Tobacco.org

• EDITORIAL: State Grabs Money Meant For Quitting Smoking 

When it comes to tobacco addiction, Connecticut's state government has been nearly as exploitative and venal as the tobacco companies it went after more than a dozen years ago.

The state led the nation in suing Big Tobacco, with then-Attorney General Richard Blumenthal demanding compensation for the high cost of Medicaid patients who are prone to smoke. The idea was that tobacco companies would give states money to care for the ill — and prevent others from becoming addicted.

The argument won the day. Connecticut and 45 other states won billions of dollars in 1998 as part of the historic tobacco settlement. But hypocrisy soon followed.

This income stream of $100 million-plus annually will end in 11 more years. It has become little more than a slush fund to pay for practically everything but quitting smoking. . . .

Between 2000 and 2009, according to an excellent Yankee Institute study (bit.ly/tobaccoct), of the $1.3 billion sent to Connecticut from the settlement, only $134 million went to the Tobacco and Health Trust Fund. But it gets even worse: The state government raided that "trust fund" of all but $9.2 million for other goals.

Mr. Blumenthal, now U.S. senator, says, "We should be embarrassed and ashamed that one of the nation's leading states in public health is failing to use the money to help people quit. "

Jump to full article »

• VIDEO: Hooked: Why bad habits are hard to break  

In the battle against addiction, "just say no" is magical thinking, says Dr. Nora Volkow. She's the head of the National Institute on Drug Abuse, and after spending decades studying the brains of addicts, Dr. Volkow has determined that drug addiction is a chronic disease that physically changes the brain. Dr. Volkow has found that even images of an addictive substance, such as alcohol or drugs, can produce a dopamine response in an addict's brain, and some foods can trigger a similar reaction. Morley Safer reports on Volkow's revolutionary research into addiction, as well as on her revolutionary family history.

The following is a script of "Hooked" which aired on April 29, 2012. Morley Safer is the correspondent. David Browning, producer. . . .

Nora Volkow: We're seeing consistently a reduction in the levels of these dopamine receptors, in this case heroin, alcohol, methamphetamine, cocaine, but also marijuana and cigarette smokers.

Problem is the brain just isn't wired to handle the intense high that drugs give. A kind of shutoff valve kicks in: reducing the number of receptors in the brain that receive dopamine's feel good message.

Nora Volkow: What happens with repeated administration of these drugs is that the ability of them to generate a sense of pleasure decreases and decreases and decreases. And there's a point where the person starts to take them, not to feel good. But to feel normal.

And other changes in the brain explain why so many addicts -- no matter how hard they try -- just can't quit.

Morley Safer: There is that school of thought that says, "Look, all you need is to be strong-willed. Your problem is you're weak. Show some determination and you can beat this addiction.

Nora Volkow: There are certain areas of the brain that are directly implicated in our capacity to exert free will. The frontal cortex is one of them: crucial, crucial. So if drugs damage the areas of the brain that we need in order to exert free will then it's like driving a car without brakes. You don't want to hit someone. But if you don't have brakes how do you stop the car?

Jump to full article »

Screening for Smoking May Reveal Illicit Drug Use in Pregnancy 

• Smoking Thwarts Positive Outcomes in Opioid Addiction 

Opioid-addicted patients who were also nicotine dependent achieved better outcomes if they did not smoke during methadone detoxification, new research shows.

Paolo Mannelli, MD, from the Department of Psychiatry, Duke University, in Durham, North Carolina, presented the findings here at the American Society of Addiction Medicine (ASAM) 43rd Annual Medical-Scientific Conference.

"These results question the 'harm reduction' argument that an attempt to quit smoking may interfere with a concurrent attempt to discontinue other drug use," Dr. Mannelli told Medscape Medical News.

According to Dr. Mannelli, studies suggest that tobacco use may offset the benefit of existing effective interventions for opioid addiction (OA).

