Your Cigarettes Or Your Sanity

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Will Truman

Will Truman is the Editor-in-Chief of Ordinary Times. He is also on Twitter.

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  1. Avatar Em Carpenter
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    A similar but less sympathy-inducing situation is jails and prisons.
    Several years ago, the regional jails here banned smoking (which was something a majority of inmates did). Who cares, right? Let criminals be miserable. What happened was cigarettes, already a hot commodity in jails, became even more valuable as contraband. It increased violence. Created a new black market for the more industrious inmates. Resulted in more folks charged for trying to smuggle it in.

    But the worst byproduct in my opinion was this: prisons still allowed smoking when the jails quit, so I had clients who were literally eager to plead guilty so they could be sentenced and transferred out of jail to prison. I know it might seem absurd that someone would do that just so they could smoke, but I heard it more than once: “I’ll plead guilty. Can I be sentenced right away so I can go to the prison where I can at least smoke?”
    It is that strong of an addiction.

    Now, you can’t smoke in prison, either. Maybe that ought to be the new iteration of a scared straight campaign: “Don’t do crime, you can’t smoke in lock up!”Report

  2. Avatar PD Shaw
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    says:

    I never really thought about this, but I guess I would have assumed (based upon the stringency of my state’s decades old anti-smoking laws) that mental health facilities would ban smoking on premises, but substance abuse facilities would not. That seems to be the national trend:

    Approximately half of mental health (48.6%) and one third of substance abuse treatment facilities (34.5%) reported having smoke-free campuses.

    Link

    OTOH, I would also assume that smoke-free campuses would provide assistance to cessation, but I guess I would be wrong:

    Among facilities with smoke-free campuses, 57.3% of mental health and 39.4% of substance abuse treatment facilities did not report offering counseling, 67.6% of mental health and 65.7% of substance abuse treatment facilities did not report offering [nicotine replacement therapy], and 74.6% and 75.8% did not report offering non-nicotine medications.

    That’s harsh.Report

    • Avatar PD Shaw in reply to PD Shaw
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      Looking closer at the underlying data, it looks like “mental health facilities” includes the types of outpatient care that usually takes no more than an hour. One that my wife once worked at is categorized as “smoking permitted in designated areas” which I believe means the parking lot more than 20 feet from the entry way. I think Will’s piece is more directed to residential facilities, and this probably means more residential facilities are smoke-free facilities than those numbers. Unclear about the rest.

      My bottom line is that I don’t see any rationale for the state to ban smoking at a substance abuse treatment center. That decision should be up to the substance abuse specialists.Report

  3. Avatar Aaron David
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    says:

    I used to smoke. 30ish years, and it took a good 6 to quit. I had to slowly wean myself away, by pushing back the time I would have my first one, limiting the number of cigarettes a day, where I would smoke them, hiding it from my wife, etc. Eventually, I got to the point where I would get nicotine poisoning after a smoke. At that point, I lasted for about another year.

    I would start smoking in a heartbeat if I was no longer married. I fantasize about cigarettes, plot ways to go have one that is not unlike the actions of a cheating spouse. I walk closer to people on the street who are smoking to just get a whiff of the smell. But I haven’t had one in probably 3 years.

    All of that said, the issue for many of the people pushing to get society to completely quit smoking, at least in my view, is that they have never had to quit as they have never had one. And it has become closer to a religion than a health issue for them, not unlike the temperance movement. Smoking also implies class, and as with many other things with that implication, it signifies a moral failing. The other smokes, the weak, the deplorable. It must be stamped out.Report

    • Avatar bookdragon in reply to Aaron David
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      says:

      My Dad smoked for years. Addiction is powerful, and it’s not just to the drug. That passes in a couple weeks (which is why cold turkey works well so a lot of people) but the psychological addiction hangs on for a long time and the closer it is tied to a sense of relief/comfort the harder it is to overcome. When my mom was being treated for cancer and couldn’t be around smoke, he couldn’t kick it. He just switched to only smoking outside. It took watching his mom die of lung cancer to finally do it.

      It’s not like he never really tried until later in life either. As a kid I would do everything, up to and including stealing his cigarettes and hiding them, to try to get him to quit. I had motive btw: I have asthma and a mild allergy to tobacco. My aversion to it has nothing to do with class or judging another as weak. It has to do with a preference for breathing without feeling like I have to work for each breath.Report

    • Avatar dragonfrog in reply to Aaron David
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      says:

      I never smoked for anything like the length of time you did, but 3 years after quitting, I also kind of wanted to start smoking again. I did occasionally have a smoke here and there, felt dizzy and gross each time, and had noticeably sore lungs for a day or two afterward.

