Should big tobacco be involved in harm reduction?

Smoking amongst people with mental health problems

I recently attended a fascinating talk on the topic of smoking cessation amongst people with mental health problems.The argument the presentation made was (as I understood it) that for many people with mental health problems, nicotine is actually a fairly helpful psychoactive substance – in that it can allow people to experience a reduction in anxiety, increase cognitive focus and help them structure their lives. The presenter also argued that e-cigarettes appear to be a low harm way of delivering nicotine and, as such, we should consider ways of encouraging uptake amongst this population.

I can generally see the validity of these points – the ‘self-medication’ hypothesis which suggests that people with mental health problems can use nicotine to manage symptoms is not uncontroversial, but has accrued a reasonable amount of evidence – for instance amongst people with attentional problems, depression and schizophrenia 123. In terms of e-cigarette being a low harm nicotine delivery system, again more research (in particular, long-term studies) needs to be done, but the preponderance of evidence supports this – to the extent of the Royal College of Physicans suggest the cigarettes are likely to be 95% safer than tobacco products4.

The presenter had done a lot of background interviews to support their case. One interesting thing that arose was that many of the interviewees they had spoken to clearly had access to NRT (usually a few boxes of patches in a cupboard!) but chose not to use it. Although this wasn’t formal ‘science’ or grounds for an evidence-based approach to treatment, this anecdotal report suggests that perhaps the cigarettes are a viable alternative these individuals – they made some effort to quit, but need something that meets their needs in a different way to patches or gum. So, I can also follow that encouraging these individuals to transition to e-cigarettes (which allow self-closing to far greater degree than do other forms of NRT) can be beneficial.

Could big tobacco compaines help be part of the solution?

What really got me thinking was a final point that was made. The presenter highlighted that tobacco companies have, in the past, offered discounted cigarettes and tobacco products to the US military and also to homeless shelters and outreach programs. They also went on to suggest that tobacco companies could perhaps be required, as a form of reparation, to do the same with e-cigarettes in regard to disadvantaged communities. This would, the argument goes, make them more accessible and reachable to people who could potentially experience reduced harm as a result. I think it is important to note the speaker clearly wasn’t an advocate of big tobacco companies. Their talk made quite clear the harms of the products of caused, and the legacy of mistruths and scientific shenanigans such companies have employed to argue, for instance, smoking is neither hazardous nor addictive. But this idea got me thinking – is getting tobacco companies involved in harm reduction something we should encourage, or something to be should be wary of?

Reparations or image saving?

My suspicion is the big tobacco companies will be more than keen to place their e-cigarette products in contexts such as shelters, clinics and outreach plans. In both the US and the UK, numbers of people using tobacco products has steadily been falling and, more importantly, so has uptake among younger people. Many people hope that we are experiencing the ‘endgame’ for tobacco products in the Western world. For the big tobacco companies, e-cigarettes represent a new product for a market who no longer wants the harmful old one. Supplying this would not only safeguard the future of their profits in these markets but also offers an opportunity to begin repairing a spoiled public image. And it is this latter aspect which I think concerns me. In countries such as the UK, the US and many other Western legislative systems, tobacco control policies (which reduce use and uptake) were only really enacted when it became very difficult for politicians to avoid doing so. In these countries it is very unlikely that such policies will be reversed such that tobacco can regain its status as a ubiquitously used substance. So, in the context of Western countries the net effect of e-cigarette’s being supplied by big tobacco companies in this way is probably positive. However, tobacco control is not the same the world over. I simply cannot see tobacco companies being as keen to supply discounted e-cigarettes in, for example, Africa or India. I also worry that if big tobacco companies rehabilitate their image in one market (for instance, the US) it may make it more difficult for pressure to be brought to bear on them in others. Thus, although may have a positive effect in some places, this may be at the expense of a more drawnout approach to the ‘tobacco endgame’ in the rest the world.

All in all,I’m really not sure what I think about this discounted e-cigarette issue though. Should big tobacco be part of the solution for people in disadvantaged communities? My feeling? To some extent, the jury is still out for me- it’s a complex, global, question, with no easy answer… But I’d always be aware that big corporations look to profits, and often do so before ethics (tobacco companies being no exception here!). So my instinct is to keep them out of it. Whether that is at all possible is, of course, another question….

