Nicorette — boon or bane?

Dear Stanton:

My husband has traded nicotine addiction in smokeless tobacco for the nicotine found in Nicorette gum. Do you have any advice to help him quit the gum? Zyban Maybe? He has struggled with this for several years and has tried therapy which basically centered on his Type A personality rather than addressing the addiction. He is unbearable to be around if he runs out of gum. It really angers me that Nicorette fails to warn users that they are trading one form of nicotine addiction for another! Any advice would be greatly appreciated.

Thank you,
Amy

Dear Amy:

Some people have discussed nicotine gum as a "harm reduction" technique, one which is an improvement over smoking or chewing tobacco but which does not remove the addiction itself — like substituting methadone for heroin. Some researchers, indeed, have argued that the FDA — because of its anti-addiction bias — has not permitted nicotine gum manufacturers to sweeten the gum or otherwise to make oral preparations palatable enough to be a habit people can engage in readily and pleasurably. They fear that then such products would become primary objects of addiction, perhaps attracting young people in particular. Nicotine, while itself a poison, is relatively harmless unless taken in quite large dosages, so nicotine based gums can be used harmlessly, as indeed your husband seems to have done. When considering the major health hazards of smoking, this is a considerable benefit.

But, as with methadone, we are left with the addiction. There is some irreducible problem with being dependent on a chemical or other substance. One is always enslaved to it, for all this implies practically and in terms of one's self image. Indeed, as you suggest, we might warn people that if they really want to quit an addiction to cigarettes, they might as well wait until they can quit nicotine altogether (unless they can control and reduce their smoking, reportedly a not very common occurrence). This has indeed always been the way the overwhelming majority (90% at least) of smokers quit, on their own, without treatment. So, you point out the dark side of the medicalization of quitting smoking — people pay a price.

Perhaps your husband should start smoking or chewing again, and quit when he feels so disgusted that he won't take up any other source of nicotine. Alternately, you and he might keep plenty of gum around so that he won't be in danger of running out.

Stanton

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