Wednesday, May 30, 2012

Reducing Tobacco Dependence: A Compelling New Rationale for Switching

We’ve long known that smokers who switch to smokeless tobacco substantially increase their chances for longer and healthier lives.  Now there’s compelling evidence that switching to smokeless can help smokers achieve complete tobacco and nicotine abstinence. 

Swedish nicotine expert Dr. Karl Fagerström and Virginia Commonwealth University psychologist Dr. Thomas Eissenberg assessed the addictiveness, or dependence, of various forms of tobacco and nicotine (abstract here).  Researchers in this field have developed a plethora of complex and sophisticated instruments to measure dependence.  For example, Dr. Fagerström developed the most widely used dependence scale for cigarette smoking – the Fagerström Test for Nicotine Dependence.

For their new analysis, Fagerström and Eissenberg took a simple, brilliant approach.  They assessed dependence for cigarettes, smokeless tobacco and medicinal nicotine by looking at the quit rates from clinical cessation trials for each of these products.  However, instead of looking at the treatment groups, they looked at the placebo groups; these provide baseline quit rates for cigarettes, smokeless tobacco and medicinal nicotine.  With this data, they could compare the relative quit rates for the three products.

The researchers found that the quit rate for cigarettes in these aggressive clinical trials was around 10% -- probably twice as high as that seen among the general population.

The average quit rate for smokeless tobacco was about 25% (range 19 – 33%), and the rate for quitting long-term nicotine gum use (in one study) was 36%.  The higher quit rates indicate that these products are less addictive than smoking. 

Fagerström and Eissenberg concluded that “…quitting cigarette smoking is more difficult than quitting smokeless tobacco and, although there is only one study from the [medicinal nicotine] category, that quitting these products may be easiest….the cigarette may be, in addition to the most harmful product, the most dependence-producing product.”

Harm reduction opponents have argued for years that switching is not a viable option because it perpetuates nicotine addiction.  This study shows that smokers who switch to smokeless tobacco may markedly improve their odds of achieving complete abstinence, in addition to improving their health.

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