It's not a patch on sucking: For many smokers, the attraction lies less in the nicotine than in the oral gratification. Artificial cigarettes could be the answer, writes Rob Stepney

If smokers need something to suck, a substitute cigarette containing nicotine but little else may be the answer.

The current route for smokers wishing to give up - nicotine gum or patches plus standard anti-smoking advice and encouragement - is proving disappointing. Only one in five smokers wanting to give up are still not smoking a year after the start of their treatment, according to an overview of research published last January in the Lancet.

Dr Godfrey Fowler, author of the Lancet report, and head of the Department of General Practice at Oxford University, says it is important to remember that without any help at all, only around 1 per cent of those smokers would have given up. 'Nevertheless, even in achieving 20 per cent abstinence, the effect of current nicotine replacement therapies is relatively small.'

One reason for this is that there is more to smoking than nicotine. Having something distracting to do with the hands and mouth, especially at times of stress, is clearly part of the habit. 'As an ex-smoker, I am myself aware that the business of handling cigarettes is important,' comments Dr Fowler. 'People who have given up for years are still playing with paperclips and sucking pencils.'

To meet the oral needs of smokers will require the development of some form of artificial cigarette which provides both a nicotine fix and an opportunity for ritualised hand-to-mouth behaviour.

The recent emphasis on nicotine addiction has tended to sideline other elements in the tobacco habit. But a century ago, Sigmund Freud was well aware of the complex attractions of smoking. Considering the origins of his own compulsive smoking, he argued that stimulation of the lips was central to the habit's satisfaction.

Freud was a classic casualty of tobacco. Despite attacks of angina which started when he was 37, he carried on smoking. As he wrote to his physician, not for him the 'misery of abstinence with nothing lit between my lips'. Freud persisted with his 20 cigars a day for two decades after his first smoking-related cancer of the mouth was diagnosed and removed.

During this period, pre-cancerous growths in the mouth were popping up at the rate of more than one a year. Yet Freud demanded of his jaw prosthesis not just that it should enable him to speak and eat properly, but that it should allow him to suck well enough to smoke.

Freud's case provides compelling early evidence about the health risks of smoking and its grip on the psyche. He theorised that thumb-sucking was a substitute for the pleasure of suckling on the breast, and a manifestation of primitive sexuality. Children for whom the erotic significance of the lips was intense would naturally graduate to smoking in adulthood.

Psychoanalytic theories are notoriously difficult to test, and their central concern with sex may seem misplaced. But there is evidence that weaning experience does relate to later smoking habits. A Harvard University study from the Fifties found that smokers unable to give up had spent less time at their mothers' breasts than those who successfully quit. And a later study showed that first-born boys who were closely followed by a sibling went on to smoke more than others, presumably because they had experienced frustration during the oral phase of development.

Such findings are supported by clinical experience. Some years ago Joseph Buchanan, a Canadian psychoanalyst from the Ottawa Civic Hospital, noted clear evidence of an 'oral personality'. His obese patients showed substitution of one mouth-based activity for another: when dieting, they smoked more.

At the Institute of Psychiatry's Health Behaviour Unit in London, Professor Michael Russell has spent 20 years researching ways to help smokers to quit. 'Though the weight of evidence is that people smoke basically because of nicotine, other aspects of the habit are important,' he says. 'I believe sensory factors become rewarding primarily because they are associated with intake of nicotine. But there is certainly a biological predisposition to conditioning behaviours that involve the hand and mouth.'

With this in mind, Professor Russell strongly advocates the development of an alternative to smoking that provides nicotine and that feels like a cigarette. To reduce smoking's toll of death and disability, such a device would have to produce negligible amounts of tar (which leads to lung cancer) and substantially less carbon monoxide (which contributes to heart disease), and ideally none of the noxious gases responsible for chronic bronchitis.

In the Eighties, the US tobacco company R J Reynolds spent dollars 300m developing an artificial cigarette. Professor Russell thinks it came close to producing a device that would save thousands of lives. In the prototype, lighting a carbon ring heated a metal core around which tobacco was wrapped. Instead of being burnt, the heated tobacco gave off a smoke that consisted mostly of water vapour and droplets of the harmless oily liquid glycerine. The smoke contained nicotine, but only 10 per cent of the tar delivered by a conventional cigarette and some carbon monoxide.

'There were drawbacks,' says Professor Russell. 'Market testing showed the flavour needed to be improved, the amount of nicotine delivered doubled and the amount of carbon monoxide cut. But then such a device would very likely persuade people to switch from ordinary cigarettes.'

Unfortunately, research on artificial cigarettes has stalled. In the US, a House of Representatives sub-committee labelled the Reynolds product a nicotine delivery system, meaning it could not be marketed as a cigarette but would have to be treated as a drug subject to strict controls.

'That was a knee-jerk response: bureaucratic technicalities abetted by misguided pressure from health experts,' says Professor Russell. 'The climate will improve when people understand there is no good evidence that nicotine itself is harmful at smoking doses, especially when absorbed relatively slowly.

'Swedish people who smear ground tobacco inside of their mouths absorb as much nicotine as cigarette smokers but suffer no more heart and blood vessel disease than those who use no form of tobacco.'

If nicotine does not cause harm, there is no rational objection to providing it in a form that smokers find satisfactory, as long as the nicotine is not accompanied by the other elements in smoke that cause disease. Yet tobacco companies in general have paid little attention to purifying the drug they purvey - an attitude that could prove very short-sighted.

