While I tend to believe the CASAA advocates I've interacted with, I'm not sure I believe what you just said to be generally true. For example, CASAA's stance on nicotine as presented
Casaa.org - Harm Reduction is very peculiar to me.
They open by basically saying nicotine has benefits, they bullet them out. Then they say "
Theoretically, the healthiest thing a smoker can do is to totally give up using nicotine in any form. But does reality conform to the theory?"...
They should be defining ~reality~ in the use cases they suggest. They don't.
They completely disregard nicotine's effects on prediabetes and diabetes as it pertains to heart disease. If you're already familiar w/ the situation what CASAA is really indicating is statistical relative risk of nicotine cessation vs weight gain. I get that, I've said that, however... shouldn't CASAA note that those who are borderline and have healthier weights might want to try to stick to that without nicotine?
And in terms of nicotine cessation I think CASAA should probably tell you what else you're ~not~ getting in vaping (vs analogs) that might be beneficial to your mental health too. The whole WTA discussions had even in this thread. I would think when you're talking about nicotine helping w/ depression and anxiety you might want to mention this too.
So while I agree it's absurd to think CASAA is out there covering up dangerous aspects of vaping, I'm not sure they're advocating for the consumer as an unbiased broker either. As an individual broker and not the whole of CASAA, you indeed may be... I just don't see the organization's outward facing presentation quite that clearly.
-Magnus
I'm going to confine myself to addressing the portion of your post that deals with the Nicotine page on the CASAA web site. I wrote that nearly two years ago. Here is the portion in question:
The official list of nicotine withdrawal symptoms in the Diagnostic and Statistical Manual (DSM-IV) includes depressed mood, sleep disturbance, irritability, anxiety, difficulty concentrating, restlessness, decreased heart rate, and increased appetite or weight gain. These symptoms are supposed to peak within a day or so and disappear altogether after a couple of weeks. However, researchers have found that in some groups of quitters, symptoms do not dissipate and can, in fact, worsen as time goes on. [9]
The problems with concentration, memory, and mood make it difficult to fulfill responsibilities of daily living. How many employers are willing to overlook impaired job performance for weeks or months at a time? What effect does prolonged irritability that sometimes escalates into anger have on relationships with family, coworkers, and friends?
For many would-be abstainers, the Catch 22 is that some improvements in physical health (for example, better lung function) must be paid for with possibly permanent declines in cognitive and emotional health. Is it any wonder that so many relapse to smoking within a few days of quitting?
As far as "use cases" go, I'll share my personal story with you. You will find dozens, if not hundreds of similar stories in this site. You will even find similar stories on some of the traditional quit smoking sites that preach you must overcome your "addiction" to nicotine.
I quit smoking by becoming abstinent from all forms of nicotine twice. The first time was when I had only been smoking for 4 years. It wasn't my idea. My husband announced that "we" were quitting, and I went along with it, since by then word was getting out that smoking can be unhealthy. I spent the next six months feeling generally on edge, as if something was wrong or "off". I experienced my first asthma attack and developed some type of sinus allergy that had my nose running 24-7. My upper lip was a piece of raw meat. Then about 6 months after we had quit, my husband came home and lit up a cigarette. "Thank God!" I said, "Give me one of those!" That smoke felt like the drink of water you take after having been parched for hours. The sinuses stopped running and there were no more asthma attacks.
I tried to stop smoking several times over the next twenty years, but it seemed that no sooner would I be off cigarettes for a couple of days, and I would get sick. Sometimes it would be the flu. Sometimes it would just be a general feeling of fatigue--being too tired to drag myself out of bed. So I'd take up smoking again and decide to try again after I felt better. After one of these episodes, I got to thinking that it was a strange coincidence that every time I stopped smoking I would get sick. So I went to the library.