      It took many years of being quit, and those periodic reminders that I didn’t physically enjoy smoking anymore, to stop wanting to smoke, smell cigarette smoke, roll a smoke just for the physical act or rolling one, etc.

      But it did happen, so gradually I didn’t really notice.Report

      • Avatar Aaron David in reply to dragonfrog
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        says:

        Yeah, that whole ritual thing…

        Getting a deck of smokes, tamping them against the palm of the opposite hand, rolling off the wrapper and unfolding the top. Gently tapping the bottom to get just one to come out, lighting it and taking that first draw. Then the exhale…

        Ok, sorry, that was a bit porny.Report

        • Avatar Jaybird in reply to Aaron David
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          says:

          Here’s what I wrote last year:

          Smoking provides five distinct pleasures.

          1. The taste. Not even just menthol or some of the wackier flavors. Just plain tobacco tasted *GOOD*. And smoking after brushing your teeth or after a really good meal. Mmmmm.

          2. The nicotine itself. It is by will alone I set my mind in motion. It is by the juice of sapho that thoughts acquire speed, the lips acquire stains, the stains become a warning. It is by will alone I set my mind in motion.

          3. The hand thing.

          4. The mouth thing.

          5. The playing with fire thing.

          All of these together created a wonderful pleasure that went on to leave you something just under “satisfied”.

          The gum? The patch?

          Meh.

          Report

          • Avatar InMD in reply to Jaybird
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            says:

            That count isn’t even exhaustive. For me the ritual was intimately connected to the social aspect. I miss the ‘taking a break’ part and the extra accompaniment at the bar with a beer more than any puff I ever had driving to work or class or whatever.

            Luckily as most of my friends have stopped its made it easier for me to break my habit. Back when everyone still smoked I found it impossible to get through a night out without one, even when I’d successfully eliminated cigarettes from my personal routine.Report

          • Avatar JoeSal in reply to Jaybird
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            says:

            I never smoked, but remember when a pack of new smokes were opened nearby I could smell the fresh tobacco. It was always that smell of a fresh commodity, like coffee or cocoa.Report

  4. Avatar North
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    says:

    I hate cigarettes myself, hate the smell and hat my families history with them. That being said I was quite satisfied and ready to call anti-cigarette crusading to an end after it was driven from the bar and public scene. It seems severe overkill to go after every enclave where smokers can huddle to indulge their addiction and it’s nonsensical bordering on farcical to go after vaping which ameliorates most of the health impacts. Anti nicotine crusading smacks more of prudery and busybodiness than justifiable advocacy now days and I definitely don’t support it.Report

  5. Avatar Jaybird
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    says:

    I quit cold turkey about 10 or 11 years ago.

    I now weigh somewhere between 60 and 70 pounds more than I did when I smoked.

    I still sometimes smoke cigarettes in my dreams.

    I don’t know that I’ve thought about my mother every day for the last 10 or 11 years… but I’ve thought about smoking every day.Report

  6. Avatar DavidTC
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    says:

    There are basically two ways to stop smoking from existing:

    1) Stop allowing the sell of tobacco.
    2) Don’t allow the sale of tobacco over the counter, make people get a prescription for it. Treat tobacco addition like a medical condition, and everyone who has it is under the care of a doctor with the goal of removing the addition. (Which doesn’t mean we do it without compassion, or even succeed always.)

    If we wished to stop tobacco use from existing, we have to do _at least_ the second. We…clearly do not wish to do that.

    If we’re not doing that, then all these restrictions exist to punish people for completely legal activities under really unscientific justifications. Let me be clear: Secondhand smoke does exist, and it was (and still is) a problem for people who stayed in smoke-filled rooms, like people who lived with smokers and bar employees. I’m on board with basically barring it inside any public building, or inside homes with children.

    But there’s basically no medical justification for barring it from entire hospital campuses…there’s not even any medical justification for ‘can’t do it outside the door, have to move large distance away’ rules I see.
    As long as smokers aren’t literally sending smoke directly into people’s faces for an hour (At which point it’s like…why are you still standing there next to smokers?), the entire ‘secondhand smoke’ outside thing is basically nonsense. Smoke rises.

