Monday Morning Crisis Quarterback

Last week, a report by the Institute of Medicine recommended that the United States Military move towards being smoking-free over the next 20 years.  On the face of it, the reasons to do this seem pretty straightforward.  Given that the American taxpayer will be picking up the health care costs for most members of the military indefinitely, it is certainly in our best interests to have these folks stop smoking.  Also, since people who smoke get sick more often with respiratory infections and the like, eliminating smoking among our soldiers improves military readiness.

It certainly seems to make sense for the military to stop subsidizing tobacco on military installations.  There's no reason for the military to be encouraging people to smoke, and studies do show that increased prices on tobacco products reduce use.

However, the Quarterback, an avid non-smoker and smoke-hater, has some mixed feelings about banning smoking in the military outright.  Don't get me wrong, I'm all for soldiers not smoking.  I wish nobody smoked.  And if we could guarantee that no person in the military ever started smoking, I'd be all in favor of that.  To the extent that we can do things, like stop subsidizing cigarettes, that will discourage people from starting smoking in the first place, we definitely should.

But let's take a look at some of the statistics from that report.  Thirty-two percent of members of the military smoke, compared to 20% of the general population.  Soldiers on deployment are twice as likely to smoke as those stationed stateside. 

To what do we attribute this?  Part of it is what the report refers to as "the image of a tough, fearless warrior," who, one presumes, smokes.  But I think that is missing a rather major point. 

Nicotine is a drug.  We all know that.  When we talk about it as a drug, we are usually talking about it's addictiveness -- and it sure is addictive.  But it also is a drug the same way valium or xanax is a drug -- it calms you, and may actually combat cognitive dysfunction in people with mental illness.  In fact, a 2000 Harvard study published in the Journal of the American Medical Association estimated that mentally ill people, who are 4-8% of the population, account for more than 44% of all cigarettes sold in this country.  In short, people use nicotine to self-medicate.  That is why deployed soldiers smoke more than non-deployed ones.  When stress goes up, so does tobacco use.  Soldiers in battle are traumatized, and they are using nicotine to ease the psychological effects of that trauma.

And who is the person most likely to turn to a cigarette to ease stress in a war zone?  Well, smokers, obviously.  But a close second would be former smokers.  People who have been addicted to cigarettes and who know what effect they have psychologically start wanting cigarettes under stress.  The question is, how bad do we think that is?

The Quarterback recently responded to the scene of a suicide.  The deceased's buddies were standing around outside the apartment, and we asked them what we could get for them in terms of food and drink.  They asked for hamburgers, cigarettes and a keg.  We got them the first two, but not the keg.  It is well-established practice in CISM to discourage substance use and abuse following trauma.  But what about cigarettes?  At least one of these guys had quit smoking the month before.  It just didn't seem like the time to argue about it.

On the one hand, discouraging smoking is, as a general rule, a good thing.  On the other hand, I worry about having a bunch of soldiers who quit smoking to join up walking around a battle zone unable to smoke and jonesing for a cigarette like mad.  I don't know what the right answer is.  The Quarterback welcomes your comments.