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Schachter, S. Pharmacological and Psychological Determinants of Smoking.. In: Thornton, R.E'. ('Editor)~. Smoking Behaviour. Physiological and Psychological Influences. Edinburgh, Churchill Livingstone, 197'8,,pp.2'©8-22$. The low nicotine and tar campaign is based on the notion that cigarette smoking stems from a variety of psychological, sensory and manipulative needs which can probably be as well satisfied with a low as with a high -nicotine cigarette. If a smoker is smoking to keep nicotine or its meta- s bolites at some optimal level, if he switches to low nicotine brands, he may smoke more cigarettes and take more puffs of each. In this case the concerned smoker should smoke high, not low, nicotine cigarettes. The recommendations for smoking low or high nicotine cigarettes depends on the relative importance of,the pharmacological versus phychological needs satisfied by smoking. Studies on the effects of' nicotine on shock tolerance, irritability, and stress and those that support a pharmacolog,ical basis for smoking behavior are reviewediwith the conclusions that: (1) The psychological and probably thee sensory and manipulative gra~tifications of smoking are illusory. Serious smokers smoke to prevent withdrawal. (2),Smokers regulate nicotine intake. (3) Variations in smoking rate which customarily have been interpreted in psychological terms seem better understood as an attempt ot regulate nicotine. (4) Apparent exceptions to a regulatory model of smoking seem understandable in terms of withdrawal. The smoker who fails to regulatPp suffers withdrawal. Therefore, a serious case can be made for a, pharmacological, addictive view of'cigarette smoking, unless there is a long-term effect of switching brands so that smokers eventually return to their former level of'consumptioni. Two such studies on long-term effects of'switehing brands are reviewed. Overall conclusions are that switching to low nicotine cigarettes results in an increase in amounts smoked'lso that the campaign for low nicotine cigarettes is not ustified.

17. Pharmacological and psychological determinants of srnokingi 5 SCHACHTER The gist of the anti+smoking campaign is simply 'Quft andl if you can't or won't quit, switch to a low-nicotine„lotiv-tar cigarette'. With the backing of the American Cancer Society; the Royal College of Physicians and the Public Headth~Service, this message pervades the mass media and appears responsible for the tediouscompetitnons among tobacco1 companies for the safest cigarette, the search1 for an acceptable tobacco •fcee cigarette: stimuiated by the British government and taxation policies such as that of New York City which taxes cigarettes by nicotine and tar, content in an apparent effort to use economic muscle in order to help the smoker help himself. Though no one has bothered to make explicit the premises on which such policy is based, it appears reasonable to guess that, in part, thelow nicotine and tar compaign is based onithextotion that cigarette smoking,stems from a variety of psychological, sensory and manipulative! needs which can probably beas well satisfied with a low as wsth a high nicotine cigarette. The possibility that this earnpaign, may perversely be increasing the health hazards of smoking has been raised byDbmino ('1973), Russell (1'974a) and'others who, point~ out that there is evidence, after all~ that nicotine is addicting. To the extent that the smoker is aniaddict, he is probably smoking tn~keep~nicotine or one of its active metabolites at some optimal level. If, then, t'heheavy smoker does switch, to iow nicotine brands, he may very well end up smoking more:cigarettes and takiitg, more puffs of each. He will in the proeess of regulating nicotine probably get the same amounts of nicotine and tar and unquestionably get more of the combustion products, such as carbon monoxide which appears to,be at least as much of'a medical villain as tar: or nicotine for it is implicated in the increased risk to smokers of arterio- sclerosis, ischaemic heart disease, fetal damage and so on (Larson, Haag,and Silvette, 19611; US Surgeon General's Report, 1972). If this shift in level of smoking,ia permanent, the net effect of switching to low nicotine eigarettes should be: to increase the dangers of smoking. From this point of view, the concerned smoker should' smoke high, not low, nicotine cigarettes. Since almost everyone would agree that cigarette smoking,involves both pharma- eological and psychological determinants there does seem to be some support for either positionl Whether rationality dictates the recornmendation of a low or a highh nicotine cigarette depends, of course, on the relative importance of'the pharmacalogicaI, versus the psychological needs satisfied by smoking. ~M 10'05053074 -

