Last week I concluded presenting 63 nicotine dependency recovery seminars in 28 prisons. During presentations I devoted about four minutes to exploring harm
reduction, via NRT not oral tobacco. The remaining 116 minutes were spent showing why getting off of all nicotine is likely the most intelligent decision they'd ever make, and how to succeed in doing so. I did so without any youth in the room, in as balanced a manner as time and my abilities allowed, while holding no financial state in nicotine delivery.
Britton advocates harm reduction while ignoring an exploding body of alarming nicotine toxicology science.(1) Macara contends NRT "does not induce dependence" when 37% of current nicotine gum users are hooked on the cure.(2)
Britton offers another quick-fix when the prescription needed - nicotine dependency recovery understanding - would take physicians a bit effort to master and dispense than pharmacology, or dependency delivery device transfer commands.
Profit driven pharmaceutical influence has taken junk science to new heights by pretending the fiction that true drug addicts cannot recognize arrival of full-blown withdrawal when randomized to placebo, or a diminished syndrome when given chemicals that enhance dopamine flow.(3) Its influence(4) has transformed government
quitting guides into near worthless pharmaceutical product shopping guides.
It has rewritten official government cessation policy so as to declare all attempts to quit without pharmacology as violating it ("Numerous effective pharmacotherapies for smoking cessation now exist. Except in the presence of contraindications, these should be used with all patients attempting to quit smoking").(5) Imagine declaring educated and supported cold turkey quitting illegal. Although the ethics of the fox residing in the hen house has been questioned,(6) corporations are driven by profits not conscience.
Quick-fix stand-alone arguments like Britton's, dispensable within 4 minutes, will appear inviting to time-strapped physicians, frustrated by years of broken promises. But with patients spending substantial time in waiting and exam rooms, with PowerPoint projectors dirt cheap, with existing office computers just one new wire away, with the man who may well be the planet's most knowledgeable cessation educator offering physicians his life's work for free,(7) there is no excuse for putting quick-fixes ahead of quality patient cessation education efforts.
Instead of cessation, imagine teaching them the relative safety of the super toxin nicotine, a natural insecticide once sold as BlackLeaf 40, whose LD50 of 60mg is more potent than strychnine at 75mg, arsenic at 200mg or cyanide at 500mg. Give cessation a try. Start with where they now find themselves, that this isn't some "nasty little habit" but full-blown drug addiction.
Getting an addict to fully accept dependency is a critical first step. Like alcoholism being permanent, with that first sip key to relapse, it makes quitting's rules simple. You cannot kill or cure dependency but only arrest it. There is no having your cake and eating it too, no in-between, the time for games is over. There's a bright line in the sand screaming that recovery truly is an all or nothing proposition. Just one rule determines the outcome for all, a rule that provides a 100% guarantee of success to all who follow it, no nicotine today.
Explain how the brain rewards nicotine's presence while punishing its absence, how by chance the nicotine molecule so resembles acetylcholine that once inside the brain, within 8-10 seconds of a puff, it docks with nicotinic-type acetylcholine receptors generating a powerful dopamine "aaah" reward sensation. Explain normal dopamine pathway function, in being the mind's priorities teacher and educating us as to species survival events, such as providing dopamine "aaah" rewards when anticipating eating or consuming food.(8)
Nicotine took their salient event, pay-attention pathways hostage,(9) quickly burying nearly all remaining memory of life without it. The brain's fooled priorities teacher did its job well. It left them totally yet falsely convinced that smoking nicotine defines who they are, gives them their edge, helps them cope and that life without it would be horrible. Teach how their enslaved mind reinforces captivity by punishing them with urges, craves and anxieties, likely via the insulas,(10) when they wait to long between feedings. Teach how via tolerance the brain tries fighting back, by up-regulating acetylcholine receptor counts, requiring patients to gradually smoke more or differently over time in order to achieve the same remembered effect.
