Breaking New Ground

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U.S. Surgeon General C. Everett Koop has put the stamp of medical authority on what 40 million former smokers and millions of want-to-be former smokers know intuitively. Nicotine in tobacco is a potent drug that is as physiologically addictive as heroin or cocaine. It is addictive whether it is inhaled through cigarette smoke or absorbed through the mouth from cigars or pipes or chewing tobacco. It is addictive because it is able to produce pleasurable mood-altering effects. As with other addictive drugs, repeated use diminishes those effects and so prompts increased smoking. Add to all this the solid link between smoking and 300,000 premature deaths a year, and the scope of a costly national problem becomes clear.

As is so often the case, though, here is a problem easier to define than to remedy. For all that has been done to discourage tobacco use since the first surgeon general’s report on its perils 24 years ago, 51 million adult Americans continue to smoke. That’s 30.4% of the population--down from 36.7% in 1976, but still a significant minority and now more than ever likely to be found among the poorer and less educated. An adult without a high-school diploma, for example, is more than twice as likely to smoke as one with a postgraduate college education.

Koop, whose goal is to have a smoke-free society by the year 2000, acknowledges that tobacco’s historical “favored place” in national life makes any ban unlikely. Instead, he and other medical authorities propose trying to restrict its access and limit its appeal by requiring it to be labeled as addictive. To attempted dissuasion Koop would add compassionate therapy. He thinks that treatment of nicotine addiction ought to be covered by the same kind of medical insurance payments that are now often provided for the treatment of alcoholism and illicit drug addiction.


The surgeon general’s report, a survey of scores of previous scientific studies, breaks new ground in its specific statement that tobacco is addictive. The report almost certainly will set the terms for a renewed debate over a major public-policy issue. The Tobacco Institute, representing an embattled multibillion-dollar industry, has already responded with a comment mind-boggling in its utter fatuity. “Smoking,” it says, “is truly a personal choice which can be stopped if and when a person decides to do so.” In other words, the millions of smokers who have tried to quit but haven’t been able to are suffering not from addiction to a drug but from a character defect.

With that contribution to public understanding out of the way, perhaps the serious discussion can now begin.