Clinton takes cigarettes to Haiti

It was an unfortunate choice that when taking supplies to Haiti, that some staffer threw in some cigarette cartons along with real necessities such as soap, water and food. But I think this is a sad commentary on how much of our society still thinks of smoking as just a bad habit instead of an addiction. I'm sure whomever bought the cigarettes thought it would bring comfort but I'm also sure that there are some that would think that a couple bottles of alcohol or a baggie of weed,  or a gram of heroin could bring just as much comfort.
"What's the big deal? So what if a little comfort is provided by smoking at this time of intense stress."
It is a big deal. Studies have shown that the high rate of tobacco use in our military can increase the likelihood of developing Post Tramautic Stress Disorder (PTSD). When faced with the atrocities of war or the devastation of a natural disaster like a hurricane, many will turn to a smoke for a quick fix of dopamine to relieve the negative feelings. But it may be that this hit of nicotine is also encapsulating that atrocity, that devastation into the smokers memory that will haunt them later. Nicotine works on a part of the brain that heightens external events which in a normal daily life will lead to the creation of habits--a cigarette goes with a cup of coffee, after a meal, --the brain is alerted by the nicotine to pay attention to what is going on at the same time. Habits can be broken, but developing PTSD can affect someone for a lifetime--ask some of our Vietnam vets.
Up to 60% of individuals with PTSD are smokers and are heavy smokers at that. They will say that smoking helps relieve their symptoms but often smoking is just making their symptoms worse. PTSD is a matter of not being able to forget and nicotine won't let them. The Department of Defense has realized what a problem smoking is and the creation of PTSD, that it commissioned the Institute of Medicine for recommendations and the main item was to eliminate tobacco use from our troops.
Maybe a few smokes won't hurt but why should we encourage any use of an addictive product that causes so many problems down the road. Are we just setting Haiti up for a ward of PTSD survivors by giving them cigarettes?

Beware the Saboteur

Often a smokers best meaning friends and family are their worst enemy when trying to quit. Smokers need support and encouragement, but our supporters often are saboteurs instead. On Franks first day, his wife asked how he did that day. Frank, a two pack a day smoker, admitted that he smoked two cigarettes. Instead of congratulating him on not smoking of the other thirty eight, she focused on his weakness and jumped all over him for smoking the two.
Many smokers have quit for varying lengths of time, only to relapse back into their regular smoking patterns and at the same time hear, "You were doing so good, I can't believe you're smoking again". What the smoker hears is "What's wrong with you?" A better response is, "Wow, you quit for (X period of time), that's great! You probably learned a lot that you can build on the next time you  quit. You  overcame a lot to quit for that period of time and I know that the next time you'll do even better! Keep up the good work."
When working with smokers, I never focus on the negative behavior but always something positive. Quitting smoking is one of the hardest things a person ever does and only needs positive encouragement because they beat themselves down more than anyone else ever could, why add to it? A smoker can tell you every time they fail, they slip, they relapse because they focus on the negative or what they did wrong instead of focusing on what they have done right. By believing they must be perfect instead of believing in progress, the smoker becames his own saboteur.
Help a smoker with positive encouragement by saying,
"You're doing great!"
"I know you're struggling, how can I help?"
"So what that you slipped, look at how many times you didn't slip!"
"I know you'll be successful when you're ready."
"I know it's hard finding the right tools to quit, so what if (whatever was tried) didn't work, you're moving in the right direction because I know you'll find what will work for you. Just don't give up looking."

"Quit or Die" or use harm reduction?

Jim quit smoking when he was in his 30's after receiving a diagnosis of Chronic Obstructive Pulmunary Disease (COPD). He took his doctor's advice and switched from smoking cigarettes to using smokeless tobacco or "chew". Thirty years later Jim is in my Stop Smoking, Stay Quit class to stop his nicotine addiction to smokeless tobacco.

This is an example of "harm reduction". The premise is that some individuals are so addicted to nicotine that they just can't quit, so harm reductionists advocate switching to the use of a less harmful tobacco product. Harm reductionists say a "Quit or Die" approach doesn't work and by using a less harmful form of nicotine is a better way to go. While I do believe that the physical addiction to nicotine can be so strong that it seems impossible to quit, that does mean we should just give up on these individuals? The same concept is used with heroin addicts by replacing heroin with methadone but not every heroin addict uses methodone to quit. There are no easy answers.

But there is a new player in mix and that is e-cigarettes. The US District Court in Washington DC just ruled that the FDA does not have the authority to regulate e-cigarettes as a drug device combination. Instead, e-cigs are a recreational product that promotes the use of nicotine in a less harmful way than by smoking cigarettes. There are many antedotal stories of smokers quitting by using an e-cig but they cannot be advertising as such because then the product would fall under the jusdiction of the Food, Drug, and Cosemtic Act (FDCA). While it would appear that e-cigarettes maybe less harmful because there are less components to the vapor of an e-cigarette than the thousands of chemicals found in tobacco smoke, we don't know for sure since there are no long term studies on e-cigs. Since currently there is no regulation on the manufacture of e-cigs, the public must rely on the integrity of the manufacturer. Are they after your money or to better your health?

Switching from smoking cigarettes to chew tobacco most certainly saved Jim's life, yet now he is dealing with the health effects of 30 years of chewing. Jim has gum disease, tooth loss, and has had both a kidney and a liver transplant. His doctor now wants him to totally quit the use of nicotine since nicotine is excreted through the kidneys into the bladder. Jim wishes that when he stoped smoking that he would had tried to stop using all nicotine products, instead of switching to chew.

I think the debate should end and nicotine be declared a drug/medication. You can't have it both ways--it can't be both a recreational product AND one that is so addictive that some individuals are unable to stop using. As a drug/medication, there may be benefits to the continued use of nicotine, just as there are benefits (as well as risks) to every drug/medication that is used.