Tanning Addiction

Recently I've been reading about the association of indoor tanning and addiction.  Concerns about tanning's health consequences are not new, though we still don't have precise understanding of the mechanism by which ultraviolet light exposure causes cancerous changes in skin.  Limited estimates indicate that indoor tanning may double the risk for melanoma, the most life threatening form of skin cancer.  Indoor tanning is done by around 15% of adults, and it has increased in recent years.  The exception to the trend is teenagers, whose tanning has gone down, perhaps because of legal restrictions on teens going to tanning salons without parental permission.  Most of this has been discussed in the media for many years.

What is new is the notion that tanning may be addictive behavior.  People seek out tanning for cosmetic reasons, because a golden skin color is valued in some circles, and people believe a tan gives a "healthy glow" to a person's skin.  Obviously this is a very subjective perception, but it is one held by millions of Americans.  Recently there has been research suggesting that UV light has an impact on MSH, a skin hormone, which then causes the release of endorphins: a name derived from "endogenous morphine."  There are receptors in the brain for endorphins, and their stimulation will have effects similar to opiate drugs.  Under experimental conditions, withdrawal symptoms have been induced in regular tanners who were administered endorphin blockers in proximity to tanning.   It is therefore becoming accepted that frequent tanning can become compulsive in an addictive way.  The question is, what does this mean for health promotion?

Addiction is an emotionally charged word, and it has many shades of meaning.  Once upon a time, addiction was only used for certain types of drugs such as cocaine and opium.  It was not until the 1980s that there was any scientific consensus that tobacco was addictive.  In the popular mind, there is uncertainty whether alcoholism is addiction, or some other type of syndrome.  The word addiction has also been applied to a wider range of compulsive behavior, such as gambling, shopping, sexuality, and even uncontrolled anger, called "raging."  The problem with all this is sorting through a lot of ambiguity.  If someone makes an unwise purchase, are they then a shopaholic?  How about two, four, or ten.  What is the threshold?  As it stands now, if you think you have a problem, you do.  On the other hand, if someone else thinks you have a problem, but you don't recognize it, you are in denial.  This kind of circular thinking complicates what can certainly be, for some people, very destructive behavior.

Addiction comes in degrees.  Some behaviors of choice are more reinforcing than others.  The key question is what are you willing to give up in order to be reinforced by something.  Smokers are able to live otherwise normal lives, because their drug is cheap and the consequences are usually postponed by years.  In contrast, alcoholics because dysfunctional: they are willing to lose wealth, family, job, safety, and even freedom, rather than give up their drug.  Yet, even people with the worst addictions have been successful in overcoming their dependence. 

The relevance to health promoters is this: according to dermatologists, there is no safe tanning, outdoors or indoors.  Health consequences are significant enough that we should continue to warn people of the risks, and as we can, initiate policies, such as restrictions for minors, to help people reduce the risk.  If there is an addictive property to tanning, it will make the health promotion task more complicated, but not impossible.  After all, millions of addictive smokers have quit.  We have pharmaceutical aids to help addicted smokers; perhaps in the future parallel aids will be developed for addicted tanners.

The more we understand about tanning, or any other health-related behavior, the more effective we can be in devising solutions.  The tanning addiction story is not finished yet, but it will bring an interesting wrinkle to the task of helping people avoid serious skin cancer.