    Smelling tobacco for a second won’t instantly give you cancer, and we don’t function this way towards _any other_ microscopic increase in the risk of cancer….like, oh, people walking through underground parking garages. Hell, way back when we started caring about secondhand smoke, a lot of research went into proving that indoor secondhand smoke was worse than outdoor car pollution…which it…might be? We’re not sure. But walking down a city street and passing a smoker is increasing your risk of cancer…from those cars you just walked past, not the smoker.

    Our air quality in the modern era is utter shit. The fleeting smell of tobacco smoke (Most of the time, it isn’t even any actual smoke, just the smell of it, because, again, smoke rises.) isn’t the problem. It’s not burning tobacco that’st the problem, it’s burning hydrocarbons.

    And people are about to say ‘Some people are very sensitive to smoke’, and it can trigger asthma …yeah, and some people are sensitive to perfumes, and weirdly we let pretty much anyone wear perfumes and body spray and whatnot in all circumstances. Even inside.

    And our response to smokers is clearly some sort of punishment. Hospitals usually have reasonably large amounts of outside spaces, and even if we wanted to keep smokers separate it would be completely possible to have a designated area. Instead we’re not letting people smoke on them at all. Other places have idiotic signs about not smoking within fifty feet of the door, because tobacco smoke is apparently made of acid and will dissolve non-smokers and entire buildings on contact.

    And, for reference, I say all this all as someone who has never smoked, and thinks that we actually should implement #2 up there for a few years and then #1. Basically, I think we should pass bills to outlaw tobacco in any form in ten years, and then spend ten years trying to help the addicts get off it. Smoking is _utterly stupid_ for us to allow as society. Incomprehensibly stupid. That opiate epidemic we’ve all forgotten about? Still kills about a fifth the people as tobacco does, and tobacco kills people _expensively_, over years, vs. a clean overdose.

    That doesn’t mean we should run around punching smokers, who are addicts who have usually either been manipulated by others or advertising, or have started as minors. They are the victims, not the enemy.Report

    • Avatar Aaron David in reply to DavidTC
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      says:

      Of those things you mentioned, the 1 and the 2, have they ever worked for any drug?Report

      • Avatar DavidTC in reply to Aaron David
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        says:

        To the extent of having less people addicted, they work fine.

        I know everyone loves to hate on the drug war, but the drug war works in reducing the amount of actual drugs. It just has a lot of very stupid side effects that are _nowhere near_ the problems of the actual drugs, and is extremely expensive.

        In fact, because tobacco is such a _bulky_ drug, and requires a lot more care and handling than marijuana, prohibition would work particularly well. Making usable tobacco takes a lot of work and a lot of space.

        But even if it didn’t: Tobacco kills more people than all other illegal drugs. And murder. And suicides. And alcohol. And car accidents. All put together. Seriously.

        Same with cost. Drug prohibition, in the US, costs about $40 billion a year. The entire thing. Tobacco use costs $140 billion in health care.

        It’s _really_ hard to imagine a world where tobacco prohibition somehow ended up worse, or costs more, than allowing tobacco currently is. Is tobacco prohibition somehow going to make the murder rate go up _times twenty_?

        The scope of problems caused by and the cost of tobacco use so dwarves the _entire_ illegal drug system it’s not funny.Report

        • Avatar InMD in reply to DavidTC
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          says:

          How much prison time do you think is reasonable for someone caught with, or growing tobacco?Report

          • Avatar DavidTC in reply to InMD
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            says:

            I don’t think any prison time is appropriate for tobacco addicts. They should get treatment, just like we should be treating current drug addicts.

            Distribution of tobacco, as well as manufacture, would be crimes, with presumably different levels for different amounts.

            And I think people have failed to notice that I have said nothing about nicotine being outlawed, and that’s actually what people are addicted to. I just argue we should outlaw tobacco. I don’t think people wearing nicotine patches or vaping is particularly a good idea, but it shouldn’t be illegal.

            Gee, I wonder if people are going to purchase legal nicotine or risk the black market?

            This is, of course, the difference when you look at drug use via a _harm reduction_ view vs. the idea that drug use is somehow inherently immoral. I don’t oppose tobacco because I think it’s ‘bad’, I oppose it because tobacco is extremely ‘dangerous’ (Which is sorta like saying ‘being on fire’ is dangerous…it’s a bit past ‘dangerous’.), and is basically the number one preventable killer in the US. Nicotine, however, is basically a harmless stimulant with a high tolerance and withdrawal, and as long as people take it in reasonable doses they’ll be mostly fine. It’s not the greatest thing in the world, but it’s like…caffeine times fifty. As long as it doesn’t come encased in tobacco.