Jump to full article »

EDITORIAL: Cotinine Conundrum—A Step Forward but Questions Remain ($$) 

In this issue of the Journal, Munafò et al. (8) provide convincing evidence that genetic variation at chromosome 15q25 locus influences cotinine levels more strongly than smoking quantity (self-reported cigarettes per day). Two single-nucleotide variants in this region were studied for their association with serum cotinine level and smoking intensity—rs16969968, which has a functional effect on nicotine signaling mediated by CHRNA5, and rs1051730, which is strongly correlated with rs16969968. Their data from 2932 smokers replicate and extend those reported in 2009 by Keskitalo et al. (9) in a smaller sample size. Both of these studies showed a much stronger association between variants in the CHRNA5-A3-B4 gene cluster with cotinine than with reported cigarette per day use. In an interesting and valuable application of their results to a published case–control study of cotinine levels and lung cancer risk, Munafò et …

Jump to full article »

Research and Markets: Analyzing the Tobacco Industry in France - Analysing one of the Most Commonly used Addictive Substances in the World 

Sigma House Treatment Centers Go Tobacco Free  

• EDITORIAL: Cigarette packaging: an invitation to addiction  

All of which has generated a predictable cry of "nanny state" from the justice secretary, Ken Clarke: "I am surprised that people think that young boys and others take up smoking because they are attracted by the packet." As well as being a former health secretary himself, Mr Clarke was also the deputy chairman of British American Tobacco. Enough said.

The case against smoking no longer needs to be made. Half of long-term smokers will die prematurely from their habit. Although the tobacco companies insist cigarette advertising is designed to generate brand loyalty and to increase market share, it is inconceivable that they do not also want to recruit new customers for their poisonous product. The super-cool Marlboro Man has been replaced by photographs of hospitalised patients with disgusting growths, but the look of a cigarette packet can still subtly suggest a longed-for sophistication. Banksy is right that our susceptibility to "lifestyle choice" advertising can make us vulnerable to sophistical techniques of manipulation. And when backed by the addictive qualities of nicotine, the libertarian case in favour of unrestricted advertising becomes an invitation to dependence, not freedom.

The only question is whether plain packaging would make matters worse. Naomi Klein's No Logo made unbranded material counter-cultural. Unbranded fags could do the same, possibly feeling just a little bit too much like exciting contraband. Addiction to the dreaded weed may be chemical, but it's also about the powerful cultural meanings that get associated with smoking. Disrupting these associations through further regulation is a worthwhile experiment. So why won't the health secretary contemplate similar measures against the fast-food industry?

Jump to full article »

GEORGE WILL: Should we end the War on Drugs? 

SULLUM: George Will: Drug Prohibition Is an Awful Flop. We Like It.  

Since Will begins the column by implicitly conceding that alcohol is morally indistinguishable from illegal drugs, it is disappointing that he leans on Wilson's comment about nicotine vs. cocaine, which is frequently cited by prohibitionists even though it is essentially meaningless. Sometimes cocaine debases life; more often (judgng from, among other things, the government's own survey data), cocaine enhances life, in the sense that it provides pleasure without causing serious problems. It is telling that Wilson picked nicotine for his comparison, since he never could have gotten away with a similarly glib claim about alcohol. Does alcohol debase life? Again, sometimes yes, but typically no. This observation tells us nothing about the proper legal status of either drug.

Contrary to Will's assertion, there are several reasons to believe that the sum total of drug addiction problems would not be much bigger, and might be smaller, if prohibition were repealed . . .

It is important to separate addiction—a hard-to-break attachment—from its consequences. Will and Wilson both assert that nicotine kills smokers, for example, when in fact it is smoke that kills smokers. Nicotine itself is safe enough that the FDA has approved it, in various forms, as a substitute for cigarettes. Nonpharmaceutical alternatives such as snus and electronic cigarettes also are much less hazardous, for the same reason: People can consume them without inhaling combustion products. A pack-a-day cigarette smoker who switches to nicotine gum or e-cigarettes may still be addicted to nicotine, but this addiction is now a much smaller problem. Likewise, people can use pharmaceutical-quality opiates for many years without suffering serious health problems, provided they follow sanitary injection practices and do not mix depressants. In addition to eliminating the drug hazards created by prohibition, legalization would enable manufacturers to compete based on safety, offering products that minimize risk while delivering the effects customers want.

Jump to full article »

• Mobile technology helps explore nicotine addiction 

Some people quit smoking on the first try while others have to try to quit repeatedly. Using such mobile technology as hand-held computers and smartphones, a team of researchers from Penn State and the University of Pittsburgh is trying to find out why.

"One thing that really stood out among the relapsers is how their urge to smoke just never dropped, in contrast to those who were successful in quitting for a month -- their urge dropped quickly and systematically -- almost immediately upon quitting," said Stephanie Lanza, scientific director of The Methodology Center at Penn State. "That was surprising to see."

With a new statistical model to interpret data and the ability to collect data via mobile devices, the researchers looked at how baseline nicotine dependence and negative emotional states influenced people's urge to smoke while they were trying to quit.

