 A need for efficacious interventions exists as 64 of ST users report the desire to quit. However, no pharmacotherapy has proven efficacy for increasing long-term 6 months tobacco abstinence rates among ST users compared to placebo. New pharmacotherapies, drug combinations, and improved dosing of existing pharmacotherapies are needed. Previous research with nicotine patches for ST users using standard doses up to 21 mgday have not increased long-term abstinence rates. However, studies of higher dose nicotine patch therapy up to 63 mgday in ST users have demonstrated a dose-dependent reduction in tobacco withdrawal symptoms as well as preliminary evidence of increased long-term 6 months abstinence rates compared to lower doses. The purpose of this study is to evaluate the efficacy of high dose nicotine patch therapy 42 mgday for increasing the 7-day point prevalence and prolonged all tobacco and ST abstinence rates at end-of-treatment week 8, 12 and 24 weeks compared to placebo in ST users who use 3 canspouches per week when all subjects receive behavioral treatment for tobacco dependence. To accomplish our aims, we will randomize 60 ST users in a clinical pilot study. The work will be conducted at the Mayo Clinic in Rochester, MN. 