EMDR, the FDA and the VA Tackle Smoking

 Chapters:
00:00 Why Veterans Smoke
00:35 VA Quit Message
01:16 What VA Gets Right
02:00 The Timing Gap
03:30 Who the Gap Hurts
04:27 Three Risk Truths
05:42 Beyond Products
06:22 EMDR Protocol Options
07:49 Evidence and Limits
08:30 Two Halves Solution
09:26 Closing Appeal
10:11 Sources and Share

Tim Vermilion argues on the EMDR News Podcast that veterans’ smoking is often tied to trauma-related feelings like calm after chaos, control, and connection, not merely willpower. He says the VA does many things right—encouraging quitting and providing counseling, Quit VET/Smoke-Free VET, medications, and nicotine pouch fact sheets—but its 2026 tobacco guideline’s evidence review closed in December 2024, one month before the FDA authorized the first nicotine pouches (Jan 16, 2025) and updated public “continuum of risk” messaging that non-combusted products generally carry lower risk for adults who switch completely. The gap most affects veterans who repeatedly quit and relapse. He stresses: benefits require fully switching off cigarettes and this applies only to adult smokers. He recommends pairing current risk information with trauma-informed EMDR addiction protocols (Popky’s Detour, Hayes’ Cravex, Miller’s Feeling State Addiction) that target triggers, craving memory, and positive feeling states linked to smoking.

Related article and sources:
https://emdrnews.com/2026/06/27/va-veterans-smoking-nicotine-risk-emdr/

EMDRNews is a source-led podcast for EMDR-informed clinicians and professionals. Episodes are for education and commentary only, not clinical advice, supervision, consultation, or a substitute for formal EMDR training. Please do not send client details or protected health information.

