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328 STATEMENT OF THEODORE H. BLAU, PH.D. SUBCOMMITH~F~S NOFBT~RESEIJTA~IVE~VIROfJMENT THANK YOU MR. CHAIRMAN FOR THE OPPORTUNITY OF APPEARING BEFORE YOUR SUBCOMMITTEE. MY NAME IS THEODORE H. BLAU. I HOLD THE DOCTORATE IN PSYCHOLOGY, RECEIVED FROM THE PENNSYLVANIA STATE UNIVERSITY IN 1951. I HAVE BEEN IN INDEPENDENT PRACTICE OF CLINI- CAL PSYCHOLOGY AND CONSULTING PSYCHOLOGY IN TAMPA, FLORIA, SINCE 1953. FORMERLY, I WAS PROFESSOR OF PSYCHIATRY AT THE MEDICAL SCHOOL OF THE UNIVERSITY OF SOUTH FLORIDA. I HOLD A DIPLOMATE IN CLINICAL PSYCHOLOGY FROM THE AMERICAN BOARD OF PROFESSIONAL PSYCHOLOGY AS WELL AS THE DIPLOMA FROM THE AMERICAN BOARD OF FORENSIC PSYCHOLOGY. I AM A MEMBER AND PAST PRESIDENT OF THE AMERICAN PSYCHO- LOGICAL ASSOCIATION AND AM CURRENTLY PRESIDENT OF THE AMERICAN PSYCHOLOGICAL FOUNDATION. I AM ALSO A MEMBER OF THE EVALUATION RESEARCH SOCIETY AND HAVE CONDUCTED EVALUATION STUDIES FOR PRIVATE CORPORATIONS AS WELL AS EVALUATION RESEARCH FOR VARIOUS BRANCHES OF THE U.S. MILITARY AND THE GOVERNMENT. I AM THE AUTHOR OF ONE BOOK, A NUMBER OF CHAPTERS AND APPROXIMATELY FIFTY ARTICLES. FOR SEVERAL YEARS, I HAVE BEEN INVOLVED IN AN EVALUATION OF THE RESEARCH AND CURRENT STATE OF KNOWLEDGE ABOUT THE PSYCHO- LOGICAL ASPECTS OF CIGARETTE SMOKING. THIS EVALUATION INCLUDES A 329 THOROUGH REVIEW OF HISTORICAL FACTORS, C RESEARCH, QUALITY OF THE RESEARCH AND PU DEPENDENCE, ADDICTION, LABORATORY AND AP ASPECTS OF SMOKING BEHAVIOR. IN ADDITIO REVIEW, I HAVE ALSO COMMUNICATED WITH AC IN THE AREA. I AM PRESENTLY WRITING THE BEHAVIOR" THAT WILL BE PUBLISHED IN THE _ PSYCHOLOGY, IT IS MY UNDERSTANDING THAT PR[ MANDATE A WARNING ON CIGARETTE PACKAGES : SMOKING IS ADDICTIVE. I WILL ADDRESS MY: FOR ALMOST IIOO YEARS THE SMOKIt NEVER LACKING PROPONENTS AS WELL AS OPPOA SEEM UNABLE TO GIVE UP THE CIGARETTE HABI STAGES OF THEIR LIVES. OTHERS CAN QUIT W SPECIFIC AREAS OF APPLIED PSYCHOLOGICAL R GREATER ATTENTION THAN THE CIGARETTE SMOK INTENSE SCIENTIFIC FOCUS ON THE BEHAVIORA ASPECTS OF CIGARETTE SMOKING, NO GENERAL EXISTS AS TO THE QUESTION OF WHETHER CIGA. ARE ADDICTIVE. THE BEHAVIOR AND RESPONSE ARE QUITE DIFFERENT THAN THOSE OBSERVED I'

