Smoking and Quitting Smoking (cont.)
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Smoking and quitting smoking facts
- What problems are caused by smoking?
- What are the symptoms and signs of cigarette addiction?
- What are the steps in quitting?
- Getting ready to quit smoking
- On the day you quit smoking
- Staying quit
- What methods can help a person quit smoking?
- Nicotine replacement therapy to quit smoking
- Nicotine patches
- Nicorette gum
- Nicotine lozenges
- What prescription products are available for smoking cessation?
- How can nicotine-containing products be used safely?
- What are e-cigarettes?
- Is an e-cigarette harmful?
- Is secondhand smoke from e-cigarettes harmful?
- What is in the future for smoking?
- Smoking FAQs
- Find a local Internist in your town
What methods can help a person quit smoking?
Several methods are available to assist those who decide to quit smoking. The main categories of methods are:
- Behavior modification and self help-literature to quit smoking
- Self-help literature
- Nicotine replacement therapy
- Prescription smoking cessation aids
Each method actually offers several different options. Moreover, combinations of the methods usually are necessary, and no one combination will work for everyone. In fact, it may be necessary to try several different methods or combinations of methods before success is achieved.
Behavioral modification and self-help literature to quit smoking
Due to the addictive nature of nicotine, some form of behavioral modification is often necessary for successful cessation of smoking. Educational programs, hypnosis, and aversion therapy (learning how to avoid cigarettes) are a few options. Smokers may be counseled to avoid specific triggers or situations that lead to smoking. For example, instead of awakening and grabbing a cigarette at the bedside or smoking immediately after a meal, people may be encouraged to replace the urge to smoke with another activity, such as, taking a walk or reading a book.
Numerous medical associations and societies, for example, the American Cancer Society, American Heart Association, and the American Lung Association, have developed brochures to help smokers quit smoking.
Nicotine replacement therapy to quit smoking
Nicotine replacement therapy (NRT) became available over the counter in the 1990's. The purpose of nicotine replacement therapy is to substitute another source of nicotine while cigarettes are discontinued. By this means, the habit of smoking is eliminated, even though the addiction to nicotine remains intact. But at the same time, nicotine replacement therapy eliminates the symptoms of withdrawal that can trigger more smoking. In addition, behavioral counseling to change smoking-related behavior usually is necessary. Once cigarettes have been replaced during nicotine replacement therapy, the amount of nicotine is then gradually reduced.
Currently, there are different forms of nicotine replacement therapy available over-the-counter and include:
- nicotine transdermal systems or patches (Nicoderm CQ and Nicotrol),
- nicotine polacrilex resin or gum (Nicorette), and
- nicotine lozenges (Commit).
The nicotine patch (Nicoderm CQ and Nicotrol) contains nicotine that is stored within a specially designed support or matrix. Once applied, the nicotine transdermal system steadily releases nicotine that is absorbed across the skin and into the blood stream. The gum contains nicotine that is released slowly upon chewing and "parking". Parking refers to the action of shifting the gum to one side of the cheek after chewing in order to speed the absorption of nicotine. Nicotine lozenges contain nicotine within a hard candy that allows for slow release of nicotine as the candy dissolves in the mouth. A program for slowly weaning users from nicotine replacement products is provided by each product's manufacturer.
The nicotine patch, Nicoderm CQ, is available in three strengths; 21, 14, and 7 mg. People are advised to begin with the 21 mg patch if they smoke more than 10 cigarettes per day or the 14 mg patch if they smoke less than 10 cigarettes per day. After six weeks of wearing the initial patch strength, the next lowest patch strength is worn for two weeks. If therapy was started with the 21 mg patch, an additional two weeks is required for the 7mg patch. A maximum of eight or 10 weeks, depending upon the strength of the first patch used, is recommended for a successful quitting program. The Nicoderm CQ patch can be worn for 16 hours (from awakening until bedtime) or 24 hours if the urge to smoke is great upon awakening.
Nicotrol is available as a 15 mg patch, and should be worn no more than 16 hours per day. Nicotrol may be worn for up to six weeks.
The side effects commonly seen with patches are:
- itching, or redness at the site of the patch,
- joint aches,
- painful menstruation, and
- changes in taste.
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