In the spirit of our previous posting, examining the welfare-based case for tobacco harm reduction, I thought I would offer my own experience with it as an example of what I consider to be a success for the welfare perspective. (For those interested, we have also expanded on the welfarist case for THR here and here, and are just finishing up a more complete analysis that will be out in a few months.)
The cornerstone of the welfare approach is that nicotine is enjoyable and therapeutic and that people want these benefits. It is thus reasonable to include among those benefitting from THR not just smokers who can switch to low-risk products that still confer many of the benefits, but also people who do not currently use nicotine but who would benefit from it. The tobacco control crowd calls these the “new users”, and they fear the creation of them because it undermines their abstinence-only viewpoint on nicotine and tobacco, both because it means one less person is abstinent, and because it makes it difficult for them to pretend that most people agree with them.
One of the oft-repeated pseudo-arguments against the promotion of low-risk alternative nicotine products is that people who are interested in nicotine (that is, benefit from it in some way) but that have chosen not to smoke because of its detrimental health effects will start to use these low-risk products upon learning that they are, indeed, low-risk. These new users are not a problem, however, based on the views of most people – including most ethicists and policy analysts – that favor humanitarian concerns over the elimination of drug use for its own sake. Every such new user represents a win from the welfare perspective, since the provision of accurate information regarding the relative risks of products has allowed a person to make a rational choice to start consuming (and enjoying) something they otherwise would not have. In other words, it has provided a welfare improvement for someone who makes the rational judgment that the benefits exceed the costs. I am one such person.
When I first started with the THR.o team I had only occasionally smoked cigarettes. I had tried smoking when I first came of legal age to buy them because it was a bit of a thrill to do so, and I tried several times over the years to inhale properly, but never did get the hang of it (much to the amusement of observing friends). Although the nicotine rush was a bit nice, I could never get used to the harshness of the smoke, and quite frankly I just didn’t enjoy it enough to incur the health risk associated with regular smoking. So, smoking was not for me. (Although, I am happy to inform the U.S. Surgeon General that I’m still alive despite those brief encounters with tobacco smoke!)
Years later, however, I joined the THR.o team and entered the wide world of smokeless nicotine products. Once I found out that I could in fact use nicotine at almost no health cost (and without the smoke inhalation that I never could get used to), I quite rationally started to use them. I’ve become a daily snus user, and I look forward to trying out new kinds and different nicotine levels. I enjoy using it, and find it helps me concentrate when working and is a pleasant addition to a coffee break. On some days I use more than others, but I sometimes go days without it. I’m sure others in the tobacco control community would characterize my attachment to it as “addiction”, but if that’s the case, many other activities in my life fit that description as well (my compulsive watching of a few seasons of 30 Rock comes to mind).
Talk of new users actually gaining something in terms of welfare is pretty much sacrilege in the tobacco control world. The fact that my experience represents a failure to tobacco prohibitionists (masquerading under the false name of public health advocates) strikes me as their problem, not mine (or the world’s). I am, after all, an adult who is perfectly capable of making decisions regarding my own health. The knowledge that authority figures have been lying and misleading to people in the name of abstinence-only not only angers me because it limited my choices for many years, but because it has endangered the lives of people I know and love, who continue to smoke.
Although most people I know are aware of my habit, I still get the occasional raised-eyebrow when I whip out a tin of snus and start using it. I just say to them, why quibble over something that is about as risky as drinking coffee? I usually find at the bottom of their disapproval is that pesky idea that humans just are not supposed to enjoy drugs for the heck of it, if you have the choice of being abstinent. In the words of the estimable Dossie Easton and Janet W. Hardy (who wrote The Ethical Slut): “our culture places a very high value on self-denial, which is fine when there is hard work to be done. But all too often, those who unapologetically satisfy their desire for pleasure in their utterly free time are seen as immature, disgusting, and even sinful.” Even though they were speaking particularly to sex-negativity, that thought can be extrapolated to so many more things, substance use included. So there we have it; and out of the closet I come with respect to my unabashed enjoyment of low-risk nicotine products.