Kicking the Smoking Habit

Nicotine is the drug that keeps people smoking. While each cigarette contains about 10 milligrams of nicotine, a smoker only absorbs 1–2 milligrams, as not all of each puff of smoke is delivered to the lungs. However, this is still a big dose and ends up reaching the brain within eight seconds. The end result is an alteration of brain chemicals that triggers the desire for more nicotine.
To put this into perspective, a smoker usually gets at least 10 "hits" of nicotine per cigarette. Multiply this by 20 for a person smoking one pack per day, and the end result is over 200 hits of nicotine per day. Needless to say, this cycling of nicotine highs (while smoking) and lows (between cigarettes) hooks the smoker into a desire for that nicotine high, stimulating cigarette cravings, as well as symptoms of withdrawal, between cigarettes.
How does nicotine replacement therapy work?NRT has helped many people decrease or even stop their dependence on cigarettes. In fact, incorporating nicotine gum or some other form of NRT almost doubles the chance for success in a person who is truly addicted to smoking cigarettes. What these forms of therapies have in common is the slow release (compared to the rapid release from the "hits" of cigarettes) of a reduced strength of nicotine, whose aim is to reduce nicotine cravings. However, it's important to realize that the separation from you and the tobacco habit is best achieved by the dual approach of NRT and behavioral modification.
First, the craving for cigarettes must be controlled. This is where NRT comes in handy. Since everyone is different and smokes at various levels, the use of "continuous" (patch) or "as-needed" (lozenge, gum, etc.) nicotine delivery systems helps to control or suppress withdrawal symptoms like these:
Nervousness
Difficulty concentrating
Headaches
Dizziness
Fatigue
Difficulty falling asleep or maintaining a restful and full night's sleep
Irritability
Increased appetite
Moodiness or depression
Next, the behavorial aspect of smoking should be addressed. You may be programmed to smoke when you wake up, when you meet friends socially, or when you drink alcohol. Psychological triggers like nervousness, depression, or anxiety are common. Using support groups, friends, family, or tobacco "quit" telephone support lines can be helpful in minimizing the need for a cigarette. The "weaning period" is when the use of NRT is slowly decreased until the "need" for a tobacco product is more easily avoided.
Fortunately, there are different forms (and dosage strengths) of nicotine replacement therapy since one size does not fit all. For example, while the nicotine patch may help some, the nicotine lozenge may be more beneficial for others. That said, it's important to remember that these products should only be used as directed, and only used for the shortest length of time needed to break the nicotine habit. Also, check with your physician or pharmacist, as the product you choose may require you to completely quit cigarette smoking before its use.
NRT options
When looking for a NRT, consider these options:
Nicotine lozenges are often used as part of a 12-week program. Nicotine is slowly released as each lozenge dissolves in the mouth.
Nicotine patches are applied to the skin on a daily basis and commonly used over a two- to three-month time frame.
Nicotine nasal spray is sprayed into the nostrils every few hours as needed over a three-to six-month period.
Nicotine inhalers that are puffed into your mouth may be used over a three- to six-month period. The dosage is usually higher over the first three to six weeks, then gradually reduced as the cigarette cravings subside.
Nicotine gum is chewed about 10–12 times when the gum is new, then once or twice as needed. Basically, just enough should be used to gradually release nicotine. Absorption occurs through the tissues on the inside of the mouth, eventually reaching the bloodstream.
Nicotine gum is especially helpful for smokers who:
Smoke more than 10 cigarettes per day
Get very anxious or agitated if they do not have a cigarette every few hours
Cannot use other smoking cessation products such as the nicotine patch, lozenge, nasal spray or inhaler
Like the independence of being able to control the amount of nicotine they receive while using NRT
Like the convenience of receiving their nicotine replacement from a chewable product
Utilize behavioral therapy and/or support systems (family, friends, 24-hour smoking cessation hotlines, etc.) in combination with nicotine replacement in their smoking cessation program
There are also non-nicotine smoking cessation options such as the prescription products bupropion hydrochloride (Zyban), which helps reduce cravings, and varenicline (Chantix), which decreases the perceived pleasurable effects of smoking as well as reduces the symptoms of nicotine withdrawal.
For further information, please speak with your physician. Also, check out the American Heart Association and the American Lung Association as well as the American Cancer Society Quit Line at 1-800-QUIT-NOW.
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Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)