Rachael Joyner’s journey from learner to Duke clinician showcases the transformational impact of the Duke-UNC Tobacco Treatment Specialist Training Program.

Tobacco use is often framed as a physical health issue—but its impact on mental health is just as significant. Many patients believe smoking helps manage stress, anxiety, or mood symptoms. In reality, the evidence increasingly shows the opposite: quitting tobacco can meaningfully improve mental well-being across multiple domains.

In the last year, the U.S. Food and Drug Administration began publicly acknowledging harm reduction as a legitimate principle within its regulatory framework. Through its Premarket Tobacco Product Application process, companies can gain authorization to sell their products in the U.S. An important distinction here is that these products are not recognized by the FDA as being safe or approved for treatment of tobacco use disorder.