            And before anyone wonders…they do not use traditional tobacco plants to get that nicotine. They grow Nicotiana rustica, which has such high levels of nicotine that it’s basically unsmokable. The controlled production line for legal nicotine is not going to have much tobacco wander off it.Report

        • Avatar Morat20 in reply to DavidTC
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          says:

          I’ll bet money that, within 20 years, you’ll have the former tobacco giants (suitably rebranded), legislating to ban cigarettes and cigars due to their incredibly costs to society and the associated health costs.

          Because, of course, they’ll make more profit off of e-cigs, vaping, and selling (fluid? oil? Whatever the heck it’s called) under whatever labels they bought out and took over.

          Same business model — sell drugs to serious addicts (nicotine is addictive as hell), but this time without that little “Cancer” problem. I’m sure vaping and nicotine use has long-term health problems, but they’re nothing compared to whole “cancer” part.

          Philip Morris will end up cheerfully selling tobacco, and use it’s own cancer-ridden history as a way to handwave away complaints about addiction and long-term health effects.

          And I can’t say they’d be wrong. I mean wave a magic wand and move every smoker in America to e-cigs and vaping? Sure, they’d still be nicotine addicts. But the odds of them dying from lung, mouth, or throat cancer would have dropped like a stone.Report

          • Avatar Will Truman in reply to Morat20
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            says:

            PMI announced a couple days ago that it plans to get out of cigarettes by 2030 or something. Though I think they have their eye on Heat-Not-Burn products.Report

            • Avatar Morat20 in reply to Will Truman
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              says:

              If they can give smokers something they’ll transition to, even requiring a hefty push to get them there, they’ll jump in a heartbeat — and close their old market behind them.

              I’m leery of vaping and the like simply because of how addictive nicotine is, and how expensive using it tends to be, sure. But cigarettes were already exactly that, and also massive amounts of cancer.

              I’ll take less cancer and call it a win. I won’t be any happier about nicotine use, nor any less angry about it being marketed to kids, but frankly it’s the cancer that’s 99% of the wind in the sails of “Have we considered abolishing tobacco use”, including my own.

              If smoking didn’t cause cancer, it’d move entirely to “That stuff is expensive and addictive as hell, and don’t blow it in my face, that’s incredibly rude but whatever man, your wallet.”Report

    • Avatar bookdragon in reply to DavidTC
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      says:

      Speaking as someone who has asthma and is sensitive to tobacco, I greatly prefer that smokers are off in designated areas rather congregating around doors. Not because I can’t hold my breath, but because it fishing hard to both hold your breath and ask a crowd to move out of the way of a door.

      And yeah, maybe smokers now feel looked down upon and that’s not fair to someone struggling with addiction. However, (1) social pressure works, especially wrt teens, and (2) it means that if I politely ask someone who sits down next to me at an outdoor event to please put out a cigarette or smoke elsewhere, they are now more likely comply whereas for much of my life it was 50/50 if they’d think it was clever to deliberately blow smoke in my face as an answer. Frankly, if smokers are overly restricted now, a lot of blame for that goes on the many who were excessively rude like that. Also, I know for a fact that long before the secondhand smoke evidence was overwhelming one hospital banned it completely inside because of all the idiots who saw nothing wrong with lighting up around people on oxygen.Report

      • Avatar Dark Matter in reply to bookdragon
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        says:

        social pressure works

        My wife is an extreme case. She smoked, for years (everyone in her section of East Europe smoked).

        She was in the US, we started dating, she found out I didn’t smoke and was opposed before I found out she smoked.

        So she quit and claimed she was a non-smoker, afaict effortlessly. How you smoke for years without getting addicted I have no idea.Report

  7. Avatar Jaybird
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    says:

    To deal with the point of the essay (rather than fondly remembering the joys of smoking and not being obese), there strikes me as being as much an aesthetic issue as a moral one.

    While it makes some amount of sense (I suppose, on a purely engineering level) to prevent people from smoking in mental health hospitals, it makes *ZERO* sense to keep them from vaping. The opposition to vaping isn’t based in harm reduction to bystanders (sure, make them vape outside in the vaping area like it’s 2005 or something). It’s barely based in harm-reduction to the person vaping given that the harm is pretty dang small.