One of the books I read was
Smoking, The Artificial Passion by David Krogh. It was a real eye-opener. Here is a review from Library Journal:
In this thoroughly researched yet entertaining book, journalist Krogh attempts to explain why people smoke, given the abundant documentation of attendant health hazards. He investigates physiological, pharmacological, sociological, and psychological responses to smoking, explaining each in simple, laypersons' terms. Krogh is adept at incorporating vast amounts of scientific evidence without weighing down his prose with dry data. He explores some alleged benefits of smoking (e.g., the paradox of smoking being both relaxing and mentally stimulating; the sex appeal of the smoker). His multifaceted approach offers fascinating reading. Having persuasively argued that the balance sheet for smoking is negative, he concludes with a fine chapter entitled "Advice on Quitting."
The book was chock-full of references, and I still had a lot of questions after reading the book. In several places where he mentioned an interesting fact, I wanted to read the entire article that he was quoting from. This was back in the days (yes Boys and Girls, it is true) when
there was no internet. So I got in my car, drove to the Library of Medicine in Bethesda, registered for a library card as a writer, and began looking up these articles and looking for more on the same subject. I spent countless coins making photocopies from the journals (you could not borrow them). I have a huge collection of Xeroxed medical journal articles. Learning to read them was a challenge, because I did not know the meaning of often used words such as "attenuated", and "mediated" when used in a medical sense. Anyhow, what I finally figured out was that for a certain portion of the population, going off nictone triggers symptoms that don't go away like they do for the others. I got the idea that if I could just get each of these underlying conditions treated when I stopped smoking, I would be able to quit and stay quit.
So, armed with knowledge, and with the best advice and products available at the time, I made up my mind to stop smoking. I went to the doctor, got a prescription for the nicotine patches, and signed up for the Lung Association's "Freedom from Smoking" class, which was supposed to teach me how to become a non-smoker. Pretty much what the course taught was tricks to outlast cravings to light up. It didn't teach me anything about how to handle the physical ills that would be coming my way. At least, they didn't hit all at once. The class met weekly, and we were supposed to go home after the second class, and throw out all our cigarettes. Some of the folks were going cold-turkey. I, at least, had a 21 mg nicotine patch to wear.
I told the doctor ahead of time that I didn't think this would be strong enough, since I took in about 50 mg of nicotine a day from my 2-1/2 packs of smokes. But he told me that he was not allowed to prescribe wearing more than one patch at a time, because 21 mg / day was the highest amount approved by the FDA.
Well, it really wasn't enough, but I was tons better off than some of the folks who had gone cold turkey. At class #3, several of the members were missing. Several people who did show up looked really ill. They had dark circles under their eyes, and their color wasn't good. After class, I talked with the instructor and mentioned that. She told me that those folks were not going to make it. She sees them every class. I asked her about how many wouldn't make it through all 6 classes, and she said that about 20% drop out before the end.
I made it to every class. I wore the 21 mg. patch for a total of 4 weeks (which got me through to the end of the course), then wore the 14 mg. for 4 weeks, followed by the 7 mg. patch for 4 weeks. I was starting to feel really punk, and the doctor took pity on me and gave me a renewal on the 7 mg. patch.
Two days after I took off the last of the lowest-dose nicotine patches, I was laying on my couch, curled up in a fetal position, crying my eyes out without knowing why. When I tried to pull myself together and carry on with daily activities, I ran into problems. I used to greatly enjoy reading the paper every morning. But at this point, trying to do that was an exercise in frustration. I would get to the second paragraph and stop. I needed to go back to the first paragraph because I had already forgotten what it said. I was told that this depression and confusion are "signs of healing" and they would pass within a few days -- at most within a few weeks. I was having troubles staying awake and was sleeping at least 12 hours a day. When I was awake, I took comfort in eating and started gainin 5 pounds a week.
I started suffering from severe muscle spasms that seemed to start at my forehead, travel over my head, down my neck and into my upper back. I hung in for two weeks (with things getting worse instead of better) and finally went to the doctor. I was prescribed an antidepressant. It reduced the number of times per day I would break out in tears, but it did nothing to help my concentration, attention, and short-term memory. The muscular pain continued. I went to the dentist who prescribed a custom-made bite plate to keep me from grinding my theeth in my sleep. On my way to the next doctor appointment, I got distracted somehow, made a wrong turn, ended up in the expresss lanes of the freeway and had to drive 10 miles before I could exit and turn around. I found this very frightening! The regular doctor prescribed muscle relaxants. When the bite plate arrived at the dentists, I had the chance to wear it for about a week, and then the muscle spasms relented.