329 THOROUGH REVIEW OF HISTORICAL FACTORS, CURRENT THEORIES AND RESEARCH, QUALITY OF THE RESEARCH AND PUBLICATIONS PERTAINING TO DEPENDENCE, ADDICTION, LABORATORY AND APPLIED RESEARCH AND CULTURAL ASPECTS OF SMOKING BEHAVIOR. IN ADDITION TO THIS LITERATURE REVIEW, I HAVE ALSO COMMUNICATED WITH ACTIVE RESEARCHERS WORKING IN THE AREA. I AM PRESENTLY WRITING THE SECTION ENTITLED "SMOKING BEHAVIOR" THAT WILL BE PUBLISHED IN THE VL& FNCYCLOPEDIA QE PSYCHOLOGY. IT IS MY UNDERSTANDING THAT PROPOSED BILL HR 5653 WOULD MANDATE A WARNING ON CIGARETTE PACKAGES STATING THAT CIGARETTE SMOKING IS ADDICTIVE. I WILL ADDRESS MYSELF TODAY TO THAT CONCLUSION. FOR ALMOST 400 YEARS THE SMOKING HABIT HAS BEEN AN ISSUE NEVER LACKING PROPONENTS AS WELL AS OPPONENTS. SOME WHO SMOKE SEEM UNABLE TO GIVE UP THE CIGARETTE HABIT AT LEAST DURING CERTAIN STAGES OF THEIR LIVES. OTHERS CAN QUIT WITH APPARENT EASE. FEW SPECIFIC AREAS OF APPLIED PSYCHOLOGICAL RESEARCH HAVE RECEIVED GREATER ATTENTION THAN THE CIGARETTE SMOKING HABIT. DESPITE THIS INTENSE SCIENTIFIC FOCUS ON THE BEHAVIORAL AS WELL AS PHYSIOLOGICAL ASPECTS OF CIGARETTE SMOKING, NO GENERAL AGREEMENT AMONG SCIENTISTS EXISTS AS TO THE QUESTION OF WHETHER CIGARETTES OR THEIR CONTENTS ARE ADDICTIVE. THE BEHAVIOR AND RESPONSES OF CIGARETTE SMOKERS ARE QUITE DIFFERENT THAN THOSE OBSERVED IN INDIVIDUALS WHO ARE -2- I

330 ADDICTED TO HEROIN AND OTHER SUBSTANCES THAT ARE DEMONSTRABLY ADDICTIVE. THE SCIENTIFIC LITERATURE DEMONSTRATES THE FOLLOWING: THERE IS APPARENTLY NO DIFFERENCE IN THE SEVERITY OF CESSATION RESPONSES BETWEEN LIGHT SMOKERS AND HEAVY SMOKERS. RESEARCH ALSO HAS SHOWN THAT THESE EFFECTS ARE FELT MORE SEVERELY BY THOSE WHO REDUCED BUT DID NOT STOP COMPLETELY THAN BY THOSE WHO ABSTAINED TOTALLY. A THIRD ASPECT REPORTED BY VARIOUS RESEARCHERS IS THAT SMOKING CESSATION EFFECTS ARE RELATIVELY MILD AND IN SOME CASES NON-EXISTENT. THEY ARE OF A NATURE WHICH MIGHT BE EXPECTED TO FOLLOW THE LOSS OF PSYCHOLOGICAL REWARDS FROM ANY LOVED OBJECT TO WHICH A PERSON WAS LONG ACCUSTOMED AND WHICH COULD BE CONCEIVED OF AS FORMING A PART OF THE INDIVIDUAL SELF-IMAGE. IT HAS BEEN REPORTED THAT MANY SMOKERS ARE ABLE TO REFRAIN FROM SMOKING FOR RELATIVELY LONG PERIODS OF TIME FOR PRACTICAL. SAFETY OR RELIGIOUS REASONS AND TO DO SO WITHOUT APPARENT DISCOMFORT. SOME EXAMPLES ARE COAL MINERS WHO MAY NOT SMOKE AT THE PITFACE. ORTHODOX JEWS WHO GIVE UP SMOKING AT SUNDOWN ON FRIDAY AND CEASE SMOKING UNTIL SUNDOWN ON SATURDAY, AND SO FORTH, SUCH BEHAVIOR DOES NOT FIT CONVENTIONAL VIEWS OF ADDICTION. WHEREAS THE EFFECTS OF USE AND WITHDRAWAL ARE CONSISTENT AND PREDICTABLE WITH KNOWN