High Anxieties "ss1.09"

NICOTINE ADDICTION

In 1988 the U.S. Surgeon General's report on the health consequences of smoking was devoted to an extended discussion of nicotine addiction. The report concluded that cigarettes are addictive, that nicotine is the drug in tobacco that causes addiction, and that the processes that determine tobacco addiction are similar to those that determine heroin and cocaine addiction.^[5] It termed tobacco use "a disorder which can be remedied through medical attention" (i) and wrote of the achievement and maintenance of "tobacco abstinence" (9).

The pharmacological/medical approach of the report has become widespread in popular literature on smoking, particularly in how-to-quit guides. According to one recent text, smokers who cannot quit are "enslaved not by cigarettes but by a single chemical, C10H14N2, or nicotine."^[6] Another claims that "if you take people who are smokers and withhold cigarettes from them

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but give them syringes containing nicotine, they will inject nicotine into their veins, exactly like heroin addicts."^[7] The language of drug addiction is also routinely adopted in smokers’ self-presentations. Actor Mel Gibson, referring to his twenty-six-year smoking career in a magazine interview ("His right hand plays with a cigarette, despite the fact that only months ago he was celebrating kicking the habit"), is reported as saying that nicotine is harder to get out of the system than heroin.^[8] Nicotine replacement therapies are the technological counterpart of these views.

Whatever the scientific validity of nicotine's particular pharmacology, reducing the meaning of smoking to "enslavement to a chemical" and insisting on its identity as a drug addiction are discursive events that produce the smoker as a pathological subject. The smoker's problem is transformed from a (bad) habit into an addictive disease, and his disordered inner being becomes the proper object of rehabilitative self-discipline. In addition, contemporary discourses of addiction have a disturbing tendency to deny the heterogeneity of human existence: they invoke a totalizing, ready-made narrative to explain the experiences and actions of all addicted subjects, and they install a teleological and universalistic morality in which the attainment and maintenance of health and normality are the principal values.^[9]

At Wrst glance, the construction of "the smoker" from the template of "the heroin addict" would seem to further the status of smokers as weak and immoral deviants. But to its adherents, the discourse of smoking as addiction is both scientific and humane, an alternative to old-fashioned moralizing about bad habits and lack of self-discipline.^[10] It argues that overcoming dependence on "the most addictive substance known to humankind" is much more than a matter of willpower, and that smokers should not be blamed for their addictive disorder.^[11] In this context, the smoker is often presented as an innocent victim of evil and rapacious tobacco companies. All smokers are regarded as passive, whether Wrst- or secondhand inhalers, while the tobacco industry Wlls the role of active agent of disease and death. One of the conditions of this benevolence is, however, the embracing of an identity based on pathology. The discourse of nicotine addiction suggests that smokers are fundamentally different from nonsmokers at a physiological level. Their bodies not only tolerate but also require a poison to function. Twin studies have supported the existence of "smoking genes" that control susceptibility to nicotine addiction, thereby suggesting that the smoker/addict identity is encoded at the deepest and most immutable level of personal identity, that is, on the DNA.^[12] According to smoking cessation expert Renée Bittoun, there is mounting evidence that individual reaction to nicotine and even difficulty in quitting may be inherited (Stop Smoking, 6).

Viewing smoking as a symptom of affliction, rather than a cultural practice

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or individual lifestyle choice, transforms the political landscape of tobacco use. Arguments based on rights and freedom are disarmed in the face of biology and the absence of choice it implies.^[13] For example, Bittoun suggests that children may become addicted to nicotine before they can speak, from inhaling parents’ smoke. She also argues that passive smoking is a crucial issue for former smokers, because they can be so sensitized to nicotine that inhaling secondhand smoke triggers "a neurological reaction" (Stop Smoking, 98–99). Pleasure and enjoyment are also largely excluded from the picture, except in the disembodied form of "psychoactive euphoriant effects" in the brain. Smoking is seen as an irrational behavior that serves no useful purpose and can only be explained in terms of pathology. If smokers are not suffering from a disorder, then why do they continue a dangerous habit that they do not really enjoy?

However, the move to refigure smokers as powerless victims of an addictive drug does not remove the debate from the realm of ethical and moral judgment. Rather, it widens the scope of normalization and imbues it with the authority and familiar appeal of medical discourse. True, the discourse of nicotine addiction constructs addicted smokers as sick, not bad, but it assumes that the only way to live a meaningful, productive, and happy life is to adopt a healthy nonsmoking lifestyle, a lifestyle that consists of much more than abstinence from nicotine.

The ethical dimensions of addiction discourse are made obvious in the theories of Nicotine (formerly Smokers’) Anonymous (NicA).^[14] A Twelve-Step program based on Alcoholics Anonymous, NicA combines a notion of physical addiction with an explicit moral stance. For NicA, smoking is a physical, emotional, and spiritual disease with "deep-seated origins and symptoms that pervade every aspect of the addict's waking and sleeping life."^[15] In the words of the "Wrst step," addicts are powerless over the drug and their lives become unmanageable. What is required is not merely cessation but recovery, involving a process of "thorough moral housecleaning."^[16] The smoker-nicotine relationship is much more than a physical dependency in this model; "smoker" becomes a subjectivity defined by reliance on a drug and marked by a deep and pervasive emotional impairment.^[17]Recovery from Smoking, a Twelve-Step guide to quitting, devotes Wftytwo pages to the process of emotional recovery, more than twice as many as it uses to discuss the physical problems faced by quitters.^[18] In this text, the nicotine addict's smoking habit is the exterior sign of a deep inner anguish, which the smoker attempts to mask and control with the compulsive use of cigarettes. Beneath their generally competent and rational demeanors smokers are intensely lonely, controlled by fear (ranging from the fear of gaining weight to the fear of abandonment), suffused with shame and, most tragically, emotionally numb (Recovery, 45–76). They have used the powerful effects of nicotine and the rituals of smoking to hide their feelings,

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not only from others but also from themselves, and to successfully recover they must embark on a long and painful journey of emotional reeducation, learning to "identify, accept, and express feelings of shame, fear, sadness, loneliness, grief, depression, and anger" (Recovery, 46).

A smoker, then, becomes a subject requiring self-improvement, and Recovery from Smoking offers a series of exercises to help the reader on the path to healthy living. The tasks for the recovery of emotional well-being are varied: completing charts, answering questions, and making lists on topics such as "feelings," "boundaries," and "intimacy;" recalling childhood memories of loneliness and parental substance use; repeating affirmations such as "I can play and have fun without being self-destructive" (Recovery, 90) and "Accepting my sadness heals my pain and helps it pass" (Recovery, 66); and visualizing and drawing pictures of different emotions. Together, they provide training in a regularized discipline of self-examination, self-interpretation, and self-expression, through which an accessible, orderly, and balanced inner self is produced.