Nicotine Anonymous

Nicotine Anonymous (NicA) is a twelve-step program for people desiring to quit smoking and live nicotine free. As of May, 2008 there are 600 meetings in thirty-eight countries worldwide with the overwhelming majority of these meetings occurring in the United States, followed by Canada, Brazil, Australia and the UK, respectively. NicA maintains that total abstinence from nicotine is necessary for recovery. NicA defines abstinence as "a state that begins when all use of nicotine ceases."

History
The first meetings began in February 1982 in Southern California by several Alcoholics Anonymous (AA) members to focus specifically on smoking cessation. These AA members began meeting under the name Smokers Anonymous in Los Angeles, shortly thereafter another group independently started in San Francisco. In 1986 the group members met for their first conference in Bakersfield, California to form a fellowship, originally known as Smokers Anonymous, later changing the name to Nicotine Anonymous as the Smokers Anonymous trademark was not available. In 2000, "NicA" was selected to abbreviate Nicotine Anonymous at the annual World Service Conference.

Structure
Adapted with permission of Alcoholics Anonymous World Services, Inc., the Twelve Traditions are utilized by Nicotine Anonymous as fundamental guiding principles. Nicotine Anonymous operates with an elected, all volunteer, nine member National Board of Directors and a set of by-laws. The Board meets regularly to discuss how to be of service to the organization including organizing the NicA annual conference and monitoring the NicA national clearing house, Nicotine Anonymous World Services, located in Huntington Beach, CA. The NicA clearing house keeps regularly updating meeting lists, manages the website, and serves as a resource for members or any interested smoker. There are no dues or fees for NicA membership, as stated in Tradition Three: "the only requirement for Nicotine Anonymous membership is a desire to stop using nicotine."

Comparison
There are several commercial and nonprofit programs supporting smoking cessation programs in the United States. Low-cost options, in addition to Nicotine Anonymous are sponsored by groups such as The American Cancer Society, The American Lung Association, The American Heart Association and The Seventh-day Adventist Church. Commercial programs include cognitive-behavioral group therapy, nicotine replacement therapies and bupropion. Combinations of these approaches, marketed in commercial packages such as Smokeless and Smoke Stoppers, are licensed to treatment providers and conducted on an inpatient or outpatient basis. These are in addition to local programs ran by regional treatment facilities.

NicA is unique among array of treatment options as its meetings are held weekly, nicotine users and ex-nicotine users can leave and enter the process as they please. Most other treatment programs are run episodically, making it difficult for members to pick it up midway through or begin when a program is not being offered. In 1996, NicA ranked twelfth in size among the thirteen twelve-step organizations studied by Klaus Makela. Sponsorship and lifetime attendance is not emphasized as much as in as in other twelve-step programs. The average meeting size is about seven people.

Although both drinking and smoking are recognized by many respondents as imposing burdens on the family, there are no auxiliary support groups for friends and family of smokers related to NicA; as Al-Anon meetings were created for friends and family members of alcoholics. Nicotine Anonymous World Services does, however, offer a pamphlet, Are You Concerned About Someone Who Smokes or Chews Tobacco? with information for friends and family of nicotine users.

Effectiveness
Success in achieving smoking abstinence current smoking therapies such as Nicotine Anonymous, cognitive-behavioral group therapy, nicotine replacement therapies and bupropion (Zyban) ranges from 9% to 40% in different studies. Alcoholics and drug addicts have better smoking cessation success rates when attempting to quit smoking early in recovery. Combining psychosocial and pharmacological treatments increases smoking cessation success rates. Acupuncture, hypnosis, inpatient treatment, and Nicotine Anonymous have not been shown effective thus far.