It’d be great to get your thoughts on this – so why not leave a comment?

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References


  1. Evans, D. E., & Drobes, D. J. (2009). Nicotine self‐medication of cognitive‐attentional processing. Addiction biology, 14(1), 32-42. 
  2. Kumari, V., & Postma, P. (2005). Nicotine use in schizophrenia: the self medication hypotheses. Neuroscience & Biobehavioral Reviews, 29(6), 1021-1034. 
  3. Markou, A., Kosten, T. R., & Koob, G. F. (1998). Neurobiological similarities in depression and drug dependence: a self-medication hypothesis. Neuropsychopharmacology, 18(3), 135-174. 
  4. Royal college of Physicians( Nictotine with smoke: Tobacco Harm Reduction 

Understanding and Managing Stress

Exciting news – Understanding and Managing Stress now out!

PsychologyItBetter is all about making the insights of psychology clear to people in useful, accessible ways. Part of of how I try to do this is the range of ‘PocketBooks’ – concise, informative volumes which hlp translate research into pratice. I’ve some news on this front- The latest PsychologyItBetter.com PocketBook – ‘Understanding and Managing Stress‘ is out now.

What inspired ‘Understanding and Managing Stress’?

The last couple of years have, for me, been marked by a lot of stress. I’ve had some great life events (welcoming my second child into the world being a highlight) and some challenging ones (competing professional pressures being a big feature). Through all the ups and downs I have experienced high levels of stress that were, personally, unprecedented. I didn’t always react well. In fact, I sometimes reacted in ways that left me disappointed with myself, and worried about how to carry on juggling my life.

I managed change my bleak outlook on the world. But I didn’t (couldn’t) do it alone. I was lucky to have an incredibly supportive partner. My work colleagues also helped, and I formed a number of new social relationships which were (and are) a source of invaluable support. I also realised that, as a researching and teaching psychologist, I had access to another amazing resource – the body of scientific evidence which attempts to understand how stress functions and how we can best manage it. I threw myself into this literature. The strategies and ideas you will find in this book represent some of the areas I found insightful and of the most use. ‘Understanding and Managing Stress’ is my attempt to crystallise these key findings. Importantly, it also tries to translate the (sometimes abstract) ideas into real, actionable suggestions. It provides information you can use to help understand the reasons why we become stressed and also actions you can take to manage it. There is no such thing as a quick fix for stress, and I don’t think many of us will ever be 100% stress free. But a good grounding in the theory and practice of stress management has helped me enormously, and I am confident it will help you to.

What’s in the book?

Whilst we may not be able to remove the sources of stress in our lives, we all have the potential to better manage how we respond to them. However, to do so effectively, we must also understand how stress operates. Drawing on a combination of decades of scientific evidence and his own personal experience, I have attempted to explains the processes which underpin our responses to stressful situations. The book also also outlines clear, effective ways to translate theory to practice – methods you can use starting today.
This book comprises 10 sections, each of which concisely and clearly describes a psychological concept which is relevant to understanding and managing stress. Each ends with a ‘how do I use this?’ segment which presents one or two realistic ways your new insight will help you. How our biology and psychology interact when we are stressed, the role of time perception, and the effects of mindfulness and self-affirmation are just some of the topics discussed. We all want to reduce the amount of stress we experience in our lives – and this book will be an invaluable aid in doing so.

Where can I get it?

I have found writing this PocketBook enormously beneficial – I hope you find reading it a helps you better understand and manage the stress in your life too.You can find the Amazon UK edition here, and the US/World editions here. Check it out today! It is also available via KOBO, Apple, Barnes and Nobel (NOOK) and many other retailers – just search ‘Daniel Frings’.

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Social connections and social prescribing

The power of social connections and the rise of social prescribing

One way of dealing with stress is to draw on the positive social identities in our lives. A growing body of research suggests that the social connections we have can buffer us from the effects of traumatic events, improve mental health and also let us bounce back from physical ailments more quickly. In the guise of ‘social prescribing’, this idea is also increasingly being used to find ways to replace or compliment medicine.

Continue reading “Social connections and social prescribing”