Smoke ‘Em if You Got ‘Em: Rethinking Smoking as a Trauma Response

We’ve all heard it before: Smoking is bad for you. It’s a bad choice. It’s an addiction. Society has been hammering this message home for decades. But what if the story is more complicated? What if smoking isn’t just about addiction or comfort, but about something deeper—something rooted in how trauma reshapes the brain?

Research into Adverse Childhood Experiences (ACEs) has uncovered startling connections between trauma and long-term health behaviors. ACE scores measure the impact of adverse childhood experiences, such as abuse, neglect, or household dysfunction, on long-term health and behavior.

People with high ACE scores—indicators of significant childhood adversity—tend to have smaller hippocampi and amygdalae, areas of the brain that regulate emotions, memory, and stress. Their stress-response systems don’t behave precisely like those without trauma. These differences aren’t due to personal choices; they’re the result of chronic adversity during critical stages of development.

You can assess your own ACE score in minutes by answering 10 questions: https://acestoohigh.com/got-your-ace-score/. The site also features tables, graphs, and charts explaining probabilities for various outcomes based on ACE score. In a nutshell, when a developing human brain is exposed to trauma, the body involuntarily releases stress-response chemistry that alters the development of key brain structures. These changes, in turn, affect associated brain functions and behaviors.

People with high ACE scores are more likely to do drugs (including alcohol, marijuana, tobacco, and a host of others). They are also more likely to struggle with depression, with finding and maintaining gainful employment, and with a variety of health issues.

When adults are exposed to enough adverse experiences, they can develop PTSD. Smoking is also more prevalent in the PTSD population than it is for the general population, too. Trauma seems to have a way of impacting brain function. For people with trauma-impacted brains, smoking isn’t just a way to unwind after a tough day; it’s a tool to quiet an ever-present storm others rarely face.

The issue extends beyond tobacco. People with high ACE scores often seek satisfaction—or simply relief or comfort—through substances like alcohol, marijuana, magic mushrooms, or opiates. Like tobacco, all of these substances are drugs. So while this essay focuses on tobacco use, please understand any principles at work apply also to other drugs used to find relief, comfort, and satisfaction.

These substances can provide comfort that those without ACEs or PTSD may not understand. This isn’t about indulgence; it’s about satisfaction in life—about finding a tolerable way to live with a trauma-sculpted brain.

For reasons science is still unraveling, smoking seems to interact with trauma-altered brain chemistry in ways that go beyond “relief” or “habit.” Nicotine or THC may balance or soothe these brains in ways people without PTSD or high ACE scores don’t experience. For someone with an ACE score of four or more or PTSD, smoking isn’t merely a “bad habit”; it’s often a biologically driven response.

Yet society’s response to smokers remains judgmental and punitive. The message is clear: Your trauma isn’t our problem. Your choice to smoke costs us money. Therefore, we’ll tax and stigmatize you. This approach ignores the evidence. Research consistently shows that people with high ACE scores are far more likely to smoke and far less likely to quit.

While smoking rates have declined overall, likely due to successful campaigns targeting casual and social smokers, what remains is a core group of “die-hard” smokers. Many in this group have endured significant childhood adversity. According to research, individuals with high ACE scores are significantly more likely to smoke.

For them, standard anti-smoking interventions like patches or gum often fall short because they don’t address the underlying emotional and neurological scars. They have a pesky biological reality to deal with.

Researchers have recognized the health consequences of having a high ACE score and the connection between die-hard smoking and a history of maltreatment.

So why do we keep punishing people for behaviors rooted in experiences they didn’t choose? People with high ACE scores are already more likely to face rejection, struggle in relationships, and battle chronic health problems. Adding financial penalties and social stigma only deepens their burdens.

Reducing smoking rates further won’t come from more taxes or shame. It will come from addressing the root causes—childhood trauma and the systems that perpetuate it.

Until science fully understands the relationship between trauma and smoking (i.e., drug use), let’s pause the blame game. People don’t choose their trauma, and many wouldn’t smoke if they didn’t feel they had to. Instead of punishing smokers for finding relief and satisfaction others enjoy drug-free, let’s focus on creating a world where fewer people need that relief in the first place.

Sadly, we depend upon the very political, economic, and social systems under which this trouble flourishes. To reduce the number and severity of ACEs children encounter, it would require us to fundamentally change or abandon the stress-producing systems outputting these results. Until then, we seem destined to continue unduly punishing people for being unduly punished.

Rather than continuing to punish those who turn to smoking as a way to manage their trauma, we must shift our focus to preventing the trauma in the first place. This requires a societal overhaul—a move toward a system that nurtures children, supports mental health, and addresses the root causes of adversity before they can shape a person’s life.

As long as we remain trapped in a cycle of stigmatizing individuals for their natural development, rather than addressing the underlying systems that perpetuate their suffering, we will continue to see the same patterns of behavior and outcomes. The solution lies not in punitive measures or financial penalties, but in creating a world where fewer people need to seek relief through substances, and where those who do can find compassionate, trauma-informed support. Until we commit to breaking the cycle of trauma, we will be forever bound to the consequences of our failure to act.

Systems to Blame

Every day in America, we hear about shootings, suicides, car wrecks, homelessness, racism, depression and mental illness, drug overdoses, partisan politics, and the growing impacts of climate change. Although each example may stand as an isolated, individual event, in reality these results are systemic. Our political, economic, and social systems combine to create these results.