    The opposition is based to the nicotine itself.

    I’ve heard the argument that nicotine is a lower-class pleasure and so opposition to it is based in classism. That strikes me as an overstatement to some degree… but it has some explanatory power.Report

    • Avatar PD Shaw in reply to Jaybird
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      says:

      Based upon experience gained from relatives working in the mental health field, never underestimate the possibility that underneath it all, the policy at issue is either cheaper monetarily, less burdensome for employees, or both.

      On vaping, Malcolm Gladwell has an article in the New Yorker:

      Among members of the public-health community, it is impossible to spend five minutes on the e-cigarette question without getting into an argument. And this is nicotine they are arguing about, a drug that has been exhaustively studied by generations of scientists. We don’t worry that e-cigarettes increase the number of fatal car accidents, diminish motivation and cognition, or impair academic achievement. The drugs through the gateway that we worry about with e-cigarettes are Marlboros, not opioids. There are no enormous scientific question marks over nicotine’s dosing and bio-availability. Yet we still proceed cautiously and carefully with nicotine, because it is a powerful drug, and when powerful drugs are consumed by lots of people in new and untested ways we have an obligation to try to figure out what will happen.

      Is Marijuana as Safe as We Think? Permitting pot is one thing; promoting its use is another.Report

      • Avatar Jaybird in reply to PD Shaw
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        Man, I started that Gladwell article and read this paragraph:

        For example, smoking pot is widely supposed to diminish the nausea associated with chemotherapy. But, the panel pointed out, “there are no good-quality randomized trials investigating this option.” We have evidence for marijuana as a treatment for pain, but “very little is known about the efficacy, dose, routes of administration, or side effects of commonly used and commercially available cannabis products in the United States.” The caveats continue. Is it good for epilepsy? “Insufficient evidence.” Tourette’s syndrome? Limited evidence. A.L.S., Huntington’s, and Parkinson’s? Insufficient evidence. Irritable-bowel syndrome? Insufficient evidence. Dementia and glaucoma? Probably not. Anxiety? Maybe. Depression? Probably not.

        Before continuing, did we get to the part where he says that these tests were prohibited by law from being done due to the whole “Schedule 1” thing?

        If he doesn’t, I’m afraid that I’m not interested in reading a word further.Report

        • Avatar PD Shaw in reply to Jaybird
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          Well, there is this:

          It’s hard to study a substance that until very recently has been almost universally illegal. And the few studies we do have were done mostly in the nineteen-eighties and nineties, when cannabis was not nearly as potent as it is now. Because of recent developments in plant breeding and growing techniques, the typical concentration of THC, the psychoactive ingredient in marijuana, has gone from the low single digits to more than twenty per cent—from a swig of near-beer to a tequila shot.

          Schedule 1 doesn’t stop studies in other countries and certain type of studies in the U.S., but long-term studies are always going to be difficult to control, particularly in an environment where the product is changing so much.

          And he really doesn’t get into vaping marijuana, something that the National Institute on Drug Abuse, started surveying in 2017, and in one year, the activity had increased by 50% among high-schoolers.Report

          • Avatar Jaybird in reply to PD Shaw
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            Well, that’s a decent acknowledgment.

            The whole “we haven’t even studied this substance!” argument pisses me off, though. IT WASN’T LEGAL TO STUDY! ARGH!!!Report

          • Avatar dragonfrog in reply to PD Shaw
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            Sure, have you seen the weed vapes that were available a few years ago? Big, unwieldy, cumbersome, breakable, expensive. Now you can get much simpler, more compact, sturdier vapes, for a surprisingly low price.

            I got fledermaus a weed vape for her latest birthday – it was surprisingly cheap for a remarkably nice device – looks nice, easy to use, feels nice in your hand, heats up quickly, and doesn’t make you cough or leave you with sore lungs at all.Report

            • Avatar Morat20 in reply to dragonfrog
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              Friend of mine tried it in Vegas. Disposable, discreet e-cigs were apparently incredibly handy. And minimal to no smell. Cheaper in the long run than something refillable, but I can’t imagine the end-use would change.Report

              • Avatar dragonfrog in reply to Morat20
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                These are liquid-base vape things, for THC rather than nicotine liquid?

                Those aren’t legally available here at least yet, and I don’t know of their existing to any meaningful degree in the illegal market. I wouldn’t trust a black market vape juice anyway.