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Transcript

Doc V 0:00

A cigarette is rarely just a chemical habit. For a lot of the veterans I have worked with, a cigarette is calm after chaos. It's connection with the people they served beside. It's five minutes of control on a day when nothing else was in their hands. That is not a willpower problem. That is a feeling attached to a behavior built under conditions most people will never face. And any serious conversation about veterans and smoking has to start there because the cigarette is doing a job This is the EMDR News Podcast. I'm Tim. Today's commentary comes from a piece I published on June twenty-seventh, and it asks one question of one institution. The Department of Veterans Affairs tells veterans to quit smoking. Fine. Good. The harder question is whether the risk information behind that message and the treatment behind that message are keeping pace with the veterans who still smoke. They're not. Not yet. And today I'm going to tell you exactly where the gap is, exactly when it opened, and exactly what it would take to close it. One piece of business before we start. If this show is useful to you, follow it. Wherever you're listening, it's one button. Done? Good. Let's go. Let's start with what the VA gets right, because it gets a lot right, and this piece is not a takedown. The VA tells veterans to quit. That message reaches a lot of people, and for the heart, for the lungs, for the years a person gets to keep, quitting combustible cigarettes carries the clearest benefit. Nobody on any side of this argument disputes that. And the VA backs the message with real support: counseling, Quit VET, Smoke-Free VET. The FDA approved medications that help people stop. It has even published fact sheets on nicotine pouches, one for patients, one for providers. This is not an institution ignoring the problem. This is an institution working the problem. But there is a gap, and it is a question of timing. Here are the dates. Write them down if you want. I'll wait. The VA's twenty twenty-six Clinical Practice Guideline for Tobacco Use Treatment is careful abstinence-centered work. Its evidence searches, the literature it was built on, closed in December of twenty twenty-four. On January sixteenth, twenty twenty-five, one month later, the FDA authorized the first nicotine pouches for sale in the United States after years of scientific review. One month. The guideline that shapes how the VA talks to veterans about nicotine risk closed its books one month before the most significant development on the lower risk side of that conversation. And since then, the FDA has refreshed its public education on what it calls the continuum of risk. The agency now states plainly on the record three things: no tobacco product is safe, combustible cigarettes are the most harmful, and non-combusted products, e-cigarettes, nicotine pouches, generally carry a lower risk for adults who switch away from cigarettes completely. That's not an advocacy group talking. That's not an industry white paper. That is the Food and Drug Administration of the United States describing risk to the public right now in twenty twenty-six. And the VA's guideline, through no fault of the people who wrote it, was finished before that description existed. So who does the gap actually hurt? Not the veteran who quits on the first try. The system works fine for him. Not the veteran who never smoked. The gap matters most for one group, and I want you to picture him because the whole piece is about him. He's tried to quit more than once. He's done the counseling, maybe the patch, maybe the medication. He quit, and he relapsed, and he quit, and he relapsed, and he is still smoking today. While the guideline works fine for everyone else, for that veteran, relative risk is not an academic seminar. It is the difference between combustion and no combustion, between burning the thing he uses to manage his nervous system and not burning it Now, here is where the information has to be exact, and I mean exact, because this is the part everyone gets wrong in one direction or the other. So I'm going to say three true things in a row, and I need you to hold all three at once because each one matters, and none of them cancels the others. One, the benefit comes only from switching off cigarettes completely. Smoking and vaping side by side is not the deal. It never was. Two, FDA-authorized means a product cleared the agency's review to be sold. It does not mean the product is an approved way to quit. Authorized and approved sound alike. They are not alike. Three, this is information for adults who already smoke. It is not an invitation for anyone else to start. Not your patients who don't smoke, not the young, nobody. State all three of that plainly, and you are telling a veteran who still smokes the truth as the FDA now describes it, and he can do the math himself. He's earned that. And right here, mid-episode, is where I'll say it. If you know a clinician who works with veterans, share this one with them. Those three sentences are the part that has to travel, and they have to travel exactly. A like helps the show. A share puts it in front of the person who needs it. That's half the job, the product half. Updating the information is necessary. It is not sufficient because remember where we started. The cigarette is doing a job. You can hand a veteran the most current, most accurate relative risk information in the world, and you will have done nothing, nothing about the feeling the cigarette is carrying, the calm after chaos, the five minutes of control, the connection to people he served beside, some of whom didn't come home. The product conversation cannot touch any of that. It was never designed to. That's where we switch to exploring how therapy can help. EMDR therapy, the trauma treatment, has addiction-focused protocols, not adaptations somebody improvised last year, protocols with names, with authors, with history that go after what sits underneath the habit, the triggers, the urge, the craving memory, the feeling that got fused to the behavior. There are three worth knowing today. First, Aj Popkey, one of EMDR's early clinicians, built a protocol called Detour out of years of work with the Armed Forces and first introduced it as a stop-smoking method in nineteen ninety-two. Nineteen ninety-two. This is not a new idea. Detour targets the triggers and the urge directly rather than trying to argue a person out of them, which if you've ever tried arguing someone out of a craving, you already know how that goes. Second, Michael Hayes' protocol, Cravex, goes after the craving memory itself, the memory of the addiction, and a randomized study reported reduced cravings after treatment. Randomized, controlled, published. Third, and listen to this one because it points at exactly the thing I described at the top. The Feeling State Addiction protocol developed by Robert Miller targets the positive feeling that has fused to the behavior. Not the guilt, not the shame, the good feeling the cigarette delivers, the one that got welded on under pressure. There was a small early study of smokers who had already relapsed, already failed at quitting, which you'll notice is precisely our veteran. Fifty percent of the people treated with the Feeling State protocol quit. The cognitive behavioral comparison group, twenty-five percent, and the results were confirmed with carbon monoxide testing, breath chemistry, not a questionnaire, not self-report. Now I'm going to tell you the size of that finding. It is a small sample. It is an early study. It is a signal worth following, not a settled result. But the signal is specific, and it points at the feeling, not the chemical, the feeling. So put the two halves together, and here's what you notice. The VA's own logic already agrees with this piece. The VA already treats smoking as more than nicotine. That is why it pairs counseling with medication instead of just mailing out patches. The VA has already had to address nicotine pouches directly. That is why the fact sheets exist at all. Nobody publishes a fact sheet about a product they think is irrelevant. So the step I'm asking for is not radical, it is modest, and it is in character. Keep the product information current to what the FDA now says, and make room for the trauma-informed treatments that work on why a veteran reaches for a cigarette in the first place. One half tells the truth about the product. The other half treats the reason. Neither half works alone. That's it. That's the whole argument. Which brings me back to the man I asked you to picture. The veteran who has quit and relapsed three times is not a willpower failure to be lectured. He is a person carrying a feeling he has not been able to put down, and he is smoking the most dangerous form of the thing he uses to manage it. He deserves two things: current information about risk and real treatment for the reason he smokes. Give him the first, and you respect his intelligence. Give him the second, and you change the odds. We asked these men and women to operate at the edge of human capacity, and many of them learned to manage that edge with a cigarette. The least, the very least we can do now is be honest about the risk and serious about the treatment. The full commentary with every source linked, the FDA statements, the VA guideline, the fact sheets, the studies, is at emdrnews.com. Read it. Check the dates yourself. And if this episode earned it, do three things on your way out. Like it. Follow the show so the next one finds you, and send it to one person who works with veterans. One. That's how this reaches the people it's actually about. I'm Tim Vermilion, and this is EMDR News.