One way to ensure that these outcomes continue is to treat each as an isolated incident, an aberration, or an individual problem—events without any underlying systemic cause.

Congress convenes to pass laws addressing these issues, and our justice system assigns blame to individuals, holding them accountable. To reduce mass shootings, for instance, we might propose laws restricting access to firearms. If we prevent certain troubled individuals from acquiring weapons, the idea is that they wouldn’t be able to carry out mass shootings. We might also limit the size of gun magazines to reduce the number of victims a shooter could harm at once. Or, we could try restricting the availability of automatic weapons, so even law-abiding citizens wouldn’t be as capable of carrying out mass shootings.

While these solutions aim to address the systemic nature of mass shootings by attempting to alter the conditions in which shootings occur, they still focus on controlling the outcomes, not addressing the causes. It’s like treating a disease by only addressing its symptoms rather than understanding and solving the root causes.

In his book Out of the Crisis, Dr. Deming tells a story about one of his clients who complained about the frequent fires at his production facility. Within just a few years, the company had experienced several fires, a clear impediment to production. Deming applied his statistical expertise and came back to the client with an unexpected finding: the company wasn’t having too many fires—they were having exactly the right number.

As it turned out, the same production system reliably producing quality product also happened to be a system producing fires with reliability. These frequent fires were systemic results. They were produced by the operation of this system.

Deming explained to his client that not only was it effectively a system for creating fires, it was, by his statistical analysis, a stable system. In other words, unless something is changed about how the system operates, we should expect more fires.

Imagining a conversation between Dr. Deming and the plant manager:

“What did you do after the first fire?” asks Deming.

“We cleaned it all up, fired the employees involved, gave the rest a good re-training, put everything back the way it was, and started making good product again,” replies the plant manager.

“Hmm,” says Deming, thoughtfully. “So, what did you do after the second fire?”

“Well, we cleaned it up again. We couldn’t determine who was responsible, so nobody got fired that time. But we re-trained ‘em again. Then we rebuilt again and started production again.”

“And a similar reaction to the subsequent fires?” asks Deming, as a pained expression starts to develop on his face.

“Yes, sir!” replies the plant manager. “We’re resilient if nothing else. How can we do better?”

“It seems you’re repeating two mistakes,” replies Deming. “First, when you put things back just as they were before, you imparted the same probability for achieving the same results. And second, you blame employees for systemic results, which seems unfair since you effectively trained them to produce precisely those results.”

In response to the plant manager’s blank stare: “Although your system reliably produces high-quality product, when it’s not on fire, it also reliably produces fires. Both outcomes are systemic and neither is by accident. Yet you treat each fire as if it were an isolated incident of mysterious origin, or the result of an individual’s poor decisions.

“In reality, your system is as fully responsible for producing fires as it is for producing product. Currently, your system is effectively designed to combust every so often. When you put it back precisely as it was, you effectively re-design it to burn again, giving it precisely the same probability of catching fire.”

“Why would you expect different results by putting everything back the way it failed and then doing the same thing again? The problems you are encountering are fully caused by the way your production system operates.

“If you want to assign responsibility for the fires, it would belong with those who designed a system that catches fire, not with employees operating a system effectively designed to catch fire . . .”

Of course the production line at this company wasn’t consciously, deliberately designed to catch fire. We can pore over the production plans and procedures, and nowhere will we find the objective of, or instructions for, starting the plant on fire. Yet reliably enough, it catches fire. Why? It was effectively designed to catch fire. Even if catching fire wasn’t an established objective or an intended output, the results are the same as if it were. By observing a system’s results, we can discern what that system was effectively designed to output.

Every system is perfectly designed for its outputs.

The system that produced quality products was also systematically producing fires. These frequent fires were not anomalies but stable, predictable outcomes of the production system.

Deming explained that the company’s system wasn’t just accidentally catching fire—it was designed to produce fires, albeit unintentionally. By simply replacing the damaged parts and retraining employees after each fire, the company was resetting its system to produce the same outcome, leading to predictable failures.

Here we are experiencing on a daily basis, shootings, suicides, car wrecks, homelessness, racism, depression and mental illness, drug overdoses, partisan politics, and accelerated climate change.

If Dr. Deming were here to apply his statistical expertise, would he conclude that these problems are systemic results? It certainly seems so. We have systems in place for reliably producing shootings, suicides, car wrecks, homelessness, racism, depression and mental illness, drug overdoses, partisan politics, and accelerated climate change. These results are not accidents. Systems producing these results appear to be remarkably stable, consistently generating these undesirable outcomes.

The plant manager’s response to these fires mirrors our societal response to systemic problems. We repeatedly clean up the aftermath, blame individuals (or elect new ones), and then restart the same processes that set the stage for the problems to occur again. It’s an example of an attempt to fix a system by only treating its consequences rather than addressing the systemic issues that are generating them.

Our systems produce undesirable results because of how they are designed and operated. And until we change these systems at a fundamental level, we will continue to see these outcomes. Whether it’s gun violence, climate change, or poverty, the systems in place are stable in their production of these outcomes. And until we acknowledge and address the systemic nature of these issues, we are destined to keep cycling through them.