Why NRT Makes it Harder to Stop Smoking
NRT, let me remind you, means so-called nicotine replacement therapy. Why ‘so-called’? Because nicotine is not a replacement for anything, nor is nicotine being replaced with something, so the name is wrong. It really means cigarette replacement but could equally well and more accurately be called nicotine maintenance therapy (NMT).
The idea is that, since stopping smoking is widely believed to be so difficult, you need some kind of stop-smoking aid to quit successfully. Well, why is stopping smoking thought to be so difficult? It’s because when smokers try to stop they feel uncomfortable – the dreaded withdrawal symptoms caused by the level of nicotine in the blood-stream falling. What are these withdrawal symptoms? Let’s do a Google search. I did it just now and got 885,000 results, the first of which gave the following list:
- intense cravings for nicotine
- tingling in the hands and feet
- nausea and intestinal cramping
- coughing, sore throat
- difficulty concentrating
Unfortunately – or rather I should say fortunately – this is not true. I’ve asked hundreds of smokers about cigarette withdrawal symptoms and they all say the same things. Also, it’s remarkable that most smokers at first find it difficult to say anything at all about what they feel when they haven’t smoked for a while. However, with a bit of thought and prompting eventually they come up with one or two or three of these typical symptoms:
- Feeling like they would like to have a cigarette
- Thinking about smoking a lot
- Difficulty in concentrating
Not uncommonly, the only symptom mentioned is that the smoker has a desire to smoke a cigarette and has none of the others in the list.
Two points need to be stressed: the above symptoms are mild; they are not that bad. Secondly, they are psychological (mental) symptoms. This does not mean, of course, that they are imagined or made up; they are real enough, but if a smoker is asked whether such feelings would ever become intolerable, the answer invariably is ‘No’. There is no actual pain and it is exceedingly rare for smokers to mention ‘intense cravings for nicotine, tingling, nausea, headaches’, etc.
Nervousness, irritability and difficulty in concentrating, then, are mental symptoms. Further, if smokers are asked what would happen to these feelings if they don’t have another cigarette, they consistently say that sooner or later they will go away!
Let’s get back to NRT – patches, gum or e-cigarettes. The underlying idea seems to be that, since the withdrawal symptoms are likely to be so awful, if you can relieve or prevent them by putting nicotine into your body by a route other than by inhaling it in cigarette smoke, you won’t experience nicotine withdrawal symptoms or will experience them to a lesser degree. Thus, you can ‘let yourself down gradually’, and then, after an arbitrary period such as a month or six weeks, you wean yourself off the NRT – and Bingo! – you’ll never want to smoke again.
The only trouble with this strategy is that it doesn’t work very well. At best only 20% of smokers who try NRT are still not smoking one year later.
There is another problem with NRT and it applies particularly to e-cigarettes: long-term continued use of nicotine, albeit in a supposedly safer form. This is because of the notion that some people seem to need nicotine, or they derive harmless pleasure from it. If they wish to labour under an illusion – and it may be perceived as a very strong or nice illusion – why shouldn’t they? Here’s one reason:
Observe someone vaping: he or she sucks on the e-cigarette device fairly regularly throughout the day, maybe 150 times – which is around 55,000 times a year. Why do they do this? Is it because it produces a real sense of pleasure or relaxation or other positive effect? They do it for the same reason that smokers smoke – to relieve the temporary discomfort of the withdrawal symptoms of nicotine.
If one puts nicotine into one’s body – by inhalation or through the skin or lining of the mouth – the addiction is maintained. Therefore, what needs to be done is for the smoker to cease putting nicotine into his or her body – by any means.
You don’t need a replacement for cigarettes, and you don’t need to put nicotine into your body.
Text © Gabriel Symonds