ADDICTIVE SUBSTANCES DESPITE A WIDE -3- 331 RANGE OF USES, DESCRIPTIONS OF TOBACCO VARIED AND INCONSISTENT. IN THIS REGA: THE USE OF CAFFEINE RATHER THAN ALCOH01 REPORTED (COSTA, 1980) THAT THE CONTINI MORE RELATED TO A WIDE RANGE OF PSYCHO: PLEASURE, STIMULATION, SENSORY MOTOR ME OF NEGATIVE AFFECT THAN AN ADDICTION FF THE UNITED STATES DEPARTMENT THAT 95 PERCENT OF THOSE PEOPLE WHO QUI OWN, THIS IS NOT ONLY A PHENOMENA IN S WITH DEMONSTRABLY ADDICTIVE SUBSTANCES EXPLORED. - CLEARLY, MANY AREAS OF SMOKIN UNEXPLORED INCLUDING WHY SOME SMOKE VER CAREFULLY CONTROLLED ANIMAL STUDIES MUS DESCRIPTION OF THE SMOKING HABIT CAN BE WITH RHESUS MONKEYS HAS BEEN REPORTED ~. JAPAN AND RESEARCHERS AT THE SOUTHWEST HAVE REPORTED CONDITIONING LABORATORY B. THESE DEVELOPMENTS SUGGEST THAT WE MAY i SMOKING IN A PROPERLY CONTROLLED LABORA' CONTROLLED ANIMAL EXPERIMENTS WITH RELIi ADMINISTRATION OF TOBACCO CAN BE DEVISEI -4- 9b-o77 0-82--22

331 RANGE OF USES, DESCRIPTIONS OF TOBACCO EFFECTS ARE EXTREMELY VARIED AND INCONSISTENT. IN THIS REGARD, TOBACCO USE IS MORE LIKE THE USE OF CAFFEINE RATHER THAN ALCOHOL OR OPIATES. IT HAS BEEN REPORTED (COSTA, 1980) THAT THE CONTINUANCE OF SMOKING APPEARS MORE RELATED TO A WIDE RANGE OF PSYCHOSOCIAL MOTIVES SUCH AS PLEASURE, STIMULATION, SENSORY MOTOR MANIPULATION, AND REDUCTION OF NEGATIVE AFFECT THAN AN ADDICTION FACTOR. THE UNITED STATES DEPARTMENT OF H.E.W. REPORTED IN 1977 THAT 95 PERCENT OF THOSE PEOPLE WHO QUIT SMOKING DO SO ON THEIR OWN. THIS IS NOT ONLY A PHENOMENA IN SHARP CONTRAST TO EXPERIENCE WITH DEMONSTRABLY ADDICTIVE SUBSTANCES BUT ONE WHICH REMAINS TO BE EXPLORED. CLEARLY, MANY AREAS OF SMOKING BEHAVIOR ARE AS YET UNEXPLORED INCLUDING WHY SOME SMOKE VERY HEAVILY AND SOME DO NOT. CAREFULLY CONTROLLED ANIMAL STUDIES MUST BE DONE BEFORE SCIENTIFIC DESCRIPTION OF THE SMOKING HABIT CAN BE EXPECTED. PROMISING WORK WITH RHESUS MONKEYS HAS BEEN REPORTED (KIYOSHI AND YANAGITA) IN JAPAN AND RESEARCHERS AT THE SOUTHWEST RESEARCH INSTITUTE (ROGERS) HAVE REPORTED CONDITIONING LABORATORY BABOONS TO SMOKE CIGARETTES. THESE DEVELOPMENTS SUGGEST THAT WE MAY BE ABLE TO STUDY CIGARETTE SMOKING IN A PROPERLY CONTROLLED LABORATORY SETTING. UNTIL SUCH CONTROLLED ANIMAL EXPERIMENTS WITH RELIABLE MODELS OF SELF- ADMINISTRATION OF TOBACCO CAN BE DEVISED AND CONDUCTED AS THEY 9&-077 0-82--22

