"Excessive" means "more than what is right, proper or necessary." When used in medicine, it means "more than is good for continued good health" We can eat too much, work too much, drink too much (including non-alcoholic liquids), sleep too much, and so on; and while any such excess is potentially troublesome, some excesses are worse than others.

Smoking must be put in that category, because it has vastly increased the incidence of lung cancer and coronary artery diseases, and because it plays a significant role in increasing the mortality rate in other pathologies.

Some people do more than one thing excessively; for example, they may smoke excessively and drink excessively and perhaps also work excessively. Since there is a reason for everything we do, there are reasons for this pattern of behaviour. Usually the excess acts as an "escape mechanism" from an emotional problem. If the habit is removed, but the cause is not, another habit generally develops. That is where the psychiatrist can make their unique contribution; he/she can seek out and remove the basic cause or causes for that particular emotional problem.

Excess can also be the result of an endless circle of action and reaction. An emotional problem causes anxiety; the anxiety itself causes greater anxiety. And as the anxiety continues to mount, feeding on itself and breeding itself, an escape mechanism becomes necessary. Relaxation effectively prevents this dangerous accumulation of anxiety and tension, and learning how to relax effectively is very worthwhile. By the way, that doesn't mean lounging by the pool with a plate of burgers and a six-pack!

With smoking, however, another element is present: cigarette advertising.

Cigarette advertising induces you to believe first that smoking leads to gratification, and second that more smoking leads to still more gratification and enjoyment.

It does nothing of the kind; more smoking leads to more damage. When it doesn't lead to catastrophic damage, it at least results in unnecessary shortness of breath, coughing, digestive upsets, and a host of other obstacles to a feeling of real well-being. The liquor industry has seen the need for self-regulation, and promotes the idea of moderation (which it certainly finds preferable to prohibition). The cigarette industry in its consumer advertising makes believe that the facts aren't there. With agile sleight-of-hand, the tobacco merchants keep your attention diverted from the dangers of smoking; instead you pay attention to their new ideas in packaging (soft package, hard package, tops that slip, flip, zip, slide or slope) and to their new brands, new sizes, and new flavors.

Although we have come a long way in recent years, tobacco promotion is still incredibly effective. In fact, among certain groups of people (young girls particularly) we are now starting to actually see an increase in the take up of the smoking habit. I passionately believe in free will, but with all the outside pressures how are we, and youngsters in particular, to exercise it?

Chris Haycock