The Pentagon can’t have it both ways on nicotine

ABOUT THE AUTHOR: Timothy Vermillion is a clinical social worker who specializes in trauma and providing readjustment therapy for military and veteran populations. He is a service-disabled veteran who served in Iraq with the Army National Guard. He lives in Neptune, N.J.

The Department of Defense has a nicotine problem, and it isn’t the one you think.

Thirty percent of active-duty military personnel use nicotine. That number comes straight from the DOD. These are not weekend warriors. These are the people we ask to function at the edge of human capacity; sleep-deprived, under-fire, operating systems that cost more than small nations. Nicotine is part of how they manage that harsh reality. It has been this way for generations of American warriors and no clinical guideline issued from the Pentagon’s health bureaucracy is going to change that overnight.

What the DOD issued in January of this year, however, wasn’t a plan for managing the circumstances. It was a retreat from it.

The new clinical guidelines push abstinence as the goal, raise speculative concerns about vaping and cancer risk, and are silent on nicotine pouches (a smokeless, combustion-free product that has been central to harm reduction conversations in public health circles for years). These new guidelines read like something produced by people who have never talked to a Marine on a 12-hour op. 

Here is what makes this more than bureaucratic incoherence: the people at the top of the DOD are saying something completely different than what’s laid out in the recent guidelines.

Air Force Gen. Dan Caine, chairman of the Joint Chiefs of Staff, has spoken openly about the prevalence of nicotine use in combat environments. This isn’t an endorsement, it is an acknowledgment of operational reality. When the most senior military officer in the country is talking about how troops use nicotine in the field, the appropriate institutional response is not to issue guidelines that pretend abstinence is a viable, near-term outcome for a third of the armed forces. The appropriate response is to ask: given that this use is happening, how do we make it safer?

Assistant Secretary of Defense Dr. Stephen Ferrara has gestured at exactly that question of discussing the idea of bridging service members from combustible products to less harmful alternatives. That is the framework for rational harm reduction. It reflects what the science on nicotine products actually supports: the danger in tobacco is primarily in the combustion, not the nicotine itself. And that alternatives like pouches and vapor products are effectively a lower risk than cigarettes.

Now we arrive at the problem. The DOD has a chairman talking about operational reality, a senior DOD appointee articulating a harm reduction direction, and a clinical guidance document that contradicts both of them. Don’t underestimate the severity of this blatant inconsistency. The DOD is speaking out of three sides of its mouth on a health issue affecting nearly one-third of its personnel.

The consequences are not abstract. When official guidance conflicts with operational reality and senior leadership signals, the guidance loses. It always loses. Service members won’t stop using nicotine because a clinical bulletin tells them to. And as a consequence, they will stop taking the clinical bulletins seriously. The credibility cost extends beyond nicotine. If the guidance on this issue is visibly disconnected from reality, why would a service member trust guidance on other critical issues?

There is also a readiness argument that deserves to be made plainly: Nicotine dependence, in a population that is not going to stop using nicotine, requires management. If the DOD’s goal is readiness — and it is — then the question is not how to achieve abstinence in a population where abstinence won’t happen. The question is how to minimize the use that will continue regardless.

Combustible tobacco is the enemy here. Helping service members transition to lower-risk alternatives isn’t just the realistic approach, it also supports the readiness mission. Pretending one-third of service members will quit, doesn’t.

The silence on nicotine pouches is its own tell. These products have no combustion, no smoke, and no secondhand exposure issues in confined environments (relevant, one might note, for submarines and aircraft). The Food and Drug Administration has authorized marketing of at least one such product with explicit reference to reduced risk. Public Health England has built an entire national harm reduction strategy around similar logic.

The products aren’t perfect. But they exist precisely in the space that the DOD’s own senior officials have been describing as the policy direction: bridge products away from cigarettes, toward something less likely to end careers and shorten lives.

The January guidelines don’t engage with that space. They ignore it entirely.

The DOD does not need another round of bureaucratic silence or a news release about tobacco abstinence. It needs the bureaucracy overseeing clinical guidance to reflect its own leadership. That means acknowledging that three decades of abstinence-first military tobacco policy has not produced abstinence. It means incorporating harm reduction as an explicit framework, not a rhetorical afterthought. It means treating nicotine pouches as a legitimate subject of guidance, rather than an embarrassing gap in the document. And it means resolving the contradiction between what the institution’s leaders are saying in public, and what its clinicians are putting in writing.

Thirty percent of the force is watching to see whether the institution can do that. Their health is the actual issue. Their trust in the DOD’s credibility is the collateral damage if it can’t.