                The one I’m talking about is basically an electric pipe – you pack it with dried flower, same as a regular pipe, except the spent flower doesn’t look much different from the fresh, as it’s never actually combusted.Report

            • Avatar PD Shaw in reply to dragonfrog
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              I didn’t know vaping marijuana was even a thing until last August. My Freshman son was trying out for the High School soccer team, which has sort of a “Hell Week” where they run up and down a steep hill at sunrise, taking breaks to do calisthenics . For his class, its supposed to encourage some to quit. For the upper classmen, its about bonding and getting ready for the season.

              In any event, driving him home one of those mornings, I noticed some kids get out of a car at the intersection and run around the car to change seats. It’s great when 1950s hijinx never goes out of style. Then all of the sudden I saw a huge vape cloud emerge from a backseat window. I later told my wife about it and how odd it seemed to want to vape after such exertions. She said it was probably marijuana. You can do that?Report

        • Avatar dragonfrog in reply to Jaybird
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          @jaybird It’s way worse than that.

          He selectively cites the bit about there not yet being solid evidence that smoking marijuana helps with chemotherapy related nausea – but conveniently forgets to mention the bit where there is solid evidence that ingesting marijuana helps, because that’s what most of the trials have focused on so far.

          And so on.

          Dave Levitan does a great job kicking the butt of this and many other fallacies, obfuscations, and misrepresentations in Gladwell’s article https://twitter.com/davelevitan/status/1082668393512267776Report

  8. Avatar Saul Degraw
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    I wonder what the statistics are for younger generations (people born 1980 or after) and what the breakdown is for geography, socio-economic class, etc.

    I briefly did the middle-school rebel thing of smoking an occasional cig. I first did this at sleepaway camp. What surprises me was that it was relatively easy to bum a cig from an adult somewhere even though I was well under 18. I stopped cold turkey when I asked a 20-something woman for a cig at a concert and she said “No you are like thirteen!” I was thirteen or fourteen at the time.

    There were a few kids in my high school that smoked but not a super lot from what I recall. In college, there were more smokers but not as many. There was only one person in my regular circle that was a smoker.

    I was in Oklahoma City last year for a depo and saw a bunch of middle school kids vaping. I thought they looked comical instead of tough or sophisticated or rebellious.Report

  9. Avatar jason
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    says:

    I am truly thankful that I never could smoke. I tried a few times as a teen and young adult, but always ended up coughing and never really got the appeal. Same with chewing tobacco.

    Of course, I struggle with food, so I got that going for me.Report

  10. Avatar Rufus F.
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    says:

    In our city, we banned smoking in bars and on patios, but not directly off the patios. So, people walk onto the sidewalks next to the patios to smoke. We still have a somewhat lower life expectancy than surrounding areas due to industrial pollution, but we don’t have as many barflies dying from secondhand smoke presumably.

    I smoked like a chimney when I quit drinking and then tapered off the cigarettes too. I’m not sure how to express why it seems very very cruel to make people seeking recovery from addiction be smoke-free other than to say that, yes, cigarettes will kill you, but people who are seeking recovery are often at the point that drugs or alcohol will kill them imminently if they don’t quit.Report

    • Avatar bookdragon in reply to Rufus F.
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      I heard a discussion on local NPR on the drive in about this. Missed part of it and wasn’t taking notes, so I can’t give the numbers/%s, but there is a debate in the city treatment centers about whether or not to make them smoke free. Not because of cancer or usual tobacco health concerns, but because multi-year studies have shown that people who give up smoking while in treatment centers are several times more likely to remain off whatever addictive substance they went into treatment for, and remain off of it in the long (5-10 year) term.

      So it comes down to a debate about balancing getting the most people into treatment (since smokers may avoid treatment for worse addictions because they can’t imagine giving up cigarettes) vs maximizing positive outcomes for those who enter treatment. Given budget constraints, the argument for maximizing the number who will remain clean is winning in a lot of areas.Report

      • Avatar Will Truman in reply to bookdragon
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        I would be extremely surprised if the addict profiles of people who can quit all at once and those who can’t are the same, or are different in a way to be controlled for.

        And it’s not just about people refusing to go or leaving so they can smoke, but also that even people who try their hardest will fail because that’s not how they can quit. So, having failed to quit to begin with, aren’t included in the relapse numbers even if they do enter treatment. (Though it is possible they did account for this.)

