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Published On: Fri, Oct 26th, 2018

Smoking cessation: When conventional nicotine replacement therapy fails

There are two aspects of smoking that smokers crave, a psychological one and a physical one. Physically, the body becomes addicted to nicotine, and withdrawal symptoms occur quickly when the smoker is without a cigarette. But beyond that, smokers crave the physical act of smoking – lighting a cigarette, holding it between their fingers and lifting it up to their lips. Traditional smoking cessation techniques address only the physical desire, but not the psychological one, which is the biggest reason smokers fail at their attempts to quit. Or if they do succeed in quitting, they replace the act of smoking with another physical act such as overeating, which is why many smokers who are attempting to quit gain weight. For this reason, any smoking cessation strategy should address both the physical aspect (nicotine withdrawal) as well as the psychological aspect of desiring a hand-to-mouth action.

photo/ public domain pictures via pixabay

In the report published by the British Psychological Society on “Changing behavior: Electronic cigarettes” the study notes, “For smokers trying to quit, e-cigarettes are more attractive than traditional smoking cessation methods, such as nicotine replacement therapy, and at least as effective.”

This and other research supports the notion that smokers don’t just crave the nicotine, they crave the physical action of smoking – the hand-to-mouth action of smoking is just as desirable in the smoker’s mind as is the pure nicotine. Nicotine replacement therapies such as nicotine gum and patches only satisfy the nicotine craving, but do nothing to address the desire for a physical action – and smokers get no psychological satisfaction from placing a patch on their arm. For that reason, many of the traditional nicotine replacement therapies are ineffective.

“Vaping, while not recognized by the FDA as a smoking cessation tool, is the only thing that satisfy both aspects – the psychological aspect of hand-to-mouth action, and the nicotine replacement component,” said Todd Skezas, CEO and co-founder of San Diego-based Vapor Authority.

The BPS report concludes, “There is also mounting evidence that they [e-cigarettes] are much safer than tobacco smoking. As a consumer product, although most Stop Smoking Services are not currently able to supply these, we recommend that they endorse them and support their use by smokers trying to quit.”

The British report does not advocate completely replacing all smoking cessation techniques with vaping, but does recommend a combination approach, with a recommendation to “Combine existing best practice, NHS Stop Smoking Services (SSS) with the most popular quitting method (e-cigarettes) to increase attractiveness of the SSS and further boost success rate. Offer e-cigarettes and technical support as part of the SSS and fund the services to support smokers to quit.”

A similar study published in the peer-reviewed BMJ (British Medical Journal) draws a similar conclusion, noting that “Electronic cigarettes (e-cigarettes) were originally designed as a smoking cessation aid, and the limited evidence available suggests e-cigarettes containing nicotine may help people stop smoking.” An additional study published by the US National Institutes of Health makes a reasoned conclusion as a result of their own research – e-cigarettes and vaping have an upside, and have potential as a smoking cessation tool. The NIH report states, “Our analysis strongly suggests that the upside health benefit associated with e-cigarettes, in terms of their potential to increase adult smoking cessation, exceeds their downside risk to health as a result of their possibly increasing the number of youthful smoking initiators. Public messaging and policy should continue to strive to reduce young people’s exposure to all nicotine and tobacco products. But they should not do so at the expense of limiting such products’ potential to help adult smokers to quit.”

When using e-cigarettes as a smoking cessation aid, it is especially useful to understand that liquids come in different strengths, allowing the smoker to begin with a higher-strength liquid and then move to lower strengths over time, diminishing the amount of nicotine being delivered while still enjoying the psychological hand-to-mouth action. Finally, there are zero-strength liquids available, which makes it possible to still enjoy the hand-to-mouth action and the vapor from the e-cigarette, while receiving no nicotine at all.

Author: Sahendra

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- Outside contributors to the Dispatch are always welcome to offer their unique voices, contradictory opinions or presentation of information not included on the site.

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