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If cigarettes were made without nicotine in its natural form or added to make them more addictive, few people would smoke them, says Prof. Peter Hajek, a clinical psychologist in London who specializes in treating and researching tobacco dependence.
Hajek, here on his third visit to participate in a Kfar Hamaccabiah conference on smoking prevention and cessation organized by the Israel Cancer Association and other groups, told The Jerusalem Post in an interview on Thursday that nicotine itself is "relatively harmless. It is the tar, numerous carcinogens and other rubbish in smoke that cause such great damage to health. Except for pregnant women, whose fetuses can be harmed by nicotine, cigarettes are like injecting a relatively safe drug into yourself with a dirty syringe."
The Moravian (Czechoslovakian)-born expert, who heads the psychology section at Barts and the London teaching hospital at Queen Mary's School of Medicine and Dentistry, said that oral and tactile gratification supposedly felt by smokers with cigarettes in their mouths and fingers play "less of a role than we thought. In fact, the main effect of smoking is to counteract withdrawal symptoms. When smokers addicted to nicotine are between cigarettes, they suffer discomfort and may be irritable and restless. The 'enjoyment' they feel is getting the nicotine again to combat these withdrawal symptoms." Oral and tactile gratification could more safely be provided by holding carrot sticks or blowing bubbles, Hajek joked.
Nicotine-free cigarettes are available on the British market, but very few people buy them because it is the nicotine to which smokers are addicted, and without this drug, smokers get no satisfaction. Many drug companies are working on nicotine-delivery systems that could replace cigarettes, as there is a lot of money in this.
"Most people know smoking is dangerous and want to quit, but many find it very difficult.," said Hajek, a consultant on smoking cessation to the World Health Organization who himself once smoked as a student "for social reasons, as a decorative smoker who thought they make me look good."
Commercial firms that claim to cure smokers' addiction may mislead customers, as there are "many different ways to calculate the success rate. If they send out letters a year afterwards to 100 people, and only 10 respond, with nine saying they are still not smoking, it doesn't mean they have a 90% success rate. The 90 people who did not respond are likely to be ashamed to say they have relapsed. People want to be nice and say they quit. However, in our studies at Bart and The London, we do validation. We don't just take their word for it but take a blood sample or have their breathe into a device. We do it the hard way. Of 500,000 British people a year who are treated for nicotine addiction, half stop smoking for six months, and 15% for a year. This figure might not seem like a lot, but giving up smoking is one of the most significant existing means to improve health."
About a quarter of the British population - similar to Israel's - smoke. Britain's National Health Service offers free smoking cessation courses - but these are not included in Israel's basket of health services: "It is a treatment like any other, so it should be free here," he said.
As only a small minority of smokers manage to quit on their own, there are a variety of methods, including psychological support and medications to help. The newest drug, called Champix, is according to some studies more effective than Zyban, which has been available for several years. There are also nicotine chewing gums and patches to help those who have quit to be weaned from their addiction.
But tobacco addiction is not treated like a bacterial infection in which you just take a penicillin pill, he said. "You have to change behavior. Just taking Champix, Zyban or a nicotine patch is not enough. You need psychological support." The best guarantee of success, he said, "is if the smoker is determined to stop."