This evidence says that "nicotine replacement" products such as the nicotine patch, inhaler, and gum are not effective ways to safely quit smoking permanently even when counseling is added. They may help temporarily stop smoking but do not help to safely end smoking for good and without becoming fat or worse ... because they fail to deal with the root cause of all unhealthy smoking. That is nicotine dependence.
Nicotine replacement therapy, NRT, to stop smoking is not based on reliable addiction science and the common
knowledge gained from specialized clinical experience.
"What NRT offers and advertises, quitting and stopping smoking, is NOT at all a meaningful
measure of success. A popular writer used to say that stopping smoking
was easy. It was so easy that he stopped every day. Becoming unwilling
to smoke cigarettes (dip or chew) even
when wanting to and without substituting anything unhealthy (junk food, for example) is the measure of success that counts." RTL
If you think tobacco is a drug,
an untruth told to you that kills,
you also believe NRT products probably work . . . at least if combined
with counseling. It is necessary to give you this evidence of unenlightenment
for you to no longer think that tobacco is a drug.
You are making an honest mistake
if you even suspect I am exposing inside evidence that nicotine replacement
therapy is not effective in order to sneakily defend or promote tobacco
and smoking. Some folks do defend and promote that way.
Devious supporters of dubious "smokers' rights"
challenge the efficacy of NRT products, but they also tell the popular
untruth that says even chronic heavier smoking is a "choice"
rather than resulting from drug addiction. They attempt to give weight
to that lie by pointing out that statistically most people stop without
external help: Smokers simply quit; they "bite the bullet" and
"go cold turkey."
Underhanded nicotine pushers allege in so many words,
"When they choose to, most of those smokers can and do stop smoking
for good on their own and without significant complications." Wrong!
The reality is far closer to they don't stop; they substitute. That's called
nicotine addiction symptom substitution or transfer. Smokers more often switch to so-called
"comfort" foods, overeating or abusing alcohol. They unwittingly
self-medicate and swap one major health threat and drain on their and our
financial resources for another.
Please avoid accepting the politically correct untruth
that it's only a coincidence that the "obesity epidemic" began
during the past four decades of pressuring far more than effectively helping
smokers to quit. Not to be critical, but little wonder restaurants increasingly
favor going "smoke-free." They and other food and alcohol sellers
are among the primary beneficiaries of nicotine addiction transfer.
- Longtime specialized clinical experience enables a different
perspective. Because of more than three decades of specialized clinical
experience that began before the widespread introduction of NRT products,
I've known to question the value of nicotine replacement therapy: now the
dominant and dominating cigarette smoking cessation intervention. In 1989,
Counselor: The Magazine for Addiction Professionals published an opinion
article I wrote entitled "Why Treat Nicotine Addiction with Nicotine?"
The more I learn the less I'm sure of what I know. One exception is that
nicotine replacement therapy is not a nicotine addiction-knowledgeable
|Behavioral health clinicians
(examples, licensed clinical counselors, clinical psychologists and clinical social workers) who are also certified or
licensed to treat addiction to alcohol and other drugs (clinical addiction
specialists*) are addiction-knowledgeable. They could help more
than professionals with training similar to my own. But they
don't know that NRT is ineffective. Those specialists have had little if any experience treating nicotine addiction. Their sources of
authoritative treatment information taught them politically correct untruths: nicotine replacement products such as nicotine patches are effective with or without
counseling and tobacco is the drug.
At least some sources of authoritative addiction treatment information are
allied with the pharmaceutical industry. They say and may think otherwise,
but still they subtly and powerfully suggest to clinical addiction specialists
that their involvement to help treat nicotine dependence is NOT needed.
Those information sources focus way too much on the plant (tobacco) and
too little on the essential problem (nicotine). They suggest that tobacco
is the psychoactive drug when they mislabel with descriptions such as "alcohol,
tobacco, and other drugs" or ATOD. Besides avoiding profit-threatening
competition from clinical specialists, the drug industry that makes nicotine-filled
cigarette replacement products may find it easier to sell those expensive
additional ways to deliver the highly addictive insecticide, nicotine,
when the drug it pushes is not so clearly identified as the real threat.
Professional addiction specialists accept the implied
killer untruth conveyed by those authorities: Nicotine replacement therapy
works and already has the cigarette smoking problem significantly covered.
When you and I raise awareness among clinical addiction specialists of
the considerable need for their enlightened expert help, the health of
a great many children and billions of their health care dollars will be
- Probably the most intense form of clinical addiction
help for smokers is a residential (inpatient) treatment program. Highly
regarded Hazelden Foundation and its residential stop smoking program avoid
nicotine replacement products. The director of Nicotine Dependence Treatment
Services at Hazelden describes this important feature of that "Your
Next Step" service: "Our thinking is that we have seven days
to get people off nicotine and develop strategies to remain tobacco-free
for the rest of their life." He says. "If they use nicotine replacement,
then they're going to walk out of here still addicted to the drug."
