GOODWIN ET AL. RESPOND

We appreciate the letter from Glasser and think she makes an excellent point about the potential usefulness of Nicotine Anonymous (NicA), a program built on the model of Alcoholics Anonymous (AA) and Narcotics Anonymous. Because use of nicotine-containing products is both prevalent and highly addictive, greater dissemination of knowledge on the availability of NicA should serve a useful public health purpose. This is especially true considering a majority of persons who smoke say they would like to quit, and yet only a small percentage are successful each year. The small size of NicA relative to AA is indicated by the number of meetings worldwide shown on the Web sites of each organization. We have also wondered over the years about the reasons for this discrepancy in size, given the serious health consequences of smoking and the widespread prevalence of smoking in the general population.

The lack of research attention to NicA is consistent with the lack of direct evidence on the efficacy of AA for alcohol dependence because AA does not make itself available for randomized clinical efficacy trials. However, several studies of professional intervention to encourage AA involvement have found that Twelve-Step Facilitation¹ is as effective as other evidence-based behavioral interventions for improving the outcome of alcohol use disorders. Parallel research on facilitation of involvement in NicA might serve a useful purpose in learning more about the effectiveness of this program in reducing smoking among its participants.

Given that participation in NicA is free, perhaps this letter can alert professionals to refer patients to NicA if it is available in their area, especially for individuals without the means to afford other treatments, which can be quite expensive (e.g., a trial of the nicotine patch is approximately $320). The NicA Web site (http://www.nicotine-anonymous.org) also provides information that can be used to start new meetings, for which a professional degree is not required. As individuals in lower socioeconomic strata are the fastest growing population of smokers, low-cost or free alternatives to reduce smoking are urgently needed.