        And even then, even if you are insistent that you should give up smoking too, it’s really not clear that the way they are trying to get you to quit smoking is actually selected for efficacy, removing both tapering and vaping (the only two ways I have quit for any period of time, as it happens) from the arsenal of tools. (And, as PD Shaw notes, a lot of them don’t even offer any tools to help at all.)

        It circles a bit back to the vaping thing. It is the position of vapers that vaping actually inhibits quitting and they have some numbers to back this up. The numbers are actually highly questionable, but let’s assume they are entirely true. What about me and a lot of people I know who needed vaping (not cold turkey, not the patch, not bupoprion) to quit?

        Their answer is invariably that we could have quit another way but… it’s just not true. Even if it is true in the aggregate (again, questionable, but a different question), it’s not true universally. That’s not how any of this works. As I say, the differing nature of addictions differ.

        As I said (or at least indicate) in the Arc post, I don’t have a problem trying to get everyone to quit everything at once. I am not even disturbed by the numbers PD Shaw presents about a substantial number of both types of treatment centers (mental health and addiction) being smoke-free (among other things, if you’re a former smoker who is now a drug addict it’s good to keep you away from smokers), depending on the setup. But there should be a place for smokers to get treatment. Smokers should get access to treatment somewhere in the system.Report

        • Avatar bookdragon in reply to Will Truman
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          Like I said, I only heard half of the piece in my car while driving, so I don’t know how much more in depth they might have gone on the studies, pros and cons, etc.

          I know that not everyone can follow the same path to quitting. I suspect that professionals who study addiction recognize that as well.

          As to vaping, I don’t have a strong opinion about it one way or the other. To the extent that it means people smoking outside won’t force me to go elsewhere to avoid an asthma attack, I’m for it. Plus fewer disgusting butts left on the ground at parks, the beach, etc. However, the way it seems to be drawing teens my kids’ age into using tobacco, I have some serious concerns about its promotion. Honestly, I think the best compromise there would be to make it prescription only. If someone wants to use it to quit, have a doctor write a prescription for the device and x months of supply, renewable based on some reasonable metric of progress at the next check up. If the metric isn’t met, then maybe vaping isn’t the magic bullet for them to quit, so move onto to trying other options and see if one of those works.Report

          • Avatar DavidTC in reply to bookdragon
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            says:

            However, the way it seems to be drawing teens my kids’ age into using tobacco, I have some serious concerns about its promotion.

            If we want to stop private companies from trying to attract kids, the most obvious way to do that is to no longer have them sell it.

            Honestly, I think the best compromise there would be to make it prescription only. If someone wants to use it to quit, have a doctor write a prescription for the device and x months of supply, renewable based on some reasonable metric of progress at the next check up. If the metric isn’t met, then maybe vaping isn’t the magic bullet for them to quit, so move onto to trying other options and see if one of those works.

            Or just…not move on. If they get stuck with vaping it’s still much better than smoking.

            And…I don’t know if I’m missing something or not, but you didn’t say anything about making actual tobacco products prescription-only, so if that’s what you meant, to make vaping prescription-only but smoking _not_, you just…pushed a bunch of young kids (and other people) who would be vaping back into smoking.Report

            • Avatar bookdragon in reply to DavidTC
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              says:

              I guess the genie is out of the bottle wrt people already addicted because of vaping, though I strongly believe kids should not be able to buy tobacco products of any kind.

              If we want to stop private companies from trying to attract kids, the most obvious way to do that is to no longer have them sell it.

              Are you saying that the only alternative to letting tobacco companies sell to kids is outlaw tobacco? Okay… well, if those are my only choices, I pick outlaw tobacco. If the only way to stop companies from targeting kids, is to make the product illegal or only available from highly controlled sources, then so be it.

              As to vaping, the genie may be out of the bottle for a bunch of people, including young people. I wish the Rx smoking cessation approach had been what we did from the beginning there. Selling it cute flavors and such is right up there with putting crack in gummies.Report

              • Avatar DavidTC in reply to bookdragon
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                says:

                Are you saying that the only alternative to letting tobacco companies sell to kids is outlaw tobacco? Okay… well, if those are my only choices, I pick outlaw tobacco. If the only way to stop companies from targeting kids, is to make the product illegal or only available from highly controlled sources, then so be it.

                What I was really suggesting, with regard to vaping, is having the government produce it, and sell basically what it is sold now, at least at first. I strongly believe we should do that for all nicotine-based products, immediately. No real packaging, no ads, no profit-motive.

