Nicotine Maintenance: Quit Smoking, Not Nicotine

Nicotine Maintenance for Inveterate Smokers. Published in Technology (Volume 6, pages 17-21, January 1999) by Brad Rodu and Philip Cole.

As our research group has been emphasizing, over 400,000 Americans die each year from smoking-related diseases. Further, the percentage of Americans who smoke has remained stable for the past several years, indicating that today's smokers may find it more and more difficult to quit. Many smokers can't quit because they cannot achieve the unrealistic goal set out for them by conventional cessation programs: complete abstinence from nicotine.

Among the 46 million Americans who smoke, we estimate that about 18 million of them are "inveterate." That is, their desire for nicotine is so strong that these smokers simply cannot live without the drug. Nicotine itself is not detrimental; in many ways it is very similar to caffeine, which is consumed safely by millions of people every day. Thus, while nicotine is the reason people smoke, it is not the reason smokers die.

Traditional quit smoking proponents believe that one shoe size - abstinence - fits everybody. Therefore, they rely on behavioral "tricks" to help smokers trying to battle the toughest problem of their lives. For example, a National Cancer Institute manual on quitting advises doctors to offer smokers tips such as "Keep your hands busy - doodle, knit, type a letter." "Cut a drinking straw into cigarette-sized pieces and inhale air." "Keep a daydream ready to go." Inveterate smokers need more than a daydream; they need a safe and satisfying alternative way to enjoy nicotine.

In this article we review the advantages and disadvantages of all available sources of nicotine. Of course, nicotine gum and the patch are currently available without prescription. Although these products have potential, they have three serious drawbacks: (1) they tend not to be satisfying to many smokers because they provide only low doses of nicotine, (2) despite their safety, the products are limited to about 3 months use, and (3) they are too expensive. These negatives are all arbitrary and imposed by the FDA. We call for these products to be made less expensive, more satisfying and for unlimited use (or maintenance).

Finally, we discuss smokeless tobacco as an alternative for the inveterate smoker who can't quit. In short, smokeless is cheaper, delivers nicotine efficiently, and its use is associated with little health risk compared with continued smoking. Other sections of this web site are devoted to various aspects of our program.