A reader wrote me the following:
I’ve been following your website for about 2 years now and I am very grateful for your recommendations, as they have improved my health. I’m in my early 30s, male, 6’3″, 195 lbs. I was in great shape until last year when I started a pack a day smoking habit. Since then my energy levels and mental clarity have plummeted. I find it hard to push through my workouts and I smoke immediately afterwards. I believe you mentioned that you were a former smoker so I would be grateful for any tips on how to quit (cold turkey doesn’t work for me) and how to overcome the stress on my body if quitting is not possible.
I am indeed a former smoker, although I quit cigarettes decades ago. I smoked from the ages of about 15 to 30 – and for those of you not around back then or if you’ve forgotten, just about everyone smoked back then.
Harm reduction is the attempt to minimize harmful effects of tobacco (and other drug) use, recognizing that many people have a difficult time quitting, and that methods for dealing with drug use are not “one size fits all”, since everyone is different.
Harm reduction occurs when a practice that is healthier, or not as unhealthy, is substituted for the original habit. For example, substituting methadone for heroin in addicts is an example of harm reduction. (Which doesn’t mean I’m wholeheartedly endorsing methadone use. Just an example.)
Harm reduction in tobacco use occurs when a smoker substitutes a different source of nicotine for cigarettes.
Let’s get one thing out of the way: cigarettes are bad news. Besides the long-term effects of possible cancer and heart disease, they also emit carbon monoxide, which makes the smoker feel lousy. This is probably what’s causing our correspondent to have low energy.
The bad health effects of cigarettes can be virtually 100% traced to products of combustion, not nicotine. The act of setting fire to tobacco creates a witch’s brew of chemicals and particles, which are then inhaled to do their damage.
Cigarettes are a very dirty nicotine delivery system; the smoker wants nicotine, but along with it gets a dose of hundreds of different chemicals and particles, most of which are toxic and carcinogenic.
Cigarettes are also incredibly addictive. Folk wisdom has it that cigarettes are more addictive than cocaine, but that appears not to be the case. (Addiction.) Nevertheless, even having to make the comparison shows the power of cigarettes. One reason they are so addictive is that nicotine can enter the brain within seconds after inhaling, thus providing a powerful psychological reinforcement mechanism, similar to injecting drugs, which are more addictive when injected.
Nicotine, by itself, can improve cognitive function (Biological Psychiatry) and may prevent Parkinson’s disease (Trends in Neurosciences). It can be toxic, although apparently not nearly as much as has been described. (Archives of Toxicology.) The idea that nicotine is toxic in tiny doses traces back to “dubious self-experiments in the nineteenth century”.
What about adverse health effects of “normal” doses of nicotine? This is hard to untangle from the effects of cigarettes or other sources of nicotine, but some sources claim that nicotine by itself is no more harmful than caffeine – which can also be toxic in higher doses and can cause mental health problems. (CNS Spectrums.)
A lot of lies are told about tobacco that has the effect of making it difficult to quit cigarettes.
The biggest lie is one that you can see on various tobacco products other than cigarettes, something like “This product is not a safe alternative to cigarettes.” Yes, that’s a lie. Some tobacco products have less than 1/1000 the health risk of cigarettes.
Smokeless tobacco – snuff or snus – “has not been definitively linked to any deadly disease”.
“There is overwhelming evidence that any risk for oral cancer (cancer of the mouth) from ST is very low.” – (Source.)
E-cigarettes appear to be quite safe, and in any case, much safer than cigarettes. (Source.)
There are also sources of nicotine such as gum and patches, but these apparently do not have as good a record at helping people quit smoking as do other sources of nicotine, the reason being that the user can’t manipulate them very well in order to control nicotine intake.
As my correspondent said, “cold turkey” or quitting altogether and abruptly, doesn’t work for him. Some studies have suggested that only about 27% of those who went cold turkey succeeded, and that after the third attempt.
Using the principle of harm reduction, it would be better for a cigarette smoker to use other forms of tobacco, such as smokeless, or other forms of nicotine, such as e-cigarettes, than to continue smoking.
The problem is that the government and anti-smoking groups are staunchly against any message that some forms of tobacco or nicotine might be safer than cigarettes, the idea being that that would encourage people to use them.
If those who use them do so instead of cigarettes, then that’s a good idea.
Needless to say, I’m not encouraging the use of tobacco, but I am discouraging the use of cigarettes.
For a full account of tobacco harm reduction, see the website Tobacco Harm Reduction, as well as the review article, Tobacco harm reduction: an alternative cessation strategy for inveterate smokers.