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Air Rage: Does Nicotine Withdrawal Play a Role?

This term has recently been introduced to describe psychological or physical violence occurring within an aircraft. It is of particular concern for obvious reasons: the cramped conditions inside an aircraft and the inevitable involvement of not only the cabin crew but also other passengers. Passengers have had to be physically restrained from entering the flight deck. In one recent incident an apparently deranged passenger died as he was being subdued by other passengers and crew. There have been instances where aircraft have had to land prematurely to offload disruptive passengers and legal action taken against those involved.

What is air rage? There is often a developing cycle of events, which may include delays, exhaustion due to lack of sleep, excessive use of alcohol (sometimes to compensate fear of flying), minor irritations due to behavior of fellow passengers (which elsewhere would largely go unnoticed) and sometimes anoxia causing irritability in those with pre-existing hypoxic illnesses. Not known is whether air rage is a new phenomenon or one that is receiving more publicity.

Smoking and alcohol: It has recently been recognized that there may be a relationship between air rage and nicotine withdrawal in heavy smokers on long-distance “no smoking” flights. Incidences of air rage have apparently increased as no-smoking flights have become more common; nearly all major airlines now have no-smoking policies, regardless of the length of the flights. Alcohol intoxication may also contribute. There is a small but growing groundswell to ban alcohol on flights.

Prevention: Nicotine gum or a mild tranquillizer may be useful ‘prophylaxis’ for heavy smokers on long flights. Passengers should also refrain from excessive alcohol consumption before and during flights, and discourage heavy drinking by their traveling companions. Airlines have the right to refuse to carry those who have previously caused disruption on a flight - warnings may be issued (the equivalent of yellow/red card system as used at football matches).