The Centers for Disease Control found in a 2010 National Health Interview Survey of 27,157 adults that about 52 percent of cigarette smokers tried to quit during the year. Six percent of all smokers -- who had been smoking for two years or more -- quit for at least six months. Also in 2010, the CDC reported that even though cigarette smoking is the leading cause of preventable death and disease in the U.S., nearly one in five Americans smokes.

The team found that those who successfully quit during the four-week study period had a weaker association between their urge to smoke and their ability to quit. However, those who were unable to abstain did not show any association between their urge to smoke and their self-confidence.

Jump to full article »

• O'HAGAN: Why do people smoke? Andrew Lansley doesn't seem to know 

The problem with Lansley's approach to smoking is that it's simplistic. It seems bizarrely optimistic to think that hiding tobacco products in large shops could make any significant dent in what is essentially a drug addiction. By that logic there would be no heroin addicts . . .

True to his word, Lansley's tobacco policies have failed to ask why a poor mum with three kids might partake in such a self-defeating and expensive habit. As his government continues to squeeze poor families, he hasn't considered that maybe those who worry about bailiffs simply haven't got the mental capacity to try and quit a lifelong addiction as well. Instead, he's decided to hide the problem under the counter; he's decided that those who continue to smoke are no longer partaking in a normal part of life.

So in Lansley's Britain, poor smokers can now add deviance to the reasons for their social exclusion, and no one will pause to ask why the our poorest citizens continue an unaffordable habit, passed down over and over again, from generation to generation.

Jump to full article »

• Mobile technology helps explore nicotine addiction 

Some people quit smoking on the first try while others have to try to quit repeatedly. Using such mobile technology as hand-held computers and smartphones, a team of researchers from Penn State and the University of Pittsburgh is trying to find out why.

"One thing that really stood out among the relapsers is how their urge to smoke just never dropped, in contrast to those who were successful in quitting for a month -- their urge dropped quickly and systematically -- almost immediately upon quitting," said Stephanie Lanza, scientific director of The Methodology Center at Penn State. "That was surprising to see."

With a new statistical model to interpret data and the ability to collect data via mobile devices, the researchers looked at how baseline nicotine dependence and negative emotional states influenced people's urge to smoke while they were trying to quit.

Jump to full article »

Mobile technology helps explore nicotine addiction 

Some people quit smoking on the first try while others have to quit repeatedly. Using such mobile technology as hand-held computers and smartphones, a team of researchers from Penn State and the University of Pittsburgh is trying to find out why.

"One thing that really stood out among the relapsers is how their urge to smoke just never dropped, in contrast to those who were successful in quitting for a month -- their urge dropped quickly and systematically -- almost immediately uponquitting," said Stephanie Lanza, scientific director of The Methodology Center at Penn State. "That was surprising to see."

With a new statistical model to interpret data and the ability to collect data via mobile devices, the researchers looked at how baseline nicotine dependence and negative emotional states influenced people's urge to smoke while they weretrying to quit.

Jump to full article »

• No Smokers Allowed (PDF) 

Smoking is the largest cause of preventable illness and death in the United States, and the Secretary of Health and Human Services recently observed that “cigarettes are responsible for approximately … 1 in every 5 deaths — every year in the United States.”1 The US Centers for Disease Control and Prevention (CDC ) estimates that businesses lose approximately $3,400 each year for every employee who uses tobacco because of increases in health costs and decreases in productivity related to smoking breaks. Another national study of the US workforce found that tobacco use is one of the greatest causes of lost worker production time — greater than alcohol consumption, family emergencies, age or education.2 On average, smokers miss 6.16 days of work per year due to sickness, compared to nonsmokers, who miss 3.86 days of work per year.3

Given these factors, it is hardly surprising that employers are seeking lawful ways to decrease the number of smokers in the workforce. Many have addressed this problem solely through incentivizing healthy lifestyle choices, while some have adopted stronger policies that prohibit hiring smokers altogether. . . .

Although the scope and effect of many of the ADAAA changes to the ADA have not yet been subject to administrative or judicial interpretation, and potential questions remain, individuals bringing federal disability discrimination claims must still prove that the employer’s actions were due to unlawful discrimination rather than the result of legitimate nondiscriminatory business reasons. In sum, under the right circumstances, employers may choose to “extinguish” smokers from the pool of potential candidates for hire without violating the ADAAA. However, employers seeking to implement no-smoking bans on new hires should carefully consider all potential legal issues, including applicable state laws, before doing so.

Jump to full article »