Switching to An Alternative Smoking

It can be hard for people to stop smoking; or they may not want to; and they may derive significant benefits from it, especially in the short and medium term before any damage is caused. There are medical, topical and personal benefits for many people in addition to pleasure. Therefore, it is not necessarily the case that quitting is good, continuing to smoke is bad - there is a balance to be struck. 

If we could continue to derive the benefits without having to accept the drawbacks, real progress would be made. Since it is the smoke that causes the harm, not the beneficial alkaloids, vaping has now provided an excellent substitute; and substitution is far more successful than cessation. Regular refill liquids only contain one of the tobacco alkaloids, the easiest one to extract: nicotine. Since some of the other alkaloids (or most, or all - we simply don't know) also have beneficial effects [9], it might be useful to obtain those as well [6]. This is particularly noticeable in people who find it very difficult to quit smoking due to severe cravings, even with a cigarette substitute and when more than enough nicotine is supplied. For such people there is an obvious need for another chemical component (or components) in tobacco, and for some of them it has been found to be alkaloids other than nicotine. This is the basis of WTA refills.

'Substitution' is the replacement of combusted tobacco with non-combusted tobacco or an effective nicotine delivery product, and is the basis of THR or tobacco harm reduction. The end result is the same as cessation since the health outcomes are too close to differentiate between, and THR is far more acceptable to the individual. In the real world, as opposed to artificial environments such as a clinical trial, substitution is at least three times more effective in terms of the success rates achieved in reality. If this were not so, Sweden would not be the world leader in reducing smoking prevalence, have a male smoking prevalence that falls 1% per year and has done since 2003, and that will be 5% by 2016 (they use Swedish Snus there, a specially-processed specially-packaged smokeless tobacco).

This is why many people can successfully switch from smoking cigarettes to a PV (e-cigarette / ecig), or other THR product. If Snus can virtually remove smoking, as it appears to be capable of, and the average health outcomes are essentially equivalent to non-smoker status, then we can expect similar (or better) results for ecigs.

In practical terms the success rate varies from very low (as low, in fact, as some smoking cessation therapies) when every factor is suboptimal, to very high when everything is done correctly. Even so, some THR products are not 100% successful and it is worth asking why.

The main factors that affect the success of any choice of an alternative to smoking are:

1. Mentoring

This is so important to any form of smoking cessation therapy, or to choices within a class of THR product such as ecigs, that the success rate can easily be halved or doubled, when mentoring is removed or introduced. In fact it is tempting to say that, in some cases, what you are actually measuring is the efficacy of different mentoring approaches rather than that of any therapy or consumer product in use. It applies equally to complex consumer choices such as ecigs or pharmaceutical interventions for smoking cessation.

It's worth defining mentoring correctly in this context: it is regular, expert advice from a user of the product that is being utilised; it is expert advice on the subtle differences between products with regard to the exact effect on the individual being mentored; it is expert advice on where to obtain any item in the range of products and how to use it; it is expert troubleshooting of problems together with a successful resolution; it is assistance with change in product use in parallel with the individual's changing requirements. In other words, to mentor a new vaper you need an expert vaper. You can't teach someone to fly a plane if you are a boat captain. If you're mentoring a new pilot you need to be a better one.

2. Consumer preferences

Do consumers like the product when used as a substitute for smoking? It probably comes down to a percentage: if the person likes the product sufficiently, and considers it perhaps 80% as good as smoking, then the other considerations (health, cost) will tip the balance and they can switch. If smoking scores 100 overall (pleasure, functionality, health positives, health negatives, cost of consumption) then an alternative needs to score higher to displace smoking. If an overall score of (say) 110 is given to the THR choice when all factors are added: comparison to smoking score = 70 ex 100, health = 20, cost = 20, then the total of 110 exceeds the 100 score of smoking and the individual moves to the THR product. If the preferences do not score high enough, smoking wins.

3. Chemical profile of the product
Removal of cravings, benefits such as improvement in cognitive function, and pleasure delivery are all factors that are affected by the chemical profile of the THR product. If cravings are still experienced then the choice will probably fail eventually. Efficient nicotine delivery fixes it for most people eventually (though not at first, for many). For some, the cravings can be intense and never go despite as much nicotine available as needed. 

Alternatively (or in addition), some people find a "sense of loss" affects them after transitioning: they know something is missing but cannot express it exactly, although they miss it - sometimes strongly. A WTA approach of some kind fixes the problem for most of these individuals.

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