332 HAVE BEEN WITH MORPHINE, COCAINE AND ALCOHOL, THE CONCEPT OF TOBACCO ADDICTION WILL PROBABLY REMAIN A HYPOTHETICAL CONCEPT ONLY PARTLY UNDERSTOOD GJARVIK, 1977). AND SO, GENTLEMEN, AT THIS TIME THE SCIENTIFIC DATA DO NOT SUPPORT THE STATEMENT: CIGARETTE SMOKING IS ADDICTIVE. I WOULD NOW LIKE TO DISCUSS VERY BRIEFLY MY CLINICAL EXPERIENCE WITH SMOKING. DURING THE PAST 30 YEARS, I HAVE WORKED AND CONTINUE TO WORK WITH PEOPLE WHO SMOKE CIGARETTES. IN REVIEW- ING MY EXPERIENCE WITH THE THOUSANDS OF PEOPLE THAT I HAVE SEEN PROFESSIONALLY, MANY OF WHOM ARE HEAVY SMOKERS, SOME CONTINUED, SOME QUIT WITH STRESS, AND SOME QUIT WITH LITTLE OR NO STRESS. THESE PATIENTS IN NO WAY ACTED LIKE THE PATIENTS THAT I HAVE SEEN WHO STRUGGLE TO BE RELEASED FROM THE ADDICTIONS OF OPIATES OR ALCOHOL. CIGARETTE SMOKERS ARE VERY ATTACHED TO THEIR SMOKING BEHAVIOR. THEY ARE OFTEN ANNOYED OR DISTRESSED WHEN THEY ARE NOT ALLOWED TO SMOKE. HOWEVER, I HAVE NOTED EQUALLY STRONG ATTACH- MENTS TO TENNIS, JOGGING, CANDY, ROCK MUSIC, COCA-COLA, MEMBERS OF THE OPPOSITE SEX, AND HAMBURGERS IN MY ADOLESCENT AND ADULT PATIENTS. WITH CHILDREN, ONE SEES VERY STRONG ATTACHMENTS TO PLAYMATES, PARENTS, CERTAIN ARTICLES OF CLOTHING, TV, BLANKETS AND TEDDY BEARS. REMOVAL FROM THESE ACTIVITIES, PERSONS OR OBJECTS CAN RESULT IN AGITATION, SLEEPLESSNESS, IRRITATION, DEPRESSION AND OTHER UNCOMFORTABLE SYMPTOMS. THEY VARY CONSIDERABLY IN INTENSITY -5- 333 AND DURATION, AS DO EFFECTS FOLLOWING A SMOKING. I, MYSELF, SMOKED CIGARETTES PACKAGES A DAY FOR THE LAST TEN YEARS 0 THE AGE OF 35 AND HAVE NOT SMOKED SINCE BLE FOR A SHORT PERIOD OF TIME, BUT WAS THE CRAVING NEVER REACHED THE LEVEL I H IN MEDICAL WEIGHT LOSS PROGRAMS. IN Sh SMOKING IS A COMMON AND PERVASIVE HABIT BASIS IN THE SCIENTIFIC LITERATURE OR I CLINICAL EXPERIENCE TO JUSTIFY LABELING ADDICTION. -6-

333 AND DURATION, AS DO EFFECTS FOLLOWING ABSTINENCE FROM TOBACCO SMOKING. I, MYSELF, SMOKED CIGARETTES FOR 24 YEARS, TWO TO THREE PACKAGES A DAY FOR THE LAST TEN YEARS OF THE HABIT. I STOPPED AT THE AGE OF 35 AND HAVE NOT SMOKED SINCE. I WAS SOMEWHAT UNCOMFORTA- BLE FOR A SHORT PERIOD OF TIME, BUT WAS NEVER HIGHLY UNCOMFORTABLE. THE CRAVING NEVER REACHED THE LEVEL I HAVE EXPERIENCED OR OBSERVED IN MEDICAL WEIGHT LOSS PROGRAMS. IN SHORT, ALTHOUGH CIGARETTE SMOKING IS A COMMON AND PERVASIVE HABIT, I CAN FIND NO CONVINCING BASIS IN THE SCIENTIFIC LITERATURE OR IN MY OWN PROFESSIONAL CLINICAL EXPERIENCE TO JUSTIFY LABELING IT OR TREATING IT AS AN ADDICTION. -6-