Beyond a craving

When millions of Americans abandoned smoking in the 1980s, many health experts and social scientists thought they had tobacco on the run. But in the '90s progress began to slow: From 1990 to 2003, according to federal figures, only 3% of Americans gave up their cigarettes.

The slowdown prompted many experts to conclude that most of the smokers who could easily quit had already done so. What remained was a hard-core group of Americans who continued to puff away despite significant health risks and severe social stigma.

So social scientists turned to a new quarry: understanding the mind of the smoker. By profiling dedicated cigarette addicts, scientists hoped they would find common traits and use that knowledge to design anti-smoking campaigns.

What they have found, however, has proved more controversial than most researchers expected: Smokers are more depressed and suffer a higher rate of anxiety disorders and other psychological maladies. At the same time, nicotine may provide a mental boost that helps them cope. These finding help explain why some people won't quit, experts say.

"We thought understanding the smoker's mind would help us end tobacco use," said Gerald Markle, professor of sociology at Western Michigan University and author of "Cigarettes: The Battle Over Smoking." "But in some respects we've raised as many new questions as we've answered."

Recent studies show smokers are 4.7 times more likely than the population at large to suffer from major depression. Dozens of other surveys reveal cigarette users are more liable to struggle with anxiety disorders, schizophrenia, attention-deficit hyperactivity disorder, alcoholism and drug use. Smokers consistently demonstrate higher-than-average levels of neuroticism and high-risk behaviors, and show poorer impulse control than nonsmokers.

"People who smoke today are, for the most part, people who are addicted in unique ways," said David Gilbert, a professor at Southern Illinois University who examines how nicotine affects the brain.

A recent study also shows daily smokers are more likely to consider or attempt suicide. Published last month in the Archives of General Psychiatry, the study examined the smoking habits of nearly 900 Detroit-area residents during a 10-year period; they were also interviewed about other health habits. Researchers at Michigan State University and the Henry Ford Health System in Detroit found that daily smokers were 174% more likely than nonsmokers and occasional cigarette consumers to seriously consider or attempt suicide, even after the results were adjusted for prior depression.