Medicine: Why It's So Hard to Quit Smoking

Anyone who has ever tried to give up smoking cigarettes knows the meaning of being hooked. Even those who succeed in quitting for the first time suffer the same 75% relapse rate as recovering alcoholics and heroin addicts. Last week the U.S. Surgeon General made official what everyone has recognized for a long time: tobacco, like cocaine or heroin, is addictive. In a no-holds-barred, 618-page report, the forthright C. Everett Koop not only proclaimed that "cigarettes and other forms of tobacco are addicting" but also urged that they should be treated with the same caution as illegal street narcotics.

Based on two decades of research by more than 50 scientists, Koop's 1 1/2- in.-thick treatise, titled The Health Consequences of Smoking: Nicotine Addiction, earned unanimous accolades from the medical community as well as praise from politicians. "The Surgeon General's report is a clear challenge to all who care about the health of smokers," says Ovide Pomerleau, professor of behavioral medicine at the University of Michigan. "This socially approved habit is going to go the way of the spittoon." Among Koop's recommendations: warning labels about addiction on packages of tobacco products, a ban on cigarette vending machines in order to curb availability to children and tighter regulation of tobacco sales through licensing. Democratic Senator Bill Bradley of New Jersey has already introduced legislation in Congress that would require tobacco companies to print an additional caveat on their products: "Smoking is addictive. Once you start you may not be able to stop."

The tobacco industry, as expected, blasted the Surgeon General's report. "The claims that smokers are 'addicts' defy common sense and contradict the fact that people quit smoking every day," said Brennan Moran, a spokeswoman for the Tobacco Institute. "The Surgeon General has mistaken the enemy," declared Democratic Senator Terry Sanford of North Carolina. "In comparing tobacco -- a legitimate and legal substance -- to insidious narcotics such as heroin and cocaine, he has directed 'friendly fire' at American farmers and businessmen."

Koop's retort was devastating. "I haven't mistaken the enemy," he countered. "My enemy kills 350,000 people a year." In the U.S. in 1986, smoking-related lung ailments accounted for 108,000 deaths; heart disease, 200,000 more. By comparison, Koop continued, cocaine and opiates such as heroin dispatch about 6,000 people a year and alcohol about 125,000. Said he: "I think we're way ahead on deaths." As for nicotine's addictive qualities, the Surgeon General cited several national surveys that reveal 75% to 85% of the nation's 51 million smokers would like to quit but have so far been unable to do so.