For Veterans Who Still Smoke, the Risk Information Should Catch Up.
VA already tells veterans to quit smoking. The harder question is whether its risk information and trauma-informed treatment frame are keeping pace with veterans who still smoke.
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A companion audio episode is available on the EMDRNews Podcast: EMDR, the FDA and the VA Tackle Smoking. The article below remains the source trail for the episode.
A cigarette is rarely just a chemical habit. For a lot of the veterans I have worked with, it is calm after chaos, connection with the people they served beside, five minutes of control when nothing else is in their hands. That is not a willpower problem. It is a feeling attached to a behavior, built under conditions most people never face. Any serious conversation about veterans and smoking has to start there, because the cigarette is doing a job.
The Department of Veterans Affairs understands part of this well. VA tells veterans to quit, and that message reaches a lot of people. For the heart, the lungs, and the years a person gets to keep, quitting combustible cigarettes carries the clearest benefit. VA backs that message with real support: counseling, Quit VET, SmokefreeVET, and the FDA-approved medications that help people stop. It has even published patient and provider fact sheets on nicotine pouches. This is not an institution ignoring the problem.
But there is a gap, and it is a question of timing.
VA’s 2026 Tobacco Use Treatment guideline is careful, abstinence-centered work. Its evidence searches ended in December 2024. Then, on January 16, 2025, the FDA authorized the first nicotine pouches for sale after years of scientific review. Since then, the FDA has refreshed its public education on what it calls the continuum of risk. The agency now states plainly that no tobacco product is safe, that combustible cigarettes are the most harmful, and that non-combusted products such as e-cigarettes and nicotine pouches generally carry lower risk for adults who switch away from cigarettes completely. The guideline that shapes how VA talks to veterans about risk was built on evidence that closed before the most important development on the lower-risk side of that continuum.
That gap matters most for one group: veterans who have tried to quit, more than once, and are still smoking.
For them, relative risk is not academic. It is the difference between combustion and no combustion. And here the information has to be exact. Lower risk is not safe. The benefit comes only from switching off cigarettes completely, not from smoking and vaping side by side. “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. This is information for adults who already smoke. It is not an invitation for anyone else to start. State all of that plainly, and you are not promoting anything. You are telling a veteran who still smokes the truth as the FDA now describes it.
Updating the product information is the necessary half. It is not the whole job.
Because the cigarette, again, is doing a job. Telling a veteran that a pouch is lower risk does nothing about the feeling the cigarette is carrying. That is the part my own field is built to treat, and it is where the conversation usually stops too early.
EMDR therapy also has addiction-focused protocols that go after what sits underneath the habit: the triggers, the urge, the craving memory, and the feeling attached to the behavior. A.J. Popky, one of EMDR’s early clinicians, built the DeTUR protocol from years of work with the armed forces and first introduced it as a stop-smoking method in 1992. It targets the triggers and the urge directly, rather than arguing a person out of them. Michael Hase’s CravEx protocol goes after the craving memory itself, and a randomized study reported reduced cravings after treatment. And the Feeling-State Addiction Protocol, developed by Robert Miller, targets exactly what I described at the start: the positive feeling that has fused to the behavior. In a small, early study of smokers who had already relapsed, 50 percent of those treated with the Feeling-State protocol quit, against 25 percent in a cognitive-behavioral comparison group, with results confirmed by carbon monoxide testing rather than self-report alone. It is a small sample and a signal worth following, not a settled result. But the signal is specific, and it points at the feeling, not the chemical. I wrote about that work in more depth on EMDRNews.
Put the two halves together and VA’s own logic holds. VA already treats smoking as more than nicotine; that is why it pairs counseling with medication. It has already had to address nicotine pouches directly; that is why it published nicotine pouch fact sheets at all. The modest, in-character step is to keep the product information current to what the FDA now says, and to 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.
For the veteran who has quit and relapsed three times, this is not a willpower failure to be lectured. He is a person carrying a feeling he has not been able to put down, smoking the most dangerous form of the thing he uses to manage it. He deserves 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 we can do now is be honest about the risk and serious about the treatment.
About the Author
Timothy Vermillion, DSW, LCSW, BCD, is a clinical social worker specializing in trauma and readjustment therapy for service members and veterans. He is an EMDRIA Approved Consultant and Trainer and a service-disabled Iraq veteran who served with the Army National Guard. He writes about EMDR and veteran care at EMDRNews.com.
Selected Sources
- U.S. Food and Drug Administration, The Relative Risks of Tobacco Products
- U.S. Food and Drug Administration, FDA Authorizes Marketing of 20 ZYN Nicotine Pouch Products after Extensive Scientific Review
- VA/DoD Clinical Practice Guideline for Tobacco Use Treatment, 2026
- Department of Veterans Affairs, Nicotine Pouches: A Closer Look – Patient Fact Sheet
- Department of Veterans Affairs, Oral Nicotine Pouches: A Fact Sheet for Healthcare Providers
- Popky, A.J., DeTUR, Francine Shapiro Legacy Library
- Hase, M., Schallmayer, S., and Sack, M., EMDR Reprocessing of the Addiction Memory
- Tsoutsa, A., Fotopoulos, D., Zakynthinos, S., and Katsaounou, P., Treatment of tobacco addiction using the Feeling-State Addiction Protocol
- EMDRNews, Cigarettes, Cravings, and EMDR
- EMDRNews, Why trauma often surfaces after service: EMDR/AIP and veteran transition
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