                After a bit, things like flavors would start being removed. Removing the different variants and whatnot. Reductions in where they can be sold. Eventually requiring a prescription for tobacco-based products, and even more eventually, phasing those out entirely. Perhaps eventually a prescription for vaping and patches, but I’m not really sure we particularly need that. I think maybe just only allowing them sold in pharmacies would be enough to keep kids away.

                And as Will said below, non-tobacco-based nicotine products should always be more accessible than tobacco-based nicotine products. Tobacco-based nicotine products have been a national health emergency for decades that we’ve been utterly ignoring. Nicotine by itself seems to be…super-caffeine or something. Let’s keep it out of the hands of kids, let’s somewhat regulate it and maybe help people off it, but I’m not going to worry that much about it, any more than I worry about the guy who takes three cups of coffee to wake up in the morning.Report

              • Avatar bookdragon in reply to DavidTC
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                says:

                That sounds like a good plan to me.Report

            • Avatar Will Truman in reply to DavidTC
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              says:

              I think Book is saying to move on if they are vaping but haven’t quit smoking.

              Which I am still not on board with. I was a dual-user for over six months before making the final leap. And even when I was dual-using, I was smoking less (studies are mixed as to whether or not this is typical).Report

              • Avatar bookdragon in reply to Will Truman
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                says:

                Yes, but by assessing progress based on a reasonable metric, I’d include the scenario where if you were smoking less while dual-using, a doctor would be justified in renewing the prescription. Perhaps along with a discussion with you as to whether you felt it was helping enough or if you wanted to look at other options you could try either instead or in addition.Report

          • Avatar Will Truman in reply to bookdragon
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            says:

            I’m a compromiser by nature, and I understand the concerns about teens, but there is pretty much no compromise I would accept that makes it substantially more difficult and expensive to access ecigarettes than regular ones.Report

      • Avatar Rufus F. in reply to bookdragon
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        says:

        I’d be interested in seeing how they figured out the numbers on that, because they’d have to measure people who were addicted to cigarettes and addicted to something else, those who were quitting drugs or alcohol but not cigarettes, and I suppose those who didn’t smoke but were addicted to something else. They seem like three groups with very different characteristics. But, who knows. Where I might see some validity is my understanding is quitting drugs or alcohol is more successful if you change your entire lifestyle to accommodate the change. But they also tell you not to change everything at once.Report

  11. Avatar InMD
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    says:

    Thanks for this post. Different topic entirely but this phenomenon is the kind of thing I was trying to get at somewhat in my post last spring. Obviously this is different and the health hazards of smoking are well documented. I don’t have a problem with general discouragement of it, helping people quit, etc.

    But this seems like another one of those situations where zealots have put primacy on the issue at the expense of broader perspective. Worse than that, they’ve been able to infiltrate and influence institutions into myopic policies. It’s almost like a weird form of regulatory capture.Report

    • Avatar InMD in reply to InMD
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      says:

      Just to add maybe the term is something like ‘social capture’ or ‘cultural capture.’ Something where an underlying truth (in this case the dangers of smoking tobacco) takes on a life of its own in the form of conventional wisdom, detached from the underlying science and promoted for its own sake above all other priorities.Report

  12. Avatar PROFESSOR ESPERANTO
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    says:

    Completely disagree. Abolish smoking and vaping in public spaces. Smoking and vaping are “acceptable” because the deaths they cause aren’t immediate and, as a whole, humans are a forgetful and forgiving lot.

    But what about heroin and alcohol and the like? Nobody’s going to be affected by heroin unless the user assaults someone with a full syringe. Alcohol? One would have to be forced to consume alcohol by some ornery lush. Obese people aren’t exactly forcing their food upon others, otherwise they wouldn’t be so fat. Can confirm: I am obese. These constitute assault. A clear and present danger to a person’s safety and well-being.

    Should one live in an coastal socialist state, the police will put away the perp and the courts will decide upon their punishment or rehabilitation.

    Should one live in flyover country where gun laws are free and easy like a fart in a Berlin bath house, and “duty to retreat” isn’t enforceable, then the assailant is endangering their own lives.

    Yet people are assaulted day in and day out by those who smoke and vape exhaling their poisons everywhere. Their residue from second hand exposure builds up and folks die despite having pursued noble, but unnecessary, straightedge lifestyles.

    Of course, everyone dies. But why hasten the process for yourself or others?

    My condolences to people who are addicted to vaping and smoking, but that’s your burden to carry. Not mine. Smoke at home and pick up your butts.Report

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