Framing Tobacco Dependence as a "Brain Disease": Implications for Policy and Practice.
BACKGROUND
Like other forms of drug dependence, tobacco dependence is increasingly being described as a "chronic brain disease." The potential consequences of this medical labelling have been examined in relation to other addictions, but the implications for tobacco control have been neglected. Some have posited that biomedical conceptions of addiction will reduce stigma and increase uptake of efficacious treatments. Others have countered that it could increase stigma, reduce treatment seeking, and deter unassisted quitting. We explored how smokers respond to the labelling of smoking as a brain disease.


METHODS
Semi-structured interviews with 29 Australian smokers recruited using purposive sampling. Thematic analysis was used to analyze the results.


RESULTS
Most participants questioned the accuracy of the brain disease label as applied to smoking. They believed that smoking was not a chronic disease because they perceived smoking to be an individual's choice. In addition, many believed that this label would increase the stigma that they already felt and, did not want to adopt a "sick role" in relation to their smoking.


CONCLUSIONS
Describing smoking as a brain disease is more likely to alienate smokers than to engage them in quitting. The application of overly medical labels of smoking are inconsistent with smokers own conceptualizations of their smoking, and may have unintended consequences if they are widely disseminated in healthcare settings or antismoking campaigns.


CONCLUSIONS
The participants in this project believed that biomedical labels of smoking as a "brain disease" or a "chronic disease" were discordant their existing understandings of their smoking. Explanations of addiction that downplay or ignore the role of choice and autonomy risk being perceived as irrelevant by smokers, and could lead to suspicion of health professionals or an unwillingness to seek treatment.
University of Queensland School of Public Health, Public Health Building, Queensland, Australia.|University of Queensland School of Medicine, Royal Brisbane and Women's Hospital Site, Queensland, Australia.
Kylie
K
Morphett
University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital Site, Queensland, Australia.|Monash Institute of Cognitive and Clinical Neurosciences and School of Psychological Sciences, Monash University, Victoria, Australia.
Adrian
A
Carter
University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital Site, Queensland, Australia.|University of Queensland Centre for Youth Substance Abuse, Queensland, Australia.
Wayne
W
Hall
University of Queensland School of Public Health, Public Health Building, Queensland, Australia.|University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital Site, Queensland, Australia.
Coral
C
Gartner
D000293:Adolescent; D000328:Adult; D001315:Australia; D001927:Brain Diseases / Q000145:classification*; D005260:Female; D006291:Health Policy; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D016540:Smoking Cessation / Q000379:methods*; D014029:Tobacco Use Disorder / Q000145:classification*; D055815:Young Adult