UP IN SMOKE

We know all about the risks, so why can’t we kick our cigarette cravings?

Whether it’s feverishly scrolling to the 73-week-plus danger zone on an ex’s new girlfriend’s Instagram, or indulging in a cigarette over wine come 6pm Friday, persisting with something despite knowing the risks defies logic. But unlike the former, the detriment of a stress-busting cigarette extends far past an acute case of RSI.

Since a full-blown anti-smoking campaign began in the early ’90s, the number of smokers has been on a consistent decline, but a triennial survey by the Australian Institute of Health and Welfare found the number of smokers stalled in the three years between 2013 and 2016, and in the last quarter of 2017, cigarette consumption increased by 2.6 per cent. Our healthy, outdoorsy image is, pardon the pun, smoke and mirrors: Australia’s smoking rate is higher than that of the US and now on par with the UK.

It’s not just pack-a-day smokers doubling down. While the number of people who smoke “occasionally” declined from four per cent in 2006 to three per cent in 2015, that figure rose in 2016, to 3.8 per cent. It’s estimated 18 per cent of those who smoke are occasional smokers – so if that’s you, you’re far from alone.

This is in spite of plain packaging and having the most expensive cigarettes in the world (we fork out around $30 for a pack, compared to $18 in London and $10 in Los Angeles), not to mention that we simply know better by now. While there’s been a concerted effort to push smoking to the periphery in social settings – in NSW, for example, smoking is banned in enclosed public spaces and dining areas, and within four metres of access to public buildings – the same bans don’t apply to otherwise chic French bloggers’ and models’ Instagram Stories, allowing us to romanticise anew, adding a rose-coloured tint to the smoky haze. Perhaps in a desire to regain balance – exhausted by overenthusiastic downward-dogging and judgey fitness bloggers – our “everything in moderation” mantra has meant that, à la Gwyneth “one light American Spirit, once a week” Paltrow, we’re leaning into a habit that might not be as harmless as we think.

The growing acceptance of marijuana (a 2016 report found 13 per cent of females aged 25 to 34 had recently used cannabis, up from 11 per cent just a few years earlier) is also making smokers of those who may not have previously touched a cigarette, but now wouldn’t think twice about mixing one into a joint.

“There is a sense that we have dealt with smoking and should now focus on other drugs, [and so] tobacco control has stalled,” says Dr Colin Mendelsohn, an associate professor at the University of NSW’S School of Public Health and Community Medicine. “But smoking is still the leading preventable cause of death and illness in Australia.”

“I was firmly anti-smoking until I moved to Sydney in my early twenties,” says Carly, now 28. “Then when I’d go out, I’d find myself left behind at the dinner table while everyone else ducked out for

a cigarette, or deserted at the pub when the smokers lit up. I eventually joined in. I’ve never bought a packet but I’ve lost track of how many times I’ve pinched ‘just one’ from a friend.”

While you might not consider your occasional indulgence (which only comes out when you are) to be a “habit”, health experts consider it on par with a stable form of chronic consumption. A person’s tendency to smoke is strongly linked to other cues – such as drinking alcohol or being in a certain place or with certain people – which could be why the first drink of the night has you looking around for a kind stranger willing to part with a cigarette. “It then becomes routine to have [a drink] in one hand, [a cigarette] in the other,” says Renee Bittoun, a tobacco treatment specialist and associate professor at The University of Notre Dame.

“One way addiction works is by forming an association between situations where a person would typically smoke, which then creates the impulse to smoke when they find themselves in that situation again,” explains Professor Robert West, an expert on smoking at University College London. So while it might happen less often, there’s little difference between your tendency to have a cigarette over a glass of rosé, and a daily smoker’s habit of one with coffee – in fact, the urge could be just as strong.

However, unlike your dry-cleaning bill after a night at a smoke-filled house party, for some people, social smoking is simply enjoyable. In 2009, neuroscientists from the University of Pennsylvania found that when nicotine triggers dopamine production in the brain, it speeds up the formation of memory pathways – so if you only smoke while socialising with friends, those positive associations become hardwired, fast. Aside from being notoriously addictive, nicotine also triggers a dopamine rush that’s easy to get hooked on. Drinking exacerbates this, because while both alcohol and nicotine boost dopamine levels in the brain, combining the two can trigger stress hormones that halt the release of dopamine, leaving you looking for a fix to re-boost your levels. If you find that in a cigarette or another drink, the cycle continues.

“Some people are much more predisposed to nicotine addiction than others, though not everyone becomes addicted,” notes Bittoun. But while you might not consider yourself hooked, around 80 per cent of occasional smokers find they can’t stop when they try.

Women find it especially hard to quit and typically need more intensive treatment to kick the habit. This is partly because our reasons for smoking are more psychologically complex – we often smoke to self-medicate, regulate our moods and cope with stress. “There is evidence that women manage stressors differently than men, and potentially have more of them,” says Bittoun. “It is important that women learn to manage their stressors without smoking.”

What’s more, our bodies metabolise nicotine at a higher rate than men’s, meaning nicotine replacement therapy such as patches, gum and sprays is less effective for women, especially before menopause.

One alternative (that’s curiously popped up in your neighbourhood bar) is vaping. With rising cigarette prices, it’s a more cost-effective option – depending on the device, liquid and frequency of use, it can be up to 90 per cent cheaper than pre-rolled cigarettes – and has the potential for more regular use (in some Australian states, you can still vape in smokingfree areas), meaning that many of those who were initially perplexed by the phenomenon are embracing it, with an estimated 250,000 users in Australia.

“I work for an airline in a pretty high-stress role,” says Hannah, 29, who considers herself an occasional smoker. “But the constant travel and most hotels’ smoke-free policies made it tricky to continue, so I bought a vape and some nicotine liquid while I was overseas. I find it just as soothing as smoking regular cigarettes, but much cheaper.”

The devices are also becoming more discreet, many now resembling a small USB stick (though the same might not be said for the puff of vapour they leave in their wake). In April, The New York Times declared “The Juul is too cool”, referring to one such Usb-like brand of e-cigarette. Juul’s market share among vapes has already exceeded that of Marlboro cigarettes at the peak of their popularity, the term “Juuling” now almost synonymous for vaping.

E-cigarettes are also gaining acceptance among some health professionals as a safer alternative to cigarettes; a crutch for those unable or unwilling to quit. “Vaping is not harmless, but there is overwhelming scientific agreement that it is far less harmful than smoking,” says Dr Mendelsohn. Because they vaporise liquid (usually containing nicotine and a flavoured substance) rather than burning tobacco, e-cigarettes don’t produce tar or carbon monoxide, the most harmful by-products of regular cigarettes. They do, however, produce a puff of potentially harmful chemicals, and experts warn the full health effects aren’t yet known.

For those looking for a fix, vaping with liquid nicotine is only legal in Australia with a prescription from a medical professional, or ordered online under the Therapeutic Goods Administration’s personal importation scheme, which allows a person to order a three-month supply for personal use. There are growing calls for nicotine use in vapes to be deregulated, but it remains a point of contention, with some health professionals (like Bittoun) firmly against their use. “With good clinical expertise we can help most smokers quit without the help of e-cigarettes at all,” she says. “The more a smoker understands about their dependence, the better they do. It may take a few weeks, or months, but start off by changing small things.” Because is there anything better than being a whole cigarette more smug than Gwyneth?

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