- Tapering off the highly addictive insecticide, nicotine,
is an essential and prominently-promoted supposed advantage of the nicotine
replacement therapy approach. What highly addicting drug other than nicotine
might we think it's okay for people not in residential treatment to
taper off? The answer is "none."
Like other substance-dependent people who aren't yet in
recovery, smokers are in denial when thinking they can stop for good by
gradually cutting back on (tapering off) nicotine. Nicotine replacement
therapy (NRT) promotes that unhealthy view. Those NRT products subtly but
powerfully promote health risk denial. See
our recent test for that denial.
Isn't it probable that urging a smoker to use nicotine,
even as part of a broader treatment such as professional counseling, suggests
that nicotine isn't the problem and negates whatever else might be done
to help? NRT suggests "NOT" . . . as in "NOT truly addicted."
- No reputably published research this author has found suggests adding counseling
to NRT was effective to stop smoking where all testing of efficacy was
done post nicotine ingestion (research subjects no longer used the drug).
See "measurements of the efficacy" below.
- Twelve-step programs talk in terms of "one is always
too many and never enough." Isn't it likely to be true that one hit
of nicotine, no matter the delivery device or method, makes someone not
yet in the recovery required to survive? I am convinced that's a fact.
- The nicotine-drenched stop smoking patch is another means
to deliver the drug. Indians in South America have "smoked" that
way. They mixed nicotine with cooked animal fat and rubbed it on their
- The drug companies that produce and sell replacements
are fond of having others suggest that delivering the drug with their products
and reduced quantities of the substance make them nonaddicting. Possibly
that's true if using replacements with folks who aren't already dependent.
- Those pharmaceutical company allies also suggest that
NRT products help by removing the activities (lighting-up, etc.) associated
with smoking. But smokers aren't addicted to the associated activities
any more than heroin users are addicted to shoving needles into their bodies.
- The fact that hardly any behavioral health addiction
specialists focus on nicotine dependence (addiction) means they
don't pay attention and question the largely industry financed, or otherwise
influenced, research that alleges replacement therapy is effective. When advertising asserts that using a replacement doubles
a smoker's chance to stop, that more likely means going from little chance
to still little chance – maybe doubled and practically no one stays stopped. (If the following link is broken, click on this link <http://www.nida.nih.gov/researchreports/nicotine/nicotine2.html>.) A 2006 NIDA research report (http://www.addictioninfo.org/articles/1138/1/Tobacco-Addiction/Page1.html)said that nearly 35 million U.S. smokers want to stop each year and a number
of them make the effort. Only about 6 percent stay free of smoking longer
than one month. Author's note: At any given time, approximately 15 percent
of trying-to-quit smokers are relying for help on the nicotine gum, lozenge,
patch or another such cigarette replacement product.
- No published research that obviously was done independent
of the influence of the makers of NRT and other psychoactive drugs (examples,
Chantix and Zyban) has shown that they performed better than simply stopping.
- A survey of 73 double-blind, placebo-controlled nicotine
replacement trials identified just 17 studies that made some effort to
assess the integrity of their double-blind procedures. Twelve (12) of the
17 studies found that subjects accurately judged treatment assignment at
a rate significantly above chance. These few studies provide insufficient
evidence for definitive conclusions about the overall integrity of blindness
in the NRT literature . . . Addictive Behaviors 29 (2004) 673–684
- Measurements of the efficacy of nicotine replacement
therapy to stop smoking are done while subjects continue to ingest the drug. Would anyone who knows about addiction
and recovery attempt to help someone hooked on heroin by selling him or
her the drug and then urge him to gradually reduce how much heroin he sucks
up his nose or smokes until he loses interest in injecting it? Of
course not. Heroin users aren't addicted to sticking themselves with
needles. So was it ever reasonable to expect smokers to be successful stopping
for good by continuing to use nicotine but tapering off how much is
ingested by changing how it's delivered? No. Nicotine replacement therapy (NRT) products do not help with the
underlying cause. Thinking that NRT products should or could help
and even when counseling is added strongly suggests non smokers are in denial.
- If nicotine replacement is science-based and effective shouldn't we reasonably expect that smoking would be declining? For most of the 20-plus years replacement products have been available the incidence
of smoking has been stagnant and now is projected to increase.
- Nicotine is a deadly poison (insecticide). It isn't somehow "good science" or "best practice" to encourage using
or do nothing as human beings unknowingly poison themselves with nicotine
replacement therapy products.
This and all other Truth for Healthy Living Web site
content are intended solely for educational purposes and are the opinions, research
findings, and clinical insights of Richard T. Lovelace, PhD, MSW and not Winston Clinical Associates. Thank you.