Share the "Law of Addiction," that administration of a drug to an addict will cause reestablishment of chemical dependence upon the addictive substance.(11) Teach that "88% (12) - 92.6% (314 of 339)(13) of quitters who taste tobacco relapse, that they are not battling an entire pack or even a whole cigarette, but that just that one puff of nicotine that could, within 8-10 seconds, result in 50% occupancy of their brain's a2b4 type acetylcholine receptors, generating a powerful dopamine explosion that would soon have their brain begging for more.(14)
Getting patients to fully accept that they smoke because they must, because a rising tide of anxieties begin to hurt when they don't, destroys their need for their long laundry list of nicotine use rationalizations,(15) the lies invented to explain the rational thinking mind's endless surrenders to the captive limbic mind.
Although I've barely scratched cessation's surface I'm now passed the word limit BMJ asked me to respect. But on behalf of all still in bondage I beg providers to let this be a beginning not an end. Also, order staff to remove all tobacco ads from all waiting room magazines as they totally undermine office cessation credibility.
Rapid Response:
Before surrender teach cessation
Last week I concluded presenting 63 nicotine dependency recovery seminars in 28 prisons. During presentations I devoted about four minutes to exploring harm
reduction, via NRT not oral tobacco. The remaining 116 minutes were spent showing why getting off of all nicotine is likely the most intelligent decision they'd ever make, and how to succeed in doing so. I did so without any youth in the room, in as balanced a manner as time and my abilities allowed, while holding no financial state in nicotine delivery.
Britton advocates harm reduction while ignoring an exploding body of alarming nicotine toxicology science.(1) Macara contends NRT "does not induce dependence" when 37% of current nicotine gum users are hooked on the cure.(2)
Britton offers another quick-fix when the prescription needed - nicotine dependency recovery understanding - would take physicians a bit effort to master and dispense than pharmacology, or dependency delivery device transfer commands.
Profit driven pharmaceutical influence has taken junk science to new heights by pretending the fiction that true drug addicts cannot recognize arrival of full-blown withdrawal when randomized to placebo, or a diminished syndrome when given chemicals that enhance dopamine flow.(3) Its influence(4) has transformed government
quitting guides into near worthless pharmaceutical product shopping guides.
It has rewritten official government cessation policy so as to declare all attempts to quit without pharmacology as violating it ("Numerous effective pharmacotherapies for smoking cessation now exist. Except in the presence of contraindications, these should be used with all patients attempting to quit smoking").(5) Imagine declaring educated and supported cold turkey quitting illegal. Although the ethics of the fox residing in the hen house has been questioned,(6) corporations are driven by profits not conscience.
Quick-fix stand-alone arguments like Britton's, dispensable within 4 minutes, will appear inviting to time-strapped physicians, frustrated by years of broken promises. But with patients spending substantial time in waiting and exam rooms, with PowerPoint projectors dirt cheap, with existing office computers just one new wire away, with the man who may well be the planet's most knowledgeable cessation educator offering physicians his life's work for free,(7) there is no excuse for putting quick-fixes ahead of quality patient cessation education efforts.
Instead of cessation, imagine teaching them the relative safety of the super toxin nicotine, a natural insecticide once sold as BlackLeaf 40, whose LD50 of 60mg is more potent than strychnine at 75mg, arsenic at 200mg or cyanide at 500mg. Give cessation a try. Start with where they now find themselves, that this isn't some "nasty little habit" but full-blown drug addiction.
Getting an addict to fully accept dependency is a critical first step. Like alcoholism being permanent, with that first sip key to relapse, it makes quitting's rules simple. You cannot kill or cure dependency but only arrest it. There is no having your cake and eating it too, no in-between, the time for games is over. There's a bright line in the sand screaming that recovery truly is an all or nothing proposition. Just one rule determines the outcome for all, a rule that provides a 100% guarantee of success to all who follow it, no nicotine today.
Explain how the brain rewards nicotine's presence while punishing its absence, how by chance the nicotine molecule so resembles acetylcholine that once inside the brain, within 8-10 seconds of a puff, it docks with nicotinic-type acetylcholine receptors generating a powerful dopamine "aaah" reward sensation. Explain normal dopamine pathway function, in being the mind's priorities teacher and educating us as to species survival events, such as providing dopamine "aaah" rewards when anticipating eating or consuming food.(8)
Nicotine took their salient event, pay-attention pathways hostage,(9) quickly burying nearly all remaining memory of life without it. The brain's fooled priorities teacher did its job well. It left them totally yet falsely convinced that smoking nicotine defines who they are, gives them their edge, helps them cope and that life without it would be horrible. Teach how their enslaved mind reinforces captivity by punishing them with urges, craves and anxieties, likely via the insulas,(10) when they wait to long between feedings. Teach how via tolerance the brain tries fighting back, by up-regulating acetylcholine receptor counts, requiring patients to gradually smoke more or differently over time in order to achieve the same remembered effect.
