Unquestionably, some folks are very susceptible to nicotine addiction. But since by far the greatest danger of smoking is not nicotine--which, in "pleasurable" doses seems to be no worse than caffeine or theobromine--but the inhaled smoke, why not simply accept the addiction for the unfortunate few and supply the nicotine in a less harmful form? I would recommend nasal snuff, which has a 400 year history and a nearly perfect safety record (I've found only two cancers reported in the literature that were blamed on nasal snuff).
Alternately, Dr. Brad Rodu has a superb plan that uses a type of "chewing" tobacco, has a fantastic success rate at stopping smoking, and by all measures is at least 98% safer than cigarette smoking. Should the oral tobacco cause leukoplakias, simple cessation of use is apparently 100% successful in preventing the development of cancer.
Rodu's site is here and quite interesting:
http://www.drrodu.com/

Great comment. I work at the same institution as Dr. Rodu. I wish that smoking cessation was that simple. We have a large variety of nicotine delivery systems, which work for some patients, but many would rather smoke. Addiction is complicated by habit associated with other pleasurable associations.

Almost any alternative to smoking should work. Alas, many patients just love to smoke.

Well, you can't fight psychological problems with logic, alas.
I enjoy smoking my pipe, and am certainly habituated to it, but I have no problem stopping for a week or two when I'm too busy to enjoy a bowl or when I stay with friends who don't smoke.
Despite the demonization of all tobacco, cigarettes really are different, in so many ways.

I smoke. I do not want to quit. **BUT** I do want to cut back. Is not dosage an important factor? Must it be all-or-nothing?

A couple of companies I worked for offered seminars by various people, including hypnotists. I asked several "therapists" if they could help me cut from 20+ cigarettes per diem to 4 or 5 - their response was always that no-one else had asked for that, and they had not considered it.

Cutting back might help, but many who cut back, actually inhale the same amount of poisons and nicotine. As one decreases the number of cigarettes, apparently one inhales more deeply and longer. I believe that is why experts are cautious about the cutting back strategy. If one really decreased nicotine levels and carboxyhemoglobin levels (the measurement of the carbon monoxide poisoning that smokers live with), then the overall risk would decrease. Risk is related to exposure - 2 pack per day being worse than 1 pack per day, etc.

John: db might not appreciate this (my apologies), but...
Try a high-nicotine cigarette. That way you'll get your nicotine with a lower exposure to smoke--assuming the higher dose makes it easier for you to cut back.
If it doesn't, then maybe you can try the Rodu method mentioned above for between cigarettes. Nicotine absorbed through the mouth provides a slower "lift" but a longer "buzz" (Rodu talks about this on his site).
Good luck!

Ah, Toren likes the high nicotine approach. It might work, although we have no data to prove that it would. We do agree that nicotine is not the culprit, rather the nicotine delivery system. I still prefer the hard road to cessation.

db "If one really decreased nicotine levels..." OK, but in some ways cut-back is harder than quitting - and must "go it alone" because no help out there...

Toren: Uh, what's higher than unfiltered Camels? Not a bad idea, actually sounds better than patch or gum, but after over forty years not too applicable.

I know it is bad, and my therapist could probably mumble stuff about oral fixations too, but a cup of coffee just is not the same without a cigarette. While I don't drink much anymore (no, not a real problem with it, but double Cuervo Especial shots have flown past my budget) but it also seemed to go with a butt.

On the other hand, it gets in the way of my reading. And Web-surfing. And other stuff. But the habit kicks in (as opposed to desire, as with coffee) and I find a half-pack gone when I thought I'd had two, not ten.

I may not be explaining too coherently, just thought there should be help for cutting back for those of us who do not want to quit - even if it has to be spun to companies and governments as a step toward quitting. But then, that may not really be "spin" after all.

I think we've just gone beyond my expertise. I'm not aware of medical literature on "cutting back". Unfiltered Camels should give you plenty of nicotine.

Your description of your habit is classic. Smoking seems insidious. Associations work in a Pavlovian fashion. Certain situations call for smoking - not certain how much is habit and how much too reduce anxiety (paradoxically, for smokers nicotine helps most in stressful situations - hence the 'smoke filled rooms'). Most experts recommend rearranging one's life, associations, etc. Good luck, and I wish I knew better how to help.

OK, thanks.

Just one more thing on my way out. About a year ago a partial study [there must be a better term, but I don't know it] was published by a doctor looking for physical brain changes in people. "The investigators found that the brains of long-term smokers had neurochemical
abnormalities similar to the brains of animals treated with antidepressant
drugs..." I do not know if this has gone further, but if some of us are unknowingly self-medicating for depression (note: I distinguish between "being depressed", a temporary condition usually in reaction to external events, and "having depression" as in my case, apparently insufficient production of some chemicals) it may be a factor in why it can be so hard to quit smoking.

Cigarettes May Function Like Antidepressant Drugs news item
SOURCE: Archives of General Psychiatry
2001;58:821-827.
lead author Dr. Gregory A. Ordway, a professor of psychiatry at the University
of Mississippi Medical Center in Jackson.
lead collaborator Dr. Violetta Klimek

Unfiltered Camels, huh?
Hmm.
Okay, I shall bow out gracefully here as well...except to say that based on experiences I've read about over at alt.smokers.pipes, the pipes newsgroup, the best bet for a smoker of "your type" seems to be to quit cold turkey, backed up by the help of a solid support group.
Thankfully there is plenty of help available these days--good luck!

Nice discussion. I think John is right about the long-term effects of nicotine. Perhaps those who are "self medicating" are the subgroup best served by Zyban (Wellbutrin by its original name).