Wednesday, July 20, 2011

Switchers: Profiles of Pioneers

The scientific rationale for switching from cigarettes to smokeless tobacco was indisputable in 1994 when I published my first two articles on tobacco harm reduction (here and here). But had anyone ever made the switch from combustible to smoke-free tobacco?

The answer, according to a 1993 report from the federal Centers for Disease Control and Prevention (available here), was a resounding YES. The report estimated that there were 5.3 million smokeless users in the U.S., and that one-third of them, or 1.7 million, were former smokers.

My research group established contact with a small number of switchers, and in 1995 we published a manuscript about them (citation here). Their average age was 50, but some were as young as 27, and some as old as 77. They were blue and white collar, women and men. Their cigarette smoking experience varied considerably, with an average smoking history of 48 pack-years. (A pack-year is a measure of exposure to cigarettes obtained by multiplying the number of packs smoked daily by the number of years smoked). Some had recognized early on that cigarette smoking was a future health threat -- they had only 3 pack-years; others made the switch with an astounding 156 pack-years behind them.

In my book, For Smokers Only (link), I shared the stories of switchers we had met. The following is an excerpt.

The people depicted below are real pioneers. They are former smokers who, for various and sometimes very personal reasons, decided on their own, without any medical assistance or support, that smokeless tobacco was a safer alternative to cigarette smoking. These profiles in courage can serve as models for those of you who may be impressed by the facts, the stats and the logic in this book, but who need a personal touch to bring the book's message to heart.

Each one of the former smokers below has shared his or her medical and personal story with researchers in my program.

Clint

Clint is a 55 year old manager of maintenance operations for a national transportation firm. He started smoking when he was 17 years old and consistently smoked a pack of cigarettes a day for the next 34 years. Clint had occasionally tried to quit. In 1985 he successfully quit smoking for an extended period of time, but soon found himself again smoking up to two packs per day.

In August 1988 Clint started experiencing pain in his lower chest and stomach area. When it did not go away, he decided to drive to the hospital for evaluation. To calm his nerves on the way, he had what turned out to be his last cigarette. Clint was suffering a heart attack.

During his hospitalization the doctors were blunt. Smoking was a big factor in the attack. To continue to smoke was to run the risk of another attack -- one that might not be as mild. For Clint this was enough of an incentive to quit for good. However, the need to smoke persisted. He seemed to be longing for nicotine every minute of every hour of every day. Finally, after a year and a half of continuous craving, he started using smokeless tobacco.

Clint's story is not uncommon from several standpoints. First, a health problem resulting from smoking made a sudden appearance. Second, he continued to experience craving long after he quit, long after the physical effects of nicotine were out of his system. This is not unusual. Many smokers enrolled in our program have quit in the past for as many as several years, but the need for nicotine did not subside. Smokeless tobacco had completely satisfied that craving.

Carl

Carl is a retired machinist who remembers smoking when he was 10 years old. For forty years he averaged two packs a day. He smoked unfiltered Camel cigarettes for 30 years, but switched to a filtered brand when he started to experience breathing problems. When his breathing started to get considerably worse, Carl consulted a doctor. The diagnosis: emphysema. The solution: stop smoking. The outcome if he didn't: a maddeningly slow death by suffocation. Carl made the decision to quit. He tried prescription nicotine gum, but it was of no help. He knew he had to try something else soon or he would break down and resume smoking. He tried smokeless tobacco.

That was twelve years ago. His lung deterioration was slowed, and, most importantly, he is convinced that without smokeless tobacco he would still be smoking, or be six feet under.

Marian

Marian is a 77 year old who smoked a pack of cigarettes every three or four days for decades. When she was 72 she developed a cough that scared her. Looking for a way to continue enjoying tobacco without harming her grandchildren (even by bad example), she hit upon the idea of trying discreet little packets of moist snuff. For the past five years Marian has been successfully substituting smokeless tobacco for cigarettes.

Wendell

Wendell is a 50 year old farm manager. He had smoked non-filtered cigarettes for 14 years when, at the young age of 35, he started experiencing severe shortness of breath, a bad cough, and numerous sinus infections. Wendell thought he could beat these problems by switching to a pipe. However, he fell into a common trap for cigarette smokers who switch to cigars or a pipe. Because a cigarette smoker gets used to the nicotine jolt obtained through inhaling the smoke, the tendency is to continue inhaling when smoking a cigar or pipe. NO SMOKE IS HEALTHY, and cigar and pipe smoke can be very irritating when inhaled.

After six years of pipe smoking, Wendell decided he'd better quit altogether. After just one week of climbing the walls, he went back to the tobacco aisle and tried smokeless tobacco. Today, 15 years later, Wendell remains smoke-free and cough-free.

Rick

Rick is 52 years old and works as a technician for a major electronics manufacturer. He started smoking when he was 20, and for the next 29 years he consistently consumed between two and four packs daily. Rick had several close calls with another "occupational risk" of the habit. He had dozed off several times with a cigarette in his hand, coming very close to starting a major house fire. (Each year in the United States, smoking is the cause of fires that kill one thousand, three hundred people.)

Rick tried to quit tobacco altogether when he quit smoking. But he frequently craved the nicotine he was missing, even though he got over the queasy disorientation of the physical withdrawal symptoms within the first week.

After three months of constant craving, he started using smokeless tobacco. For the past three years he has been sleeping better, knowing that he won't wake up with a problem in his lungs or a burning cigarette in his hand.