In a controlled study of 205 alcoholics with three months or more of continuous abstinence from drugs and alcohol and heavy tobacco dependence (an average of 26.8 cigarettes per day) were placed at random in one of three treatment groups: an American Lung Association Quit Program plus Nicotine Anonymous meetings group, a behavioral counseling plus physical exercise group, or a behavioral counseling plus nicotine gum group. The effectiveness of the treatment programs was measured at post-treatment, six months, and twelve-months following post-treatment based on self-reports confirmed by confirmed biochemical and informant reports. Immediately following treatment the behavior counseling and exercise group had the highest quit percentage (60%) followed by the behavioral counseling plus nicotine gum group, with the ALA quit program plus NicA group at 31%. At the six-month follow up all groups had similar percentages of members maintaining abstinence from tobacco (29%, 27%, and 21%, respectively) and also at twelve-months (27%, 27%, and 26%, respectively). Out of all the participants, only 4% relapsed on alcohol or drugs. The alcohol relapse rate did not differ by treatment group.

Demographics
In a survey of 104 smokers (ages 18 an older) 78% reported they believed spiritual resources could be helpful in an attempt to quit smoking. In the same survey, male smokers, ages 31 and over, and females were found to be significantly more open to using spiritual resources in the smoking cessation process than controls. Heavy smokers, those smoking more than fifteen cigarettes per day, were also significantly more receptive to encouragement of spiritual resources in an attempt to quit.

Alcoholics may have experienced twelve-step approaches to recovery, and therefore may be more open to the possibility that same technology can be used to initiate and maintain abstinence from tobacco use. The first edition of Nicotine Anonymous: The Book published results of an internal survey of members showing that 25% of members responding to a survey on the topic reported they had prior twelve-step experience. Many smokers do not see group treatment as a potentially useful.

Literature
Nicotine Anonymous publishes four books, several pamphlets, and one newsletter. Nicotine Anonymous: The Book explains the various twelve-step principles as they apply to nicotine addiction and includes testimonials from NicA members. Our Path to Freedom: 12 Stories of Recovery includes testimonials from NicA members. 90 Days, 90 Ways has 90 daily meditations on topics related to cessation of nicotine use. A Year of Miracles has 366 daily meditations on topics related to recovery from nicotine addiction. The pamphlets provide information to new and prospective members, suggestions on establishing new NicA meetings, and include titles such as: A Nicotine User's View of the 12-Steps, Introducing Nicotine Anonymous to the Medical Profession, Introducing Nicotine Anonymous, To the Newcomer and Sponsorship in Nicotine Anonymous, How Nicotine Anonymous Works, and The Serenity Prayer for Nicotine Users. Seven Minutes is a quarterly newsletter used to keep members informed about developments within the organization.


 * Nicotine Anonymous World Services (April 2008). A Year of Miracles, 1st Edition, Huntington Beach, CA: Nicotine Anonymous World Services. ISBN 0977011544.
 * Nicotine Anonymous World Services (April 2008). A Year of Miracles, 1st Edition, Huntington Beach, CA: Nicotine Anonymous World Services. ISBN 0977011544.
 * Nicotine Anonymous World Services (April 2008). A Year of Miracles, 1st Edition, Huntington Beach, CA: Nicotine Anonymous World Services. ISBN 0977011544.
 * Nicotine Anonymous World Services (April 2008). A Year of Miracles, 1st Edition, Huntington Beach, CA: Nicotine Anonymous World Services. ISBN 0977011544.

Analysis
A NicA pamphlet, Tips for Gaining Freedom from Nicotine, was reviewed in 1999 by a convenience sample of twelve professional colleagues of psychologist Edward Lichtenstein. The sample of professionals were asked to review the cessation tips from the pamphlet and rate them on whether they were cognitive, behavioral, or neither. To that extent, they also rated how consistent the tips were with current cognitive-behavioral cessation techniques. It was found that many of the tips were very consistent with modern cognitive-behavioral smoking cessation treatment programs. The cognitive behavioral tips included setting dates, making commitments, planning things to keep one's mind of smoking, having something to fidget with, having something to put in one's mouth, rewarding oneself when goals has been met, remembering that discomfort associated with withdrawal will subside within two weeks. Other tips were found to be spiritual or exhortational such as: "Remember, every minute you were sucking on cigarettes they were sucking on you," or "Don't say, I'll take my chances' and continue to smoke. They are not ours to take ... that is up to God." Since 1999 many of the NicA pamphlets have been updated and current versions may not contain the information analyzed.