We all have the "What did I come in here for?" experience on occasion. It was happening to me every single time I got up to do something. I found this frightening as well. Luckily, I was a "work from home" writer. Before my stop smoking campaign, I used to write about 10 pages a day. After I achieved nicotine abstinence, and after getting through the period before the antidepressant medication where I could do nothing at all, I was able to write again....a little. My output was 1 page per day, and it felt like a huge drain on my energy to get that done.
To cut a long story short, after 6 months of this, I was starting to experience some problems with work. They wanted to put me at a client site. I was a mess and knew I could not handle this. Back to the doctor I went and said, OK, you've taken care of my depression to some extent, but my brain is still messed up. I can barely drive a car. I have to keep telling myself over and over to concentrate. I can't remember things like I should. What can you give me to fix this? The doctor told me that there was nothing she could prescribe and that for some former smokers these problems seemed to be more or less permanent. I sighed and told her that I had no choice. I wanted my life back, I wanted to be able to concentrate, think and remember. I told her that I was going to go back to smoking. She just looked sad and shrugged her shoulders.
Keep in mind that back in these pre-internet days, there were no OTC nicotine replacement products. We had all been brainwashed to believe that smokeless tobacco products were six times more likely to give you cancer than smoking, and besides, who wants to spit tobacco juice?
When I have told my story to a lot of former smokers, I have gotten a lot of disbelief. "Wow, nothing like that happened to me," they would say. Well, it doesn't happen to everyone. It doesn't even happen to the majority of smokers, although the percent to whom it happens is growing, because we are what they call the "hardcore" smokers.
I corresponded with researcher Dr. John Hughes of the Univeristy of Vermont about a journal article he published on "withrawal symptoms" in which the abstact stated that for most smokers, symptoms peak within two to four weeks and then subside. He wrote back that any symptoms that go beyond 6 weeks are likely not true "withdrawal symptoms" but rather symptoms of underlying conditions that had been kept under control by the nicotine. I asked him about how many smokers this applied to, and he responded about 25%.
So Magnus, if you are one of the lucky ones who just enjoys the effects of nicotine but can live a happy and healthy life without it, I envy you. But there is a subset of us who are not as lucky. We are NOT healthier when we give up nicotine. Oh we are healthier in that our lungs and cardiovascular systems are at less risk, but we buy our physical health at the price of our cognitive and emotional health.
I wanted to reach out to those people. They are downtrodden. They have tried over and over to quit without success. They have been convinced that it is all their own fault and they are just too weak willed and "addicted" to quit.
As far as diabetes goes, it wasn't even on the radar when I wrote that page. I don't think that there is enough evidence yet to say with certainty that nicotine causes diabetes. In fact, in the MRFIT study, those in the intervention group who managed to succeed in smoking cessation developed diabetes at a higher rate than those who were still smoking. The hypothesis is that those who quit gained weight, developed hypertension at a higher rate, and were prescribed Hydrochlorothiazide. HCTZ has a tendency to raise blood glucose levels.
Perhaps the cause of the diabetes or prediabetes in the NRT group is explained by the fact that the quantity of nicotine has been greatly reduced from when they were smoking. They gain weight at a slower rate than those who gave up all nicotine, but enough to trigger a rise in blood sugar directly, or indirectly because they develop hypertension and are treated with HCTZ.
For a good overview of nictoine safety and toxicity, I recommend you take a look at the presentation that Dr. Neal Benowitz gave to the FDA last fall on the question of whether to approve NRT for long-term use. The link is under "Panel 2".
Presentations
The largest negative for nicotine use is adverse pregnancy outcomes. Lower birth weights, preterm delivery, and preeclampsia.