The technology of delivering nicotine virtually free from harmful tars and gases requires some further refinement, and the resistance of regulatory authorities must be overcome. But designing a truly less hazardous form of cigarette that provides both the drug and the sensory stimulation smokers need is the logical way forward for those who find themselves genuinely unable to forsake tobacco.

No Smoking Day is tomorrow.

(Photograph omitted)

Life and Style
ebookA wonderful selection of salads, starters and mains featuring venison, grouse and other game
Arts and Entertainment
Standing the test of time: Michael J Fox and Christopher Lloyd in 'Back to the Future'
filmReview: A week late, Secret Cinema arrives as interactive screening goes Back to the Future
Arts and Entertainment
Sydney and Melbourne are locked in a row over giant milk crates
artCultural relations between Sydney and Melbourne soured by row over milk crate art instillation
Arts and Entertainment
Adèle Exarchopoulos and Léa Seydoux play teeneage lovers in the French erotic drama 'Blue Is The Warmest Colour' - The survey found four times as many women admitting to same-sex experiences than 20 years ago
filmBlue Is The Warmest Colour, Bojack Horseman and Hobbit on the way
Arts and Entertainment
Preparations begin for Edinburgh Festival 2014
Edinburgh festivalAll the best shows to see at Edinburgh this year
Two giraffes pictured on Garsfontein Road, Centurion, South Africa.
Kenny Ireland, pictured in 2010.
peopleBenidorm, actor was just 68
View from the Llanberis Track to the mountain lake Llyn
Du’r Arddu
environmentA large chunk of Mount Snowdon, in north Wales, is up for sale
Arts and Entertainment
arts + ents
Morrissey pictured in 2013
Travel Shop
the manor
Up to 70% off luxury travel
on city breaks Find out more
Up to 70% off luxury travel
on chic beach resorts Find out more
sardina foodie
Up to 70% off luxury travel
on country retreats Find out more
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    Grad / Trainee / Experienced Recruitment Consultant - Oil & Gas

    £20000 - £25000 per annum + OTE £35,000. : SThree: Progressive Global Energy a...

    Commercial Property

    Excellent Salary: Austen Lloyd: KENT MARKET TOWN - An exciting new role has ar...

    Financial Accountants, Cardiff, £250 p/day

    £180 - £250 per day + competitive: Orgtel: Financial Accountants - Key Banking...

    Regulatory Reporting-MI-Bank-Cardiff-£300/day

    £200 - £500 per day + competitive: Orgtel: I am currently working on a large p...

    Day In a Page

    Dress the Gaza situation up all you like, but the truth hurts

    Robert Fisk on Gaza conflict

    Dress the situation up all you like, but the truth hurts
    Save the tiger: Tiger, tiger burning less brightly as numbers plummet

    Tiger, tiger burning less brightly

    When William Blake wrote his famous poem there were probably more than 100,000 tigers in the wild. These days they probably number around 3,200
    5 News's Andy Bell retraces his grandfather's steps on the First World War battlefields

    In grandfather's footsteps

    5 News's political editor Andy Bell only knows his grandfather from the compelling diary he kept during WWI. But when he returned to the killing fields where Edwin Vaughan suffered so much, his ancestor came to life
    Lifestyle guru Martha Stewart reveals she has flying robot ... to take photos of her farm

    Martha Stewart has flying robot

    The lifestyle guru used the drone to get a bird's eye view her 153-acre farm in Bedford, New York
    Former Labour minister Meg Hillier has demanded 'pootling lanes' for women cyclists

    Do women cyclists need 'pootling lanes'?

    Simon Usborne (who's more of a hurtler) explains why winning the space race is key to happy riding
    A tale of two presidents: George W Bush downs his paintbrush to pen father’s life story

    A tale of two presidents

    George W Bush downs his paintbrush to pen father’s life story
    Restaurateur Mitch Tonks has given the Great Western Pullman dining car a makeover

    The dining car makes a comeback

    Restaurateur Mitch Tonks has given the Great Western Pullman dining car a makeover
    Gallery rage: How are institutions tackling the discomfort of overcrowding this summer?

    Gallery rage

    How are institutions tackling the discomfort of overcrowding this summer?
    Louis van Gaal has £500,000 video surveillance system installed to monitor Manchester United players

    Eye on the prize

    Louis van Gaal has £500,000 video surveillance system installed to monitor Manchester United players
    Women's rugby: Tamara Taylor adds fuel to the ire in quest to land World Cup

    Women's rugby

    Tamara Taylor adds fuel to the ire in quest to land World Cup
    Save the tiger: The day America’s love of backyard tigers led to a horrific bloodbath

    The day America’s love of backyard tigers led to a horrific bloodbath

    With only six per cent of the US population of these amazing big cats held in zoos, the Zanesville incident in 2011 was inevitable
    Samuel Beckett's biographer reveals secrets of the writer's time as a French Resistance spy

    How Samuel Beckett became a French Resistance spy

    As this year's Samuel Beckett festival opens in Enniskillen, James Knowlson, recalls how the Irish writer risked his life for liberty and narrowly escaped capture by the Gestapo
    We will remember them: relatives still honour those who fought in the Great War

    We will remember them

    Relatives still honour those who fought in the Great War
    Star Wars Episode VII is being shot on film - and now Kodak is launching a last-ditch bid to keep celluloid alive

    Kodak's last-ditch bid to keep celluloid alive

    Director J J Abrams and a few digital refuseniks shoot movies on film. Simon Usborne wonders what the fuss is about
    Once stilted and melodramatic, Hollywood is giving acting in video games a makeover

    Acting in video games gets a makeover

    David Crookes meets two of the genre's most popular voices