Does one risky lifestyle choice lead to another or are some people just different?
Is smoking a gateway to problem gambling or is problem gambling a gateway to smoking? People who have a gambling problem are certainly more likely to smoke — and vice versa. Observational epidemiology suggests that tobacco smokers in the UK are three times more likely to have a gambling problem than non-smokers. They are also more likely to drink heavily and take illegal drugs. It would not be surprising if they are more likely to ride motorcycles and have unprotected sex. It turns out that risk-taking thrill-seekers are more likely to pursue risky thrills than people whose idea of a good time is staying home and watching A Place in the Sun. Who knew?
Similar research has shown that vapers are also more likely to be problem gamblers and, thanks to a new study from Japan, we now have evidence that the same is true of people who use heated tobacco products. Heated tobacco products (HTPs), such as IQOS and Ploom, are non-combustible, emit fewer toxins and are less dangerous than cigarettes. They have barely gained a foothold in the UK market but are big in Japan. Cigarette sales have halved there since HTPs were introduced in 2014, and so has the number of smokers. It is a public health success story similar to Sweden’s experience with snus and the British experience with vaping and, as in those countries, there has been a lot of scaremongering about supposed “gateway” effects that never come to anything.
Japan’s high use of HTPs makes it the perfect place to look for an association with problem gambling, if that is your thing. The Japanese researchers found that users of HTPs were more than twice as likely to be problem gamblers than people who did not use any nicotine products. This association is hardly surprising since the relationship between smoking and gambling is well established and HTP users, like vapers, are all smokers, ex-smokers or the kind of people who would be smokers if HTPs did not exist.
The authors mention a few reasons why the kind of people who get a kick out of smoking might also get a kick out of gambling:
From a psychological and behavioural perspective, individuals with high impulsivity are more prone to engage in both smoking and gambling. Moreover, symptoms of depression and anxiety have been shown to drive some individuals to smoke and gamble as mood regulatory strategies.
… From a neurobiological standpoint, both nicotine and gambling activate mesolimbic dopamine pathways. Nicotine enhances dopamine release in the brain, thereby amplifying the sensation of reward, whereas the uncertain outcomes inherent in gambling similarly stimulate dopaminergic circuits.
This all makes intuitive sense, and there is nothing wrong with scientists confirming a fairly obvious hypothesis. But expanding the field of human knowledge is never enough in modern epidemiology, especially when dealing with hot topics such as gambling and tobacco. There always have to be “implications for policy-makers”.
For policymakers, combining gambling-related interventions with smoking cessation measures, such as implementing smoke-free policies in gambling venues, may be an effective approach.
An effective approach to what? It is true that smoking bans drive away some gamblers away from casinos, but “public health” campaigners are loath to admit this because they insist that smoking bans do not cause any economic harm to the businesses that are forced to comply with them. The authors of a review of gambling policies went off message in 2007 when they admitted that “significant 15%-25% reductions in gambling revenues have followed gambling venue smoking bans in various jurisdictions” and took this as evidence that “smoking bans may inadvertently act as one of the more effective policies to reduce problem gambling”. This is an example of the now-familiar switcheroo from “this isn’t happening” to “it’s happening and it’s a good thing”, but forcing problem gamblers out of casinos doesn’t stop them gambling and it won’t stop them having a gambling problem.
Most social scientists pay lip service to the old adage about correlation not equalling causation, but the temptation to find a deeper meaning in statistical relationships can be hard to resist. In Australia, which is becoming a centre of excellence for human stupidity, an anti-vaping program was recently launched on the basis that: “Studies have shown that engaging in unsafe sex, other substance abuse, drink driving, texting while driving and driving without a seatbelt are associated with increased e-cigarette use among youth”. I dare say they are, but a campaign to reduce unsafe sex by clamping down on e-cigarettes (which, incidentally, are already illegal in Australia) is as doomed to failure as a campaign to reduce drownings by clamping down on ice cream sales.
Some people, especially younger men, are impulsive, sensation-seeking and don’t worry too much about tomorrow
The authors of the Japanese study never quite use the word “gateway”, but they beg the question when they say that “longitudinal studies are necessary to clarify the causal relationship” between HTP use and problem gambling. But there is almost certainly no causal relationship. Smoking is no more likely to cause problem gambling than problem gambling causes smoking.
The relationship between nicotine use and pathological gambling is mildly interesting, at best. All it shows is that some people, especially younger men, are impulsive, sensation-seeking and don’t worry too much about tomorrow. As neo-puritanism envelopes the world, the range of behaviours that are considered dangerously deviant expands, and there is bound to be some overlap between them, but unless the health establishment is going to go back to performing lobotomies, they should just accept that some people are different.
