One of our constant themes on this site and in our writing is that people derive benefits from nicotine. There really is no other conceivable explanation for its popularity. In other words, some people’s lives are made better, and in some cases simply not miserable, by using nicotine. We promote tobacco harm reduction (THR) which rather than arguing that abstinence is the best and only solution for all nicotine users takes the position that smokers should have the information about the risks of smoking and alternative products, and that there should be few barriers (including financial) of switching to safer methods of obtaining nicotine. Then, with the information, smokers can decide what course benefits them most. And while we think that it makes sense to switch to electronic cigarettes or smokeless tobacco (or to go ahead and just quit), the ultimate decision rests with the smoker.
We need to accept that smokers have good reasons for smoking. Part of THR is finding alternatives that will satisfy those reasons and letting smokers (and everyone else) know about them.
Recently a couple of us were putting together a document and wanted to cite another individual or group that researches or educates about harm reduction that also takes a welfare approach to nicotine. That is, that they have expressed the idea that nicotine provides benefits to some if not many people and that saving some of those benefit is an advantage of THR compared to simply demanding abstinence. We had great difficulty in finding such a person active in THR – at least, one who was explicit in stating their welfare approach. (If you are such a person, leave a comment and get a citation in that paper).
Nicotine and smoking are usually described as having no benefits and only costs. Continued smoking is explained as driven by the avoidance of withdrawal or of simple addiction with no sense that smokers are getting anything out of their habit but avoiding pain. This is obviously not the case – just ask the next smoker you run into.
Adding welfare into the equation restores user dignity by treating them as rational and normal human beings. Just because someone happens to smoke should not define them beyond the behavior itself; it certainly does not mean that by liking nicotine they have lost all sense of reason.
Perhaps some THR people also have concerns about appearing pure and don’t wish to even give the appearance of supporting any sort of nicotine use; it is, after all, easiest to maintain credibility and avoid confrontation by sticking to the status quo at least on some of the issues (and the abstinence-is-best approach is certainly the most popular). They will promote it as restricted to those who cannot quit, and maintain that abstinence is still preferable (which is in effect saying that the benefits are worthless, that better to be abstinent and less happy is preferable to being happy with a negligible risk attached).
The thing is that as much as we might pontificate about the taste of a particular wine or a coffee or the smoothness of a cigar, at the heart of our enjoyment lies the appreciation of a drug. We use and like drugs. They make us feel better and sometimes the cost has to be awfully high for us to give them up.
Smoking has many pleasures to offer but without the nicotine it would never have caught on. And what the central question is how do we deal with a drug with such subtle yet substantial positive effects but that in its most popular form causes such great health costs.
The lazy approach is to dismiss lifelong smokers as unique exceptions to normal rational consumer behavior. That offers the easy option of leaving these deluded souls out of the discussion about how we can improve their lives for them, rather than considering that they are reasonably rational individuals like everyone else who, having weighed the costs, determined that the advantages of smoking outweigh those of quitting. That is powerful testimony about a powerful benefit, and calls for us to offer something other than the lazy simply solution.
– Paul L. Bergen