Are there effective treatments for nicotine addiction?
"What people frequently do not realize is that the
cigarette is a very efficient and highly engineered
drug-delivery system. By inhaling, the smoker can get
nicotine to the brain very rapidly with every puff. A
typical smoker will take 10 puffs on a cigarette over a
period of 5 minutes that the cigarette is lit. Thus, a
person who smokes about 1-1/2 packs (30 cigarettes)
daily, gets 300 "hits" of nicotine to the brain each
day. These factors contribute considerably to nicotine's
highly addictive nature."
Yes, extensive research has shown that behavioral and
pharmacological treatments for nicotine addiction do
work. For those individuals motivated to quit smoking, a
combination of behavioral and pharmacological treatments
can increase the success rate approximately twofold over
placebo treatments. Furthermore, smoking cessation can
have an immediate positive impact on an individual's
health; for example, a 35-year-old man who quits smoking
will, on the average, increase his life expectancy by
5.1 years.
Nicotine Replacement Treatments
Nicotine was the first pharmacological agent approved
by the Food and Drug Administration (FDA) for use in
smoking cessation therapy. Nicotine replacement
therapies, such as nicotine gum, the transdermal patch,
nasal spray, and inhaler, have been approved for use in
the United States. They are used to relieve withdrawal
symptoms, because they produce less severe physiological
alterations than tobacco-based systems, and generally
provide users with lower overall nicotine levels than
they receive with tobacco. An added benefit is that
these forms of nicotine have little abuse potential
since they do not produce the pleasurable effects of
tobacco products. Nor do they contain the carcinogens
and gases associated with tobacco smoke.
The FDA's approval of nicotine gum in 1984 marked the
availability (by prescription) of the first nicotine
replacement therapy on the U.S. market. In 1996, the FDA
approved gum (NicoretteŽ) for over-the-counter sales.
Whereas nicotine gum provides some smokers with the
desired control over dose and ability to relieve
cravings, others are unable to tolerate the taste and
chewing demands. In 1991-1992, FDA approved four
transdermal nicotine patches, two of which became
over-the-counter products in 1996, thus meeting the
needs of many additional tobacco users.
Since the introduction of nicotine gum and the
transdermal patch, estimates based on FDA and
pharmaceutical industry data indicate that more than 1
million individuals have been successfully treated for
nicotine addiction. In 1996 a nicotine nasal spray, and
in 1998 a nicotine inhaler, became available by
prescription. All the nicotine replacement products-
gum, patch, spray and inhaler- appear to be equally
effective. In fact, the over-the-counter availability of
many of these medications, combined with increased
messages to quit smoking in the media, has produced
about a 20 percent increase in successful quitting each
year.
Non-Nicotine Therapies
Although the major focus of pharmacological
treatments of nicotine addiction has been nicotine
replacement, other treatments are being developed for
relief of nicotine withdrawal symptoms. For example, the
first non-nicotine prescription drug, bupropion, an
antidepressant marketed as ZybanŽ, has been approved for
use as a pharmacological treatment for nicotine
addiction. In December 1996, a Federal advisory
committee recommended that the FDA approve bupropion to
become the first drug to help people quit smoking that
could be taken in pill form, and the first to contain no
nicotine.
Behavioral Treatments
Behavioral interventions can play an integral role in
nicotine addiction treatment. Over the past decade, this
approach has spread from primarily clinic-based, formal
smoking-cessation programs to application in numerous
community and public health settings, and now to
telephone and written formats as well. In general,
behavioral methods are employed to (a) discover
high-risk relapse situations, (b) create an aversion to
smoking, (c) develop self-monitoring of smoking
behavior, and (d) establish competing coping responses.
Other key factors in successful treatment include
avoiding smokers and smoking environments and receiving
support from family and friends. The single most
important factor, however, may be the learning and use
of coping skills for both short- and long-term
prevention of relapse. Smokers must not only learn
behavioral and cognitive tools for relapse prevention
but must also be ready to apply those skills in a
crisis.
Although behavioral and pharmacological treatments
can be extremely successful when employed alone, science
has taught us that integrating both types of treatments
will ultimately be the most effective approach. More
than 90 percent of the people who try to quit smoking
relapse or return to smoking within 1 year, with the
majority relapsing within a week. There are, however, an
estimated 2.5 to 5 percent who do in fact succeed on
their own. It has been shown that pharmacological
treatments can double the odds of their success.
However, a combination of pharmacological and behavioral
treatments further improves their chances. For example,
when use of the nicotine patch is combined with a
behavioral approach, such as group therapy or social
support networks, the efficacy of treatment is
significantly enhanced.
Source NIDA Research Reports
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