What’s so wrong with being “second best”, anyways?

As discussed in a recent post on this blog, tobacco control advocates tend to think dichotomously when it comes to tobacco use: they lump behaviour into either abstention or use (with abstention being good, and use being bad).  Most people I talk to (and it seems, even many tobacco harm reduction advocates) seem to consider THR as a second best option to abstinence (creating three categories: smoking, THR, and abstention).  The general consensus seems to be that if you can’t quit smoking, then using a low-risk form of nicotine is acceptable.  If, however, you’re capable of quitting entirely, then abstention should be your only goal.

This categorization makes sense when you consider the political positions that people are in.  If your goal is eliminating the use of nicotine rather than improving public health (as it is with most anti-tobacco groups), then THR isn’t even second best… it’s no better than smoking.  Which is, indeed, the message being sent out by anti-tobacco zealots (with the dichotomies of abstention vs use).  For the THR advocates – who actually factor health into the equation rather than the all-or-nothing goal of nicotine abstinence – it’s a little trickier.  My own opinion on this tendency to place THR in the second best category is that it’s probably the result of trying to be as politically correct as possible in a politically incorrect field.  THR is the “fine, if you absolutely must use nicotine, then at least do it in this safer form” category.  Most of the people who I’ve talked to and who are aware of THR also think that it is the second best option.  The majority of smokers I know who have managed to switch would still like to quit nicotine entirely at some point (although for the years I’ve known them they have not been successful, and some feel a sense of failure about this fact).

From our view, however, THR can be the best option for many people. We’ve discussed the welfare perspective a few times on this blog and elsewhere (like here, here, here, and here), the idea being that abstinence is not necessarily the best idea if you consider a person’s quality of life.  Forcing someone to quit a relatively innocuous drug that provides them with cognitive benefits seems particularly unnecessary; if people benefit from nicotine and have the option to switch to a safer delivery mechanism (and find it satisfying), then using low-risk nicotine products is no longer the second best option, but the best option (this goes even for some people who don’t smoke at all).  In fact, for some, nicotine is such a boon to their quality of life that to go without it would inhibit their ability to function on a day-to-day basis, making the adoption of THR a clear win for them.

(In fact, we can argue that adopting THR is probably the best immediate option for any current smoker, period, since the health benefit of switching to a low-risk product right away is actually better than repeatedly trying to quit and failing over a few months.)

Viewing things in black-and-white reflects a tendency in our society to view things as either winning-or-losing.  Second best is not exactly what most people strive for in a competition; if THR is considered second place to abstention, it seems to infer that since you’ve only merely switched to a low-risk product instead of quit entirely, you’ve lost the race (in particular, the purity race).  And if you think that first place is simply not achievable (abstinence being first place in the mind of tobacco control), or you end up trying to achieve abstinence several times and fail miserably in the process (even though you’ve been told time and again by anti-smoking groups that abstinence is possible for everyone), it’s going to feel pretty damn discouraging (and may end up resulting in learned helplessness).

If, however, the THR option of “second best” is promoted as more of a desirable option (and in fact the best option for many people) rather than just a sad second place to abstinence, we may have more people warming up to the idea.  Since THR doesn’t ask people to make the huge adjustment that abstinence demands (because so many low-risk nicotine products are indeed still satisfying), it’s much easier to adopt.  And because using low-risk products is roughly the same as abstention from a health perspective, then whoever has the biggest number wins.

So why not put smokers in a win-win situation with a quit or switch message?  Either one gets you to a healthier place.

CMNissen