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The nicotine distribution features of smokeless tobacco make it both addictive and a feasible substitute for cigarette smoking for many consumers, since it delivers a higher nicotine dose than other tobacco cessation products [47]

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In the studies where alcohol and other drug use were reported (only 11 of the 34), those who received a smoking intervention had similar abstinence rates compared to those who did not in other words, their substance use outcomes did not appear to be negatively affected by participating in smoking interventions

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