Share the "Law of Addiction," that administration of a drug to an addict will cause reestablishment of chemical dependence upon the addictive substance.(11) Teach that "88% (12) - 92.6% (314 of 339)(13) of quitters who taste tobacco relapse, that they are not battling an entire pack or even a whole cigarette, but that just that one puff of nicotine that could, within 8-10 seconds, result in 50% occupancy of their brain's a2b4 type acetylcholine receptors, generating a powerful dopamine explosion that would soon have their brain begging for more.(14)
Getting patients to fully accept that they smoke because they must, because a rising tide of anxieties begin to hurt when they don't, destroys their need for their long laundry list of nicotine use rationalizations,(15) the lies invented to explain the rational thinking mind's endless surrenders to the captive limbic mind.
Although I've barely scratched cessation's surface I'm now passed the word limit BMJ asked me to respect. But on behalf of all still in bondage I beg providers to let this be a beginning not an end. Also, order staff to remove all tobacco ads from all waiting room magazines as they totally undermine office cessation credibility.
John R. Polito
Nicotine Cessation Educator
1. Slotkin, TA et al, Separate or sequential exposure to nicotine prenatally and in adulthood: persistent effects on acetylcholine systems in rat brain regions, Brain Res Bull. 2007 Sep 14;74(1-3):91-103; also Slotkin, TA et al, Lasting effects of nicotine
treatment and withdrawal on serotonergic systems and cell signaling in rat brain
regions: separate or sequential exposure during fetal development and adulthood, Brain Res Bull. 2007 Jul 12;73(4-6):259-72; and see Ginzel KH et al, Critical review:
nicotine for the fetus, the infant and the adolescent? J Health Psychol. 2007
Mar;12(2):215-24
2. Shiffman S et al, Persistent use of nicotine replacement therapy: an analysis of
actual purchase patterns in a population based sample, Tob Control. 2003
Sep;12(3):310-6.
3. Mooney M et al, The blind spot in the nicotine replacement therapy literature:
assessment of the double-blind in clinical trials, Addict Behav. 2004 Jun;29(4):673-84
4. Appendix C: Financial Disclosures for Panel Members, Consultants, and Senior
Project Staff, Clinical Practice Guideline, Treating Tobacco Use and Dependence, June 2000
5. Finding and Recommendation 7, Clinical Practice Guideline, Treating Tobacco Use
and Dependence, June 2000,
6. Helliker K, Nicotine Fix - Behind Antismoking Policy, Influence of Drug Industry, Wall Street Journal - February 8, 2007, Page A1
7. Spitzer, J, Joel's Library, www.whyquit.com/joel
8. Wang GJ et al, Similarity between obesity and drug addiction as assessed by neurofunctional imaging: a concept review, J Addict Dis. 2004;23(3):39-53
9. Volkow ND et al, Dopamine in drug abuse and addiction: results of imaging studies
and treatment implications, Arch Neurol. 2007 Nov;64(11):1575-9.
10. Naqvi NH et al, Damage to the insula disrupts addiction to cigarette smoking,
Science. 2007 Jan 26;315(5811):531-4.
11. Spitzer J, The Law of Addiction, 1988, an article in "Never Take Another Puff"
12. Brandon TH et al, Postcessation cigarette use: the process of relapse, Addict Behav. 1990;15(2):105-14
13. Borland R, Slip-ups and relapse in attempts to quit smoking, Addict Behav.
1990;15(3):235-45
14. Brody AL et al, Cigarette smoking saturates brain alpha 4 beta 2 nicotinic
acetylcholine receptors, Arch Gen Psychiatry. 2006 Aug;63(8):907-15
15. Polito JR, Tearing Down the Wall, WhyQuit.com, June 2004
Competing interests:
Nicotine Cessation Educator
Competing interests: No competing interests