Updated August 2022
Smoking is one of the worst things you can do for your health. According to the NHS, smoking kills around 78,000 people a year in the UK alone and is the cause of over 50 diseases and health issues including:
- heart disease
- many types of cancer
- emphysema
- impotence
It goes without saying that you should never take up smoking. However, while the impact of smoking cigarettes is dreadful, there may be some benefits (albeit vastly outweighed by the harms of smoking).
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Smoker’s paradox refers to the idea that despite the harms of smoking, there are also some benefits. It can also be more narrowly defined as smokers’ ability to survive after a heart attack.
It’s also highly controversial. Unfortunately, smoking is highly politicised and it can be hard to distinguish between good science and science carried out to make a point. Part of that is due to funding - it can be hard to get funding to research the benefits of smoking or nicotine and researchers who show benefits can damage their ability to get grants in future. At the same time, some older studies that show the benefits of smoking may have been funded by the tobacco industry. In theory, good science should be independent of the funding source - but that’s not always the case in practice.
Where there are benefits, they may derive from the nicotine in smoking rather than smoking itself. This means it’s also important to point out that smoking is the most harmful way to access nicotine.
In an experiment carried out by Wesnes and Warburton, smokers and non-smokers were required to watch a clock for 80 minute. Every time the hand of the clock paused, they had to press a button.
Not only did smokers outperform non-smokers, they were still performing just as well 60 minutes into the task AND they had a 10-15% faster reaction time. A 2018 paper by Valentine and Sofuoglu also argued that nicotine had cognitive benefits, particularly in the area of attention, working memory, fine motor skills and episodic memory functions.
Still, the belief that nicotine has cognitive benefits is hotly debated. The benefits may be temporary, and some scientists believe that they are outweighed by the ability of nicotine to cause long term harm.
In 1967, researchers Heimstra, Bancroft and DeKock hired smokers and non-smokers to carry out tasks for 6 hours without pause. The non-smokers became angry, frustrated and aggressive – but the smokers remained calm.
This was reinforced by a 2004 study by Potkin and Fallon who tested the impact of nicotine with people with low and high ‘hostile’ levels. (Hostile levels referred to significant levels of aggression, anxiety and depression.) For people with high hostile levels, nicotine stimulated significant activity in the parts of the brain that control social response, thinking and planning.
As with many studies that show the benefits of nicotine/smoking, you can usually find others which show the opposite. A Pew Research study found that smokers were more likely to experience stress than former smokers and non-smokers, suggesting the benefits found in some experiments may not be replicated in real life.
Smoking was long thought to prevent Alzheimer’s. However, there are reasons to be sceptical. A 2010 Guardian article by Ben Goldacre argued that many of the studies that showed smoking has a protective effect were produced by scientists with tobacco links, while the Alzheimer’s Society argues that there is strong evidence that smoking increases the risk of dementia.
Nicotine may help memory - at least in those already suffering from memory loss. A small 2012 study by Paul Newhouse and others found that people with mild cognitive impairment experienced improvements in attention, memory and mental processing. Commenting on the study, Paul said:“If you’re already functioning fine, but slip down the hill, nicotine will push you back up toward the top. A little bit of the drug makes poor performers better. Too much, and it makes them worse again, so there’s a range. The key issue is to find the sweet spot where it helps.”
The link between nicotine and mental illness is highly controversial. Researchers agree that many people who use nicotine have a mental illness. For example, when Alexander Glassman surveyed people with schizophrenia, he found that an astonishing 86% of sufferers smoked.
However, there is debate over whether people use nicotine because they have a mental illness, whether they have a mental illness because they use nicotine or whether people who are more likely to have a mental illness are also more predisposed to smoking.
One reason why people with mental illness use nicotine is because it releases dopamine, potentially bringing temporary relief to people with illnesses such as schizophrenia. Nicotine may also help more directly. For example, a 2017 study found that nicotine helped normalise brain activity in mice with schizophrenic symptoms.
We’ve already seen that the brain releases dopamine. That makes you feel good - but the effect is only temporary, and when the nicotine leaves the bloodstream it leaves you craving more.
Nicotine also helps increase the pleasure of non-smoking activities. It’s perhaps most famous for use after sex, but nicotine also helps increase the pleasure of music and video.
There’s another interesting aspect to nicotine, which is that it can both calm or stimulate. The effect depends on the dose - when experienced smokers want stimulation, they take short, sharp drags that lead to a moderate nicotine increase in the bloodstream and a stimulating effect. In contrast, deep inhales lead to a higher level of nicotine in the blood which causes a mild sedative effect.
It’s possible that smoking may have some benefits. In fact, we’ve only begun to touch on possible benefits, which also include a reduced risk of Parkinson’s disease and a lowered risk of obesity.
However, many of these benefits are controversial, and are certainly outweighed by the harms caused by smoking. That may well be because of the politics around smoking and nicotine. Still, if there are benefits, they may well be linked to the use of nicotine - and the most harmful way to use nicotine is by smoking.
The advice remains that you should never take up smoking, and if you do smoke you should try to stop. If you do choose to use nicotine, or if you are addicted to nicotine but can’t stop, then you should do so in a way that is less harmful than smoking, such as vaping or chewing nicotine gum.