Dan

Dan is a 38 year old non-commissioned officer in the army. He started smoking when he was 16 years old. After smoking 2 packs per day for 12 years, Dan started developing shortness of breath. He saw the handwriting on the wall and made an overnight switch to smokeless tobacco.

Like many successful participants in my quit-smoking program, Dan did not experience a moment of physical or psychological withdrawal after giving up his cigarette habit. He had not read about the relative safety of smokeless tobacco, but he intuitively knew that it had to be healthier than pouring fumes into his body.

John

John is a 66 year old who owns a small business. He had been smoking 3 packs of cigarettes per day for 52 years. Four years ago doctors told him that he had hardening of the arteries, a blood vessel condition that is complicated by smoking. He switched to smokeless tobacco as soon as he realized, to his surprise, that dipping snuff gave him the same satisfaction he got from cigarettes.

Dr. Lee R.

Dr. Lee R. is a health professional in rural Alabama. He started when he was 20 years old, smoking one and a half packs per day for 26 years. Like many other smokers, his entire breathing apparatus started to rebel. Dr. R. started wheezing, especially at night. In addition, he had shortness of breath, a persistent cough, and irritated sinuses and eyes. Dr. R.'s medical training had not been forgotten; these were ominous signs of more serious problems ahead if he didn't quit. He quit for 3 months, suffering continuous craving like so many other former smokers. Then he discovered smokeless tobacco, and for the last ten years he has been looking and feeling better.

Dr. R. tried to convince smoking friends and relatives to make the switch. He worked on his brother for years, but was not able to convince him to make the transition. His brother has since died from lung cancer.

If you’re a switcher, share your story. It might inspire other smokers who are struggling to manage one of the most powerful of human addictions. Submit a comment to this post, or send me an email -- brad.rodu at louisville.edu

3 comments:

Anonymous said...

My name is Greg. I'm a 24 year old graduate student from the suburbs of Philadelphia. From the age of 15 until 23, I was a very light smoker. While I smoked daily, my cigarette consumption never went beyond 10 a day, and the average was more like 5. However, I'd arrived at 5 per day after spending my first 4 years as a smoker with an average of more like 2 or 3. In the back of my head I always knew that as life's stresses grew, it was likely that my cigarette consumption would as well.

I've read that someone is not truly addicted to nicotine unless they smoke 10 cigarettes a day. That may very well be true, which is probably why the gum and lozenge did absolutely nothing to help me in the past. In my opinion, it was undoubtedly the mere habit of smoking those 5 cigarettes a day that was addictive, and it was a habit that I was both unable and largely unwilling to break.

I gave e-cigarettes a try in late-2008 when they were first being heavily marketed on the Internet. While the cheap model did help me cut down from 5-a-day to 2-a-day, the second winter came and I couldn't differentiate the vapor from my breath in the air, I was back to smoking just like I used to.

I finally got fed up with the habit last summer, and bought a 510 e-cigarette, which I later upgraded to a box model. Since the time it arrived 11 months ago, I've had no desire to smoke, and in fact, the two times I've taken puffs off a friend's cigarette, I've found the whole process to be disgusting.

Thanks for all the great work you do.

Dave Anderson said...

I'm Dave and I live in Minneapolis. I grew up with pretty bad asthma but started smoking one drunken night as a freshman in college. I was in love with it immediately, and smoked, on average, about a pack a day for the next twenty years. I spent a significant portion of that 20 years trying to quit. Once, after hypnosis, I quit for a full year. So much time had gone by that I thought I could have just *one* cigarette with a beer at a party. Wrong! I also tried Zyban, the patch, gum, Chantix, and cold turkey.
I discovered "e-cigs" (hate the name) in March of this year, and while I wasn't immediately a convert, it was interesting enough for me to keep trying it and investigate it further. Once I got a better kit than the one I started with, I let my tobacco run out and haven't bought any since. In the nearly four months since making the switch to vaping, I've smoked a cigarette three times, mostly because I wanted to remind myself how it compared to vaping. Each time I did, I found my foggers more enjoyable. I think of it as a huge upgrade to smoking. Like going from using a modem to broadband. Or coal power to wind. The act of smoking was more compelling to me than the addiction to nicotine. If it weren't, using gum or the patch would have been fine.
I feel much, much better than I did before. My smoker's cough is gone. I no longer sometimes wheeze at night. No stink breath. On top of it all, I don't have to sneak off to vape in secret like I did with cigarettes.
I'm so happy with "e-cigs" that I've become a big vapevangelist, and am working to convert as many other smokers as possible in the hopes I'll find many who take to it as easily as I did.

Unknown said...

I'm a 31-year-old smoker of about 17 years. I was smoking at least a pack a day (two if I went out to a bar or a party) by the time I was in my early 20s, and despite trying multiple smoking cessation techniques over the years I was never able to quit for more than a few days. My problem was, though I understood I should quit, I didn't want to; I really enjoyed smoking.

I discovered e-cigs around 2010 when I read an article about them. I thought it was cool but didn't think much of it until I saw one in a store some time later. I bought it and hated it: it tasted bad, and I couldn't even feel the vapor in my mouth or see much of it when I exhaled.

Just a few months ago, I met a guy with a fancy e-cig when I was out at a bar. It didn't look at all like a cigarette (more like a flashlight), but he was getting huge puffs. It intrigued me so much that I researched them online and eventually bought a kit. I was sold immediately. I smoked my last cigarette on the car ride to my local e-cig retail store (this was on January 5, 2013). I haven't had a craving for another one yet, almost three months later. I am thrilled to have finally been able to get off tobacco!