PH,AIRMACOL©CICAI: A,1tD'P'SYCHOLfJCICAL DET'ERVt1NANTS OF SMOKING 209 On the gratifucationa of smoking, Almost any smoker camconvince you and himself that there are majwr psychologicall components to smoking: Theywill convince you that smoking,calms them; that'it helps them work; that they smokemore at a party'and so on. In short, smoking serves some psychological function; it does something positiive fort'he smoker and Presumably nicotine or tar or some component of theact, of'smoking is so gratifying thaU despite the welllpublicised dangers the smoker is unnvilling to give up the habit. =~ -,. .:.: this is the reason he smokes. This emphasis on the functional properties of smokuog, .,, „ is a the heart of virtually every serious psychologicaI'attempt to understand smoking. i', ,.> I Undoubtedly the ultimate eulogy of the act is Marcovitz's suggestion (Marcovitz, 1969) that 'as a, psychological phenomenon, smoking is comparable to the ritual of the Eucharist. There the communicant incorporates bread and wine and in so doing symbolically introjects the Lord Jesus Christ. This is a conscious process, with the hope of identification, of attaining some of the attributes of Jesus. Similarly, the smoker, incorporates the smoke introjecting in an unconscious fantasy some object which will eonfer on him its magic powers.' (p. 1'0$2). Among,thesemagic powers,, smoking serves to'delirnit the body image in the quest for the sense of self,'-to 'teyeve the unconscious fear of'suffocation''and as `proof o'f'inunortality'. Thoughh no one has matched Marcovitz's panegyric, almost all!attempts to account for the habit have assumedi that it does something positive for the smoker - an assumption that is shared by thesmokerr himself for'numerous studies indicate that heavy smokers report that cigarettes relax them or stirnulate them„put them at ease, give them something to do with their hands, and so on. In short, for both the psychologist and the smoker, the act' of smoking is functional; it does something for the smoker and this is the rm-on he smokes. In this paper, I shall concentrate on one of the presumed motivations fpr smoking. Smokers widely report that they smoke more when they are tense or anxious an& they also report that'smoking calms them. Smoking, themserves a respectable psychological function and this presumably is one of the motivations for and explanations of smoking under stress. Before worrying through interpretatnons ot these fact!s, let us make sure that they are facts. Firstly, does smoking increase with stress? The available evidence indicates that indeed it does, ifthe stressis fairly intense. In, two almost identical experiments (Schachter etcrl, 1977b; Sckach'ter, Silverstein and Perlick, 1'977), my associates and I manipulated, stress within the context of experiments presumably'designed to measure. tactile sensitivity: In high stress conditions, such sensitiirity was measured by the admiiustration, sporadically over an experimental hour, of a series of intense, quite, painful shocks. Inilow stress conditions, the shocks were a barely perceptiblie tingle. Between thelesting intervals, the subjectis, all smokers, were free to smoke or not as they pleased. Inbothistudies, the subjects'smoked considerably more in high than inlotiv stress conditions. Turning to the effects of smoking on stress, we ask next does smoking reduce stress? The answer appears to be that irdepends upon how you look at'it. Silverstein (11976) attempted to answer the questioniby measuring how much electric shock a subject was willing to take within the context of a study of tactile perception,. The procedlnre required that electrodes be attachedl to a subjeet's fingers, that he be exposed to a series of'shocks of gradually increasing voltage and that he report when

2110 S`tpKl.~'r6IIEHavtOUR - he eould! first feel the shock, next when the shock farst became painful an& flnally when the shock becameso painfuLthat he could'no longer bear it. Silverstein assumed that the more anxious the subject, the less pain he would be willing to tolerate. There were four experimental groups - smokers who smoked either high or low nicotine : cigarettes durirng,the experiment or who did not smoke at all during;this time and!a group of non+smokers who did not smoke. The results of'this experiment are presented'in Figure 17:1. The ordinate plots the number of shocks t'he subjects endured before calling; it quits. It is clear that smokers take rnoreshocks.when they are sznoking,high nicotine than when smoking low nicotine cigare,ttes than1when not smoking. Giveni this pattern one has a choice of interpretatimns: either nicotine decreases anxiety or lack of nicotine increases anxiety. The choice of dppends; of course, on the position of the group of non- smokers who, as can be seen in, Figure 17.11 take virtualljrthe same number of shocks. as stnokers on high nicotine. It would appear t'hen that smoking is not anxiety reducing but, rather, that no srnoking,mr insufficient nicotine is for the heavy smoker, anxiety increasing. Preeisely the same patternlof results emerges in a studyof irritability conductediby Perlidk (1977). Within the context of a study of aircraft noise, subjects, watching a television drarna4 rated1ow annoying they found a series of simulated over.-fhgtits: During the experiment, heavy smok'ing subjects were permitted ad 10 smoking of high nicotine cigarettes in, one condition, of low nicotine cigarettes; in another condition and were prevented from smoking in a third condition. Finally, there was a control group of non-smokers. The results.are presented in Figure 17.2 where it canbe seenithat smokers on high n'tcotinecigaret;tes are markedly less irritated. by this series of'obnoxious noises than are smokers restricted to low nicptine cigarettes or prevented from smoking. However, these high nicotine smokers are neither less nor more :irritated than the group of non-smmkers. Again it would appear that smoking doesn't make the smoker less irritable or vulnerable tp annoyance, not smoking orr insuffcient nicotine makerhim more irritable. This same pattern is charactezsstic of psychotnotor as well as emotional behaviour. Heimstra{ Bancroft and DeKock (1967) eexamined the hypothesis that smoking facilitates driving performance by comparing ad lz'b smokers, deprived smokers andd non-smokers in a six-hour simulated driving; test. On a variety of measures of tracking and vigilance, ad libsmokers,do neither better nor worse than non-smokers but do markedly better than deprived smokers. Again and again, then, one finds the same pattern - smoking doesn'f t improve the mood or caltrt the smoker or, improve:his'perforffnance when compared with the non- smoker:' However not srnoking,or insufficient nicotine makes him cortsiderably 'T}iere is of course.,analternative interpretation of this consistent pattern. Rtither than indicating withdrawal, it is conceivable that people who become smokers:are by nature more frightened of shock, more irritated by noise and worse drivers than people who never become smokers, and that for such peoplrsmoking,is indeed calming and does improve psychomotor performance. Though nothing short of a longitudinal study could unequivocally settle the matter, it should be notedlthar there have been a formidable number of studies that compared smokers and non-smokers on virtually every personality dimension imaginable. Smith (197~0) inihis review of thisliterature concludes that the oruty vzriables which+ withireasonable consistency, discriminate between smokers and non-smokcrs are artraversion attd'anti,social tendencies. And even on these variables the differences are quite small. 100505307*16