A while back, Pat Lowry's column addressed an annoying stage-hypnotist's snake-oil pitch to an audience interested in quitting tobacco use. While this experience was disappointing, there are encouraging elements in Pat's account.

Pat's column did suggest that for some, quitting could be a good thing. This insight, along with a journalist's nose for news, motivated him to check out a man who, as it turned out, mainly sought to exploit the victims of tobacco addiction. Hypnosis can be useful, but not this kind.

We're all tobacco victims -- the people who smoke or chew it, those who breathe the air they share with a smoker, those who confront the budgetary losses imposed by the enormous health costs of tobacco-related disease, those who must watch loved ones suffer and die.

Doesn't everybody already know that smoking is injurious? You'd think so. Large-scale surveys have repeatedly shown that around 70 percent of smokers want to quit. So why haven't they quit already? And what about the other 30 percent, who sincerely maintain they don't want to quit at all?

The answers lie in nicotine's ability to alter the structure and function of the brain. Exposure to this mighty little molecule changes the number and sensitivity of "receptors" on the surface of brain cells. This physical process is just as "real" as the throat inflammation caused by strep germs. That's why physicians and mental health professionals regard addiction as a "disease." It's not weak willpower or a character flaw. In principle, we can choose what to do; it's harder to choose what to want.

Just as kidney disease changes the nature of urine made by the kidney, nicotine-induced brain disease changes the nature of thoughts made by the brain. Surprisingly little nicotine exposure is required to subtly alter thought processes. For some vulnerable individuals, mostly the young, a single cigarette is enough to trigger the onset of addictive thinking. Not everyone is equally susceptible; smoking that first cigarette is a gamble, a bet that "it won't happen to me."

Surrounded by evidence that it does happen to a lot of people, why would anyone wager he'll be the exception who can stop any time he wants? Around 90 percent of tobacco addiction begins in young people who are just experimenting, people under the age of 20. The young are notoriously unwilling to believe that they are mortal. They harbor an inflated perception of their own ability to maintain their autonomy. Independence is new to them, and asserting it is a supremely important part of the maturity they crave.

The irony, the paradox, is that young people in search of a distinct personal identity are often the first to try to "fit in," to join a group by dressing, talking and acting like other members of the group. Hence the role of "peer pressure" in the initiation of tobacco use. Smoking might seem desirable if one can be led to believe that it is normal, that it's more prevalent than it really is, that it's a sign of maturity, a sign of independence. They simply don't understand or believe how destructive it can become. It's safe to say that few smokers had any idea in the beginning what it would really be like for them, living with it, dying from it. They didn't do this on purpose.

The tobacco industry knows all this, and it forms the basis for the longest-running, most successful mass marketing campaign in history. They know that if new smokers aren't recruited before they reach the age of 20, the window of opportunity will close. Enlisting new smokers is no longer aimed at expanding the customer base; now it's necessary just to maintain established sales levels, as the current smoking population dwindles due to premature disability and death.

A third of people who become regular smokers will die prematurely as the direct result of their addiction. Smoking will disable another third, to varying degrees, before they die of something else. Of those who smoke until they die, fully half will perish because of their own tobacco use, and tobacco death doesn't come gently.

But some do quit -- in fact, a lot of people quit. Of all living Americans who have ever been regular smokers, more than half have already quit. Tobacco addiction can be overcome.

When nicotine begins calling the tune, victims find ways to rationalize their use, to ignore signs that they themselves have become enslaved, to disregard clear evidence of ongoing injury. They convince themselves that they feel fine, and that feeling fine is not jeopardized by smoking. The reason they don't "choose" to quit is because they enjoy smoking. (It's true that they often do enjoy it. But that's not the whole story.)

For years, we have assumed that "high self-esteem" protects non-smokers, especially youth, against experimenting and addiction. When the issue was actually studied systematically, the opposite proved to be true. People with high self-esteem tend to believe that since they are usually successful in whatever they undertake, they can resist tobacco addiction when lesser mortals would succumb. Big mistake.

Overcoming denial and developing insight into nicotine's ability to control us are crucial steps toward quitting. The next step is making an informed quit attempt. This complex addiction is best understood before trying to conquer it.

* Next time: Know your enemy -- bricks in the wall of addiction.

Jon Hauxwell, MD, is a retired family physician who grew up in Stockton and now lives outside Hays.

hauxwell@ruraltel.net