21 May 2011

Unhealthful News 141 - Follow-up: Addiction & the more you read, the funnier Simon Chapman gets

Having written rather involved essays on addiction and the poor scholarly skills and negative public health contributions of Simon Chapman lately, I thought I would make it shorter and simple today by doing a quick follow-up on these.

Yesterday I noted how almost all discussions of addiction to cigarettes lack any definition of their key term,  and so it just becomes a legal/political game.  Today I did a search of news items from the last day that mention addiction, and found the following:
Booming Addiction: Baby Boomers Using Drugs In Record Numbers (CBS News)
What did addiction mean in this article?  Basically in meant "use" (which was also synonymous with "abuse").  There was one story of someone who was "hooked" on prescription painkillers, which is a bit better than just equating addiction with "uses something the author does not approve of", but begs the question of what "hooked" means.  This is the typical usage of the word, basically as background noise, offering no distinction between use that might not be abuse and abuse that might not represent addiction (or vice versa).  So why even have a word?  More interesting was:
'Hypersexual disorder' might make DSM-5 (Los Angeles Times)
This article was actually broader than the headline and photo of Tiger Woods implied.  It also noted that in addition to sex,
Compulsive gambling will likely be grouped with substance-use disorders in the new DSM, the first so-called behavioral addiction to be added to a category that traditionally has been reserved for drug and alcohol problems. Other "behavioral addictions" — including Internet addiction, shopping addiction and exercise addiction — also have more in common with drug abuse than other types of mental disorders, experts said.
This is likely to produce an outcry that they want to call everything an addiction in the DSM (the American Psychiatric Association manual which is, unfortunately, consider to define what constitutes mental illness as I wrote about before).  But it is not actually unreasonable.  We can start with the notion that whatever addiction is, it must be characterized by extreme economic choices (i.e., consumption behavior patterns) similar to those we see for highly destructive use of drugs that are the canonical examples of addiction, like opiods or amphetamines.  If that is the concept, then it is certainly true that some people engage in consumption of gambling, or sex or shopping, in a way that seems quite similar.  These behaviors seem much more similar to "drug addiction" than does almost all consumption of nicotine (or any specific delivery device thereof).  Recall from my previous post about the DSM how ridiculous the proposed new entry for Tobacco Use Disorder was, with references to loss of control and other acutely destructive behavior patterns that describe the canonical "addictive drugs" but that clearly do not describe tobacco use.

If all of the behaviors listed in the above quote become recognized as sometimes being a lot like hard drug use, I wonder if it will create some pressure to better define "addiction" (even though the DSM does not actually use that word).  If universal behaviors like sex and internet use can be addictive, then addiction cannot just synonymous with "ongoing use", as it is typically used.  Similarly, if behaviors like these, especially exercise, can be addictive, then it will have to be recognized that addiction must have some specific meaning that discriminates from sensible and health versions of a behavior, even if they are intensive.

Perhaps this means that people will learn to distinguish sensible nicotine use from other variations on the behavior.

Probably not in Australia, though, as long as they have Simon Chapman.  His latest brilliant suggestion is that a total ban on smoking is but a few years away, and to pave the way for the ban, the government should start by issuing licenses to smoke:
"They would get a swipe card with their photo on it and - just like the pre-commitment gambling card - they could say how much they wanted to smoke a day. If it was 10 cigarettes a day you'd get a category one licence, 20 cigarettes would be a category two and there would be a higher cost to the card if you wanted to smoke more. The most anyone could buy would be 60 a day."
Do you remember when you were a child of about ten, making up games, fantasy worlds, or social policies with your friends, with elaborate rules and fancy devices.  My male readers probably do, anyway.  Doesn't this sound like one of those games?  (...and then we will make a blue card if you are only allowed to smoke on weekends, and you can buy one extra pack but then you get a penalty and you suffer minus 1 to all die roles until you buy some Nicorette, unless you play the "dingos at my last pack" card...)

Apart from the silliness, what's wrong with this picture?  First, creeping prohibition has been a remarkably effective strategy, because people have not resisted each little step, figuring that step alone was not so unreasonable and still allowed some freedom (it is that slowly boiling a frog metaphor).  But when you actually declare that this is the penultimate step on the way to prohibition, that complacency may not continue to work so well.  Remember, this smoking ban would take place in a country where the appealing low-risk alternatives (both smokeless tobacco and e-cigarettes) are banned.  Second, this demeaning and controlling action very different from even punitive sales taxes that lots of people will pay until they become so high that the financial incentives to evade them are just too strong.  Forcing people to buy a license at any price will produce an instant backlash, with people who would not normally do so immediately turning to the black market.  I suppose maybe I am missing something and Australians are more complacent about such things than most people I know, but I am guessing that Chapman is more clueless about people than most people I know.

For those who choose to partially comply, the easiest black market would be for people to get licenses to buy cigarettes for resale.  Obviously, "The most anyone could buy" would be limited only by how many people they know (though 60 is well more than enough to saturate your nicotine receptors, so you might as well be smoking sham cigarettes for most of those anyway).  Presumably the per-cigarette license fee will increase with quantity, so there will be a whole new interest in "becoming a smoker" to get the low-priced low-quantity license and make a bit of money the resale to those avoiding the upper-bracket fee or just having a supply to help out people who want to go over their limit this week.  Assuming, of course, that everyone does not just say f*** this, and switch to the black market.

Of course, Chapman is handicapped in his analysis not just by his unfamiliarity with human nature, but by not understanding that black markets exist, and that they sometimes get ugly.  Recall from my previous post that he seems to think that a tobacco black market does not exist in Australia, because such things only happen in backward corrupt countries, like Canada, and those with open borders (I am not sure what he meant by the latter, but he might want to look at a map – the borders of his country are pretty difficult to build a fence across).  He further argued that black markets are easy to shut down because if buyers know where to buy then cops can know where to make arrests. The mind boggles as to why he never explained this great insight to those fighting the War on Drugs; he could have cleared that whole problem right up. 

[Update:  Chris Snowdon also found this amusing and suggested that in future columns Chapman might use his great insight to come up with solutions that no one else ever thought of to solve the Palestinian problem or cure the common cold.]

(Aside: It may not be obvious, but this is another great example of why someone should have a modicum of understanding about economics before they start spouting off about public policy.  Economics introduces the assumption that people are doing the best they can rather that being utter idiots who are missing obvious easy opportunities.  It is not always right, but it is a much better starting point than the opposite.)

Finally, Chapman says that getting a license "would involve them passing a test, not dissimilar to a driving test".  I am not sure I can think of a final punchline that is funnier than the concept itself.  But I am wondering (a) if they will offer 'Smokers Ed' class in high school to prep for the test, (b) if parents will look forward to kids turing 18 so they can finally get their license and help out with the family cigarette purchases, (c) if the hardest part of the test will be smoking while backing up into a tight space between some orange cones, (d) if you need a chauffeur's license to offer someone else a light, (e) will the rule of thumb "always mark the the answer that makes the most dire claim about smoking" get you through the written test (not so funny – that will undoubtedly be the case), (f) who will monitor the practical test portion of the exam, since no one can be exposed to smoke in a work setting, (g) will beginning smokers get a learner's permit that allows them to smoke only when they are with an experienced smoker?

This could get addictive.  I had better quit and post this thing.

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