When quitting is an option and not a necessity

Though it seems to be so much more common and easier to divide behaviors into good and bad, the problem with drug use is that it is so much more complicated than that. Drug users are as varied as anyone, and since almost everyone is a drug user of some kind, its pretty specious to draw such presumptuous demarcations. Once you replace morality with health (health, in my opinion, actually being the more “moral” approach) more natural and pragmatically useful categories come into play.

Rather opposing abstention and use, why not envision an opposition of bad enough to worry about and not bad enough to worry about. Forgive the vernacular but to me it seems to make more sense than terms like safe or dangerous.

With the dominant mindset we have all nicotine users (whether snus-ers, smokers or vapers) lumped together and on the other side the abstainers. The inappropriateness of this grouping (in the context of public health) is also evident when nicotine users are contrasted with prescription drug users, alcohol consumers or any other drug users. Its just not helpful when someone on anti-depressants or beta blockers criticizes someone for boosting their neural process or relaxing via a dose of nicotine.

But the main point is that the practical division is along the lines of how risky a behavior is. Once health is the measure then we will find that the constructive nicotine use breakdown is smokers on one side and everyone else on the other. (This is not meant in any way as castigating individuals who choose to smoke but is simply a breakdown of what health risks the behaviors are associated with. Its no different that separating high from low risk sports activities. Higher risk activities are not morally suspect; they are just higher risk.)

Once the powers that be stop blocking basic information about the comparative risks of various nicotine deliveries and once people understand that in the long run switching to snus or e-cigarettes is roughly equivalent to quitting then we should see a dramatic increase in switching and we might also see attitudes toward quitting change.

As mentioned in the last post, even if the health risks of using nicotine are perceived as negligible some people will still want to quit -and all the power to them. The point is that people should have the information and they should have the right to do what they will with that information.

What intrigues me is what might happen to the multi-billion dollar cessation industry should the THR message be widely acknowledged. Obviously some of the current cessation products will be reconfigured or remarketed as “dual use”, that is, as either cessation or switching products. (I’m pretty sure this is already taking place to a degree.) This industry, which maintains such mutually beneficial bonds with tobacco control, just might need to disengage in the interest of developing and then promoting products for tobacco harm reduction.

If Big Pharma holds its present course, and tobacco/nicotine use policy moves to being health-based, then the whole cessation industry will become even more like the diet or exercise fad industries – useful for a very small part of the population but a waste of time, money and effort for most. Those industries serve to delay too many people from pursuing the real solutions to their problems.

Most smokers have been browbeaten into believing that they have to try and quit on a regular basis, and many do the quit and relapse dance to exhaustion. (I wonder how much smoking takes place to take the edge of having to contain that identity clash of simultaneously being a smoker and being a quitter.) They have also been misled to believe that pharmaceutical aids to quitting are pretty well mandatory. (See here for Chapman’s critique of the lack of official support for cold turkey; if you are in the market for quitting nicotine, it seems to be the way that has worked for most).

The “official” explanation of the failure rate is that it takes many attempts to successfully quit. I can just imagine the meeting on that one.

“Bob here says the figures show that almost all our customers are failing up to ten times. They do eventually quit but hey, there must be something wrong with our product. And thanks for that Bob but you are looking at it the wrong way. Its not a product problem; its a user profile. The product is perfect. Smokers are just so addicted that it takes that many time to break through their addiction.”

“Maybe they’re just quitting after trying that long and it has nothing to do with our product?”

“Don’t be an idiot.”

Regardless of the THR message being widely accepted or not, these companies will still push their products as being healthier and safer than e-cigarettes and smokeless tobacco. In the meanwhile, most everyone will come to understand that there are few real differences among all these low risk nicotine delivery methods (especially once the smoke clears on the crucial combustion/noncombustion divide). People will also realize they have the power to choose between continued use or quitting with negligible differences in health consequences.

When we reach that point, those who have been actively opposing and obscuring the truth about these products will be revealed for what they really are: not public health advocates, not beneficient guardians of the public trust, but as sadly impoverished abstinence-only advocates. And not only just abstinence-only advocates, but abstinence-only advocates of a relatively benign (and in fact very useful) drug. Here’s hoping that day comes soon.

-Paul L. Bergen

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  • richard hansen  On February 3, 2011 at 7:15 pm

    Excellent article Paul, it is always refreshing and hopeful to read your reasoned, pragmatic articles which consistently make the case for ‘harm reduction’ and ‘risk assessment/risk management approaches to health. I truly wish you had much more of the public ear – we are in dire need of the effective and humane approaches to health to which you subscribe. I have deep concerns about the utterly destructive nature of the current ‘players’ in the fields of public health, public policy and health research. The extremism and the injection of moralism (as you also note) into issues of personal and public health only serve to create divisiveness, classism and “public/Institution sanctioned” bigotry.

    • Paul  On February 4, 2011 at 4:58 pm

      Thanks Richard. Always good to know there are a few like minded souls out there.

  • G  On February 4, 2011 at 2:07 am

    Great article — love your site


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