Treatment for Nicotine Addiction

A detailed look at nicotine addiction treatment to help you stop smoking: nicotine replacement therapies and products, medications for smoking cessation, and counseling - support groups.

Nicotine Addiction Treatment to Help You Stop Smoking

Some individuals are able to just stop smoking. For others, studies have shown that pharmacological treatment combined with behavioral treatment, including psychological support and skills training to overcome high-risk situations, results in some of the highest long-term abstinence rates. Generally, rates of relapse for smoking cessation are highest in the first few weeks and months and diminish considerably after about 3 months.

Behavioral economic studies find that alternative rewards and reinforcers can reduce cigarette use. One study found that the greatest reductions in cigarette use were achieved when smoking cost was increased in combination with the presence of alternative recreational activities.

Nicotine Replacement Therapy for Treatment of Nicotine Addiction (non-prescription)

For most people who are trying to quit smoking, nicotine replacement therapy is useful. According to one study, nicotine replacement therapy doubles your chances of quitting smoking.¹ When used properly, all forms of nicotine replacement products appear to be about equally effective. Keep in mind, however, if you are pregnant or have heart disease, nicotine replacement therapies may not be right for you. Also, it's important to remember that before starting nicotine replacement therapy, you must quit smoking entirely.

Several nicotine replacement therapies can be obtained without a prescription.

Nicotine chewing gum (Nicorette, others) is one medication approved by the Food and Drug Administration (FDA) for the treatment of nicotine dependence. Nicotine in this form acts as a nicotine replacement to help smokers quit smoking. The success rates for smoking cessation treatment with nicotine chewing gum vary considerably across studies, but evidence suggests that it is a safe means of facilitating smoking cessation if chewed according to instructions and restricted to patients who are under medical supervision.

Nicotine lozenge (Commit) is a tablet that dissolves in your mouth and, like nicotine gum, delivers nicotine through the lining of your mouth. The lozenges are also available in 2- and 4-milligram doses. The recommended dose is one lozenge every couple of hours for six weeks, then gradually increasing the intervals between lozenges over the next six weeks.

Another approach to smoking cessation is the nicotine transdermal patch (Nicoderm CQ, Nicotrol, Habitrol, others), a skin patch that delivers a relatively constant amount of nicotine to the person wearing it. A research team at the National Institute on Drug Abuse's Intramural Research Program studied the safety, mechanism of action, and abuse liability of the patch that was consequently approved by the FDA. Both nicotine gum and the nicotine patch, as well as other nicotine replacements such as sprays and inhalers, are used to help people fully quit smoking by reducing withdrawal symptoms and preventing relapse while undergoing behavioral treatment.

Prescription Nicotine Replacement Products

Nicotine nasal spray (Nicotrol NS). The nicotine in this product, sprayed directly into each nostril, is absorbed through your nasal membranes into veins, transported to your heart and then sent to your brain. It's a quicker delivery system than that of the gum or patch. It's usually prescribed for three-month periods, for a maximum of six months.

Nicotine inhaler (Nicotrol inhaler). This device is shaped something like a cigarette holder. You puff on it, and it gives off nicotine vapors in your mouth. You absorb the nicotine through the lining in your mouth, where it then enters your bloodstream and goes to your brain, relieving nicotine withdrawal symptoms.

Non-Nicotine Medication to Help with Smoking Cessation

There are other medications to help you in your efforts to quit smoking, but they should be used in conjunction with a behavior modification program.

One tool in treating tobacco and nicotine addiction is the antidepressant medication bupropion, that goes by the trade name Zyban. This is not a nicotine replacement, as are the gum and patch. Rather, this works on other areas of the brain, and its effectiveness is in helping to make nicotine craving, or thoughts about cigarette use, more controllable in people who are trying to quit. As with many medications, bupropion (Zyban) has side effects, including sleep disturbance and dry mouth. If you have a history of seizures or serious head trauma, such as a skull fracture, don't use this drug. Another antidepressant that may help is nortriptyline (Aventyl, Pamelor).

Varenicline (Chantix). This medication acts on the brain's nicotine receptors, decreasing withdrawal symptoms and reducing the feelings of pleasure you get from smoking. Potential side effects include headache, nausea, an altered sense of taste and strange dreams.

Nicotine vaccine. The nicotine conjugate vaccine (NicVax) is under investigation in clinical trials. This vaccine causes the immune system to develop antibodies to nicotine. These antibodies then catch nicotine as it enters the bloodstream and prevent the nicotine from reaching the brain, effectively blocking the effects of nicotine.

Counseling, Support Groups and Smoking Cessation Programs

Many people need help to quit smoking. A number of telephone helplines are available for people giving up nicotine, such as the National Cancer Institute's 800-QUITNOW, or 800-784-8669, and the American Cancer Society's at 800-ACS-2345, or 800-227-2345.

Your doctor may also be able to recommend local support groups or smoking cessation programs. Additionally, some people find that a form of counseling called behavior therapy can help them come up with productive ways to change the behaviors and thoughts associated with smoking.

Sources:

• Stead LF, et al. (2008). Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews (1).
• National Institute on Drug Abuse
• Mayo Clinic