-meaning people but bloody useless" (from the report) staff at stop smoking services.
 “I had worried that quitting smoking would be bleak dull soulless and righteous. Everyone I dealt with through stop smoking services confirmed that view. Not wanting to be like them is one of the reasons I started smoking again”, “It was rubbish and I was rather stunned when it was pointed out to me that ‘By now you are supposed to be using weaker patches and close to quitting’. I was not aware I was on some kind of timetable and they witter on so much at you. They turn it into something much bigger than it needs to be and pepper their speech and information packs with so much negativity and wittering on that it just isn’t worth continuing.” 
Smokers commented that they had found a judgemental attitude on the part of staff within the smoking cessation clinics that had a negative impact on their contact with the service: "I felt the advisor was condescending and holier than thou", "Weak, of little consequence, and coming from a position of sanctimony and patronisation, anti-smoking products are a placebo, they don't work", "Pseudo sales person for the pharmaceutical industry products. Promoted by quit smoking advisors who lacked any knowledge of smoking other than the anti-smoking dogma", "Negative vibe because I am a smoker".
I'm sure staff who profess to be committed to stopping people smoking might not like the idea that their attitude isn't helping, but just like any other industry it is the messages from above which are responsible for it. In an atmosphere, created by the extremists in tobacco control, where smokers are denormalised and society treats them with contempt - merely 'nicotine addicts' who imagine pleasure instead of experience it - it's hardly surprising.

Of course, there is another way.
Successful models of engagement of smokers need to recognise and work with the enjoyment and pleasure that can be found in smoking. If smoking cessation services solely or principally stress the health harms associated with smoking and lay strongest emphasis on an addiction model to explain continued smoking in the face of those acknowledged harms, they will simply continue to find themselves very distant to the sorts of smokers we were surveying. 
The report also details how these committed smokers are very well aware of the health risks involved but - contrary to every policy justification the tobacco control industry has ever suggested - make value judgements based on the (exaggerated) guidance they are given and choose to smoke anyway. In the section on willingness to try harm reduction products like e-cigs, for example, a concern for health was way down in fifth place behind the ability to use them in public places, the fact they are cheaper, and preferences about flavour and smell.

In fact, the CSUR report covers this counterproductive tobacco control idiocy too.
A small number of smokers drew attention to sanctions on public vaping and some people's negative reactions to vaping as having undermined their experience of using the devices. "Same social stigma as as smoking so what's the point, may as well keep smoking the real cigarettes as much more pleasurable", "Still had to stand outside to vape, often right next to rubbish bins, this made it pointless to switch hence not using now", "Restrictions on use" and "Vaping bans"
In light of this, I shall digress briefly and remind you that there are individuals around who believe smokers should quit smoking and use e-cigs instead; are head of organisations which have policies supportive of e-cigs; yet still go to national newspapers like, oh I dunno, The Times, and say that vaping should be banned in all public places. I mean, how cretinous do you have to be to come out with ignorant garbage like that, eh?

It's especially counterproductive when the CSUR research also found that smokers who had tried e-cigs "reported enjoying cigarettes significantly more than those who had not". By attacking vaping simply based on their stupid prejudices, anti-smokers could therefore well be actively harming the chances of committed smokers switching to e-cigs.

Of course, they have no way of knowing that because they won't talk to smokers - instead being determined to ignore them - and will also dismiss today's published report. How do we know this? Well, because they have done so already.

In October, ASH Scotland prepared the way in a blog entitled "The “smokers survey” that can’t tell us anything about “smokers”".
The stated aim “To find out what smokers really think” seems to have missed this crucial point. Surely FOREST is not intending to use the results of this survey to make claims about smokers as a whole? To allay our concerns, will they state clearly that their survey cannot be taken as representative of the views of all smokers and will not be presented as such?
As is customary, attempts were made to make it clear that this wasn't the intention of the report, something that CSUR are open and transparent about in the Executive Summary. However, ASH Scotland were the very opposite of open and transparent, and two months later have still refused to publish comments on their article.

This is because the tobacco control industry, as I have said, don't want to hear about the views of smokers and will wriggle and squirm to make sure they never have to. The CSUR report is very revealing and could be useful to an industry wishing to help smokers to quit. Sadly, the tobacco control industry isn't interested in that at all. It doesn't care about why smokers smoke and definitely doesn't want to hear about what smokers think, far less to engage with them.

So this report will be widely ignored; lessons will go unlearned; and it will all be dismissed as being a tobacco industry plot. This, my valued fellow jewel robbers, is why it has never been about health. 

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