Why Gradual Reduction in Nicotine Leads to Complete Withdrawal

Nicotine affects the brain like the neurotransmitter acetylcholine. Together they activate dopamine surge and a person feels a good mood and relaxation effects. Regular use of nicotine causes physical and psychological addiction. If you haven't read this article yet — How Nicotine Affects the Brain and Why Nicotine Addiction Occur, I recommend starting with it.

How to quit smoking or vaping effortlessly

The most effective way to get rid of nicotine addiction is to reduce the amount of nicotine you consume at a time gradually and comfortably to zero. This way you give time for the normalization of biochemical processes in the body and contribute to natural psychological recovery.

Why does it work?

Through this approach, the number of acetylcholine receptors will decrease while their sensitivity — increases. As a result, the symptoms of physical withdrawal will be greatly reduced, and eventually, disappear completely.

But the most interesting thing will happen with your psychological addiction. As you consume less amount of nicotine, the dopamine surge you received while smoking or vaping will decrease. Your subconscious mind will eventually begin to realize that this nicotine stimulation method is not as effective as it was before and will therefore be discarded as unnecessary.

And most importantly, all of the above positive effects you will experience without any effort or compulsion on your part.

How reduce the level of consumed nicotine?

The easiest and most correct way is to use e-cigarettes as a cessation tool. With the help of e-liquid with different strengths of nicotine, the dosage can be easily and precisely adjusted. At the same time, all your behavioral smoking/vaping habits remain unchanged.

It is important to understand, that if you are still a tobacco cigarette smoker, switching to electronic cigarettes will greatly reduce the harm to your health due to the lack of carcinogens caused by combustible tobacco. If you still have doubts about the safety of these devices, it's only because tobacco companies spend a lot of money to discredit electronic cigarettes, as a threat to their business.

What science says about the way to quit nicotine with e-cigarettes by reducing nicotine levels?

To understand how the phenomenon of nicotine addiction is currently being studied and what effective ways to overcome it, let's overview the work of scientists Judith J. Prochaska and Neal L. Benowitz — “Current advances in research in treatment and recovery: Nicotine addiction”. All further quotations will be from this scientific publication.

About the authors and the publication itself

Judith Prochaska, Ph.D., MPH, is a Professor in the Department of Medicine at Stanford University with the Stanford Prevention Research Center and a member of the Stanford Cancer Institute.
Neal L. Benowitz is an American academic physician and professor of medicine at the University of California, San Francisco, with expertise in the pharmacology of nicotine and tobacco addiction.

Both of these authors are senior researchers and scientists who have devoted almost their entire lives to studying the phenomenon of addiction, including nicotine addiction. Their work, which we are going to overview, is based on the conclusions of 235 studies and scientific papers, the whole list of which you can see in the reference section.

Overview and excerpts of the scientific report

Let's start with the introduction, and it is indeed intriguing.

“To lower nicotine too much might end up destroying the nicotine habit in a large number of consumers and prevent it from ever being acquired by new smokers.”
– British American Tobacco Company internal document, June 1959

Does this mean that the management of BAT knew how to overcome nicotine addiction back in 1959?

The report begins with statistics on various diseases related to tobacco smoking, comparing nicotine-containing products on the market and emphasizing that a significant proportion of people continue to consume the most harmful to the body combusted cigarettes.

Despite the diversification, conventional combusted cigarettes remain, by far, the most common nicotine product used by adults in the United States and in most places globally. Worldwide, there are approximately 1 billion smokers. While products of tobacco combustion are the main cause of smoking-induced disease, nicotine addiction sustains tobacco use.

Further, the authors tell us how nicotine affects the body and why addiction occurs. Earlier in this article, this topic was covered, but if you want a more scientific explanation, I recommend reading about it in the report.

While nicotine is necessary for tobacco dependence, conditioned behavior is also an important factor and has strong implications for behavioral treatment. When a person quits smoking, cravings for cigarettes persist long after nicotine withdrawal symptoms have resolved. A smoker typically associates smoking with particular situations, moods, or environmental factors that become cues to smoke. Thus, smokers often smoke after a meal, with coffee or alcohol, while driving, and/or with friends who smoke.

In addition to physical addiction, psychological addiction also has a very important role, and this is even decisive when choosing a method that will effectively help to cope with it.

Let's switch on to the most interesting part — “Pharmacotherapies to aid smoking cessation”.

While counseling and psychosocial treatments help promote cessation, medications that address the neuropharmacological effects of nicotine and nicotine withdrawal further enhance the likelihood of quitting. E-cigarettes, which allow continued self-administration of nicotine without combustion, can also promote quitting smoking.

Further in the report, indicated a comparative table of different medications for smoking cessation, note the column Adverse Effects:

About e-cigarettes

The e-cigarette concept is to deliver nicotine by an inhaled route without generating products of tobacco combustion. NRT medications can aid cessation as discussed previously, but most smokers do not find NRT very satisfying and quit rates are modest.
Recently, a randomized clinical trial with 886 smokers treated in the United Kingdom’s National Health Service evaluated a second-generation e-cigarette refillable tank-type device to patients’ choice of NRT provided free of cost for up to 3 months. All received standard behavioral support. At 1 year, the sustained abstinence rate in the e-cigarette group was twofold greater than the NRT group

Benowitz has advocated the idea of federal regulation of the nicotine content of cigarettes to reduce levels over time, resulting in a lower intake of nicotine and a lower level of nicotine dependence.

Very low nicotine content cigarettes (VLNCs) are engineered to have reduced yields of nicotine in the tobacco contained in the cigarette rod. These cigarettes deliver much lower levels of nicotine than earlier cigarettes that were marketed as “light” or “ultralight” but which in practice allowed smokers to obtain levels of nicotine similar to regular “full-flavor” cigarettes through compensation behaviors, such as blocking ventilation holes or inhaling more deeply. Reducing the nicotine content of cigarettes to approximately 0.5 mg per cigarette is believed to render cigarettes minimally addictive and lead to lower levels of consumption, making it easier for smokers to quit.

So what is the final conclusion of this report?

Thus, if smokers were to switch completely to e-cigarettes, then the smoking-related disease is predicted to decrease substantially. Population-based models of the impact of e-cigarette use predict an overall health benefit because many smokers will quit, while those who continue vaping or take up e-cigarettes anew experience much less harm.

That concludes this short review, the scientific opinion about reducing nicotine levels and usage of e-cigarettes is certainly positive.

Why nicotine addiction treatment with e-cigarettes is not popularized and implemented at the level of public policy?

There are two reasons for this:
1. The main counterargument against the adoption of this method is that the impact of electronic cigarettes in the long term on the body has not yet been fully studied. In simple words, some people think that not much time has passed since the technology appeared and it is necessary to wait to observe.

The first e-cigarette was introduced back in 2003. Negative side effects on human health caused by e-cigarettes that used legal liquid have not yet been identified. At the same time, there are many studies that show the positive health benefits confirmed by people who switched from tobacco. But most importantly, the number of people who have quit smoking completely is overwhelming.

2. In order to understand the second reason, you have to answer the counter-question — who benefits from smokers? 
Tobacco companies are no longer just cigarette manufacturers, they are big corporations with their own media, fake research, and people in government and regulation institutions.

As a new technology, e-cigarettes faced regulatory lag. Minors got the opportunity to buy nicotine e-liquids without proper control. This was a great opportunity for tobacco corporations to start their information campaign to discredit all e-cigarettes, which eventually turned into manipulation at the level of legislation. What to say about countries with corrupt governments, which make such a great place for tobacco corporations?