Smokeless Tobacco for a Nicotine-Dependent Schizoaffective Patient

To the Editor: Approximately 83% of the patients with schizophrenia and 65% with mood disorders are nicotine dependent (1). The following case demonstrates the benefit of switching from smoking to oral tobacco in a severely nicotine-dependent psychiatric patient.

Using smokeless tobacco is less deleterious to health and less socially stigmatizing than cigarette smoking. According to Dr. Rodu, dentist and oral pathologist, switching to smokeless tobacco considerably reduces the risk of all cancers, including oral cancer. Rodu and Cole (2) published similar results in Nature, demonstrating that the life expectancy of a 35-year-old smokeless tobacco user is relatively the same as that of a nonuser, while a smoker’s life expectancy is around 7.8 years less than both the nonuser’s and the smokeless tobacco user’s life expectancy. Because long-term success rates of nicotine-substitution products are often low, the substitution of smokeless tobacco may be more desirable for individuals who have failed traditional techniques of cessation. These results—along with population-based studies demonstrating decreased relative risks for cardiovascular, respiratory, and oncological disease with smokeless tobacco compared to smoking—have prompted a pilot study using smokeless tobacco as a substitute for smoking in inveterate smokers. This study found a 25% cessation of cigarette use at the 1-year mark (3). These data, combined with the experience of our patient, suggest that in select patients, smokeless tobacco may be less harmful than continued smoking.