Session 9: Liking, wanting and needing—contemplating and regulating appetites and addiction

In 1994, the CEOs of seven major tobacco companies in the U.S. were pilloried because they testified under oath before Congress that they believed nicotine was not addictive. Their testimonies were met with howls of derisive laughter from countless commentators who thought they knew better. But did they? If you sat through the ninth breakout session on the afternoon of the second day of the 2017 Global Tobacco & Nicotine Forum, “Liking, wanting and needing—contemplating and regulating appetites and addiction,” you probably started to wonder.

One participant made the point that people who ingested nicotine gained only very mild pleasure from the effect it created. The real satisfaction was in the cognitive enhancement it provided in areas such as information processing, concentration and mood stabilization. The point was made that we don’t say that a person is addicted to antidepressants if she uses them to treat her depression, and we don’t say she should get off those antidepressants. We accept that she has a dependence on something that improves her overall brain function. The big question that arises here, of course, is that if some or all smokers and vapers are using nicotine for cognitive enhancement (without necessarily knowing it), what happens if we take their nicotine away, as, in a sense, is being proposed in the U.S.

A question was raised, too, about whether, given that smoking levels had in the past been much higher than they are today in countries such as the U.S. and the U.K., and that these levels had been deliberately driven down by anti-tobacco campaigns, there could exist a hidden demand, or at least a desire, for nicotine.

The theme of the session, of course, was about liking, wanting and needing, and one presentation suggested that a way of looking at addiction concerned people moving along, or being moved along, this “spectrum of compulsion,” where their volitional control was not eliminated but was reduced. Their behavior became compulsive as they moved from wanting something to needing it.

They could be moved along the spectrum by people fine-tuning two factors—dials, if you like: psychopharmacology, as in drug taking, and experience, as in gambling. It was possible to make an experience very salient and not have much psychopharmacology going on, and conversely it was possible to make the psychopharmacology very pronounced and turn down the experience. What was scary here comprised the examples given of how effectively the behavior of gamblers could be manipulated by the programs of the machines they were using, but then related techniques are being used on social media.

There was much else in this presentation, including evidence about how drug tolerance can depend on location and how the efficaciousness of analgesics can depend on whether the person taking them is aware that they are taking them (the analgesics work better if the patient knows).

Another presentation sought to explain addiction through a story. A man who wants to learn Zen is turned away initially because he is a smoker. Two months later he returns, saying that he has given up but is told that he has taken only the first and easiest step. The hard step is for him to quit not smoking. In other words, you’re addicted to something not if you really want it but if you cannot stop thinking about it when you don’t have it. The session was told that almost every pleasure would eventually degenerate into a comfort, into something that a person would miss if they didn’t have it, and this meant that we were all on that treadmill. In some sense, the logic of the consumer society was the logic of addiction, something that explained the otherwise-puzzling fact that, in the developed world, the GDP had gone up by a factor of 10 since World War II while the level of happiness had not budged.

Finally, I must admit to having felt a little uncomfortable during the last formal presentation of the session, not because I couldn’t understand it, but because of my nationality. Apparently, Perfidious Albion has not always acted ethically in its dealings with the peoples of other countries. Hmm. The session was told how, mainly in the 19th century, the British turned what had been in previous centuries a burgeoning demand—I’m not sure whether that demand was based on liking, wanting, addiction, any two of those or all three—for Chinese tea in Britain into a free-trade issue involving opium and the addiction of large swathes of the Chinese nation.

Perhaps I could be allowed to add that we’re a lot nicer now that we’ve overcome—or very nearly overcome—our addiction to overseas adventures. —George Gay