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Quitting smoking requires many supportsEveryone's an expert when it comes to dispensing advice on the best way to stop smoking. Some suggest going cold turkey. Others opt for hypnosis or counselling. Nicotine Replacement Therapies (NRT), such as the nicotine patch and nicotine gum, are also popular. NRT is designed to lessen nicotine withdrawal symptoms, for example, cravings, anxiety and irritability. But according to a study in a 2002 issue of the Journal of the American Medical Association, cancer researchers at the University of California at San Diego found that NRT is no longer effective in helping smokers quit for the long term. They found that in 1992, of people trying to quit smoking using NRT, 50.5 per cent were successful. This rate fell to 17.2 per cent in 1999. So, why the huge drop? Dr. John Pierce, part of the research team and associate director for Cancer Prevention and Control at the university, says the turnaround in NRT usefulness occurred in 1996 when NRT became available without a prescription in the United States. (In Canada, the two-mg nicotine gum was first sold over the counter in 1992, followed by the four-mg gum in 1997 and the nicotine patch in 1998.) Without physician support and advice, NRT seems to be ineffective. Pierce points to the limitations of previous clinical trials, which show that using NRT roughly doubles the chance of quitting smoking. "The clinical trial data is overestimated," he says. "There isn't one clinical trial that uses NRT alone." Smokers in these studies get support throughout the process, including counselling. Pierce says that advertising has burgeoned the myth that you just slap on the patch and quit. But it's not that simple. NRT works on the principals of biology. It may help lessen the cravings for a cigarette, but smoking also has social, environmental and psychological components that must be addressed. The only way the nicotine patch is going to be foolproof "is if you put it over your mouth," says Dr. Peter Selby, head of the Nicotine Dependence Clinic at the Centre for Addiction and Mental Health in Toronto. He points out that NRT may only help certain types of smokers, those addicted to nicotine. Generally, these are heavy smokers who smoke more than 10 cigarettes a day and tend to have their first cigarette within 30 minutes of waking up. Yet only 30 per cent of smokers are nicotine dependent. Almost half of smokers in Canada smoke less than 15 cigarettes a day. Using medication to treat only the biology of the problem, nicotine withdrawal, will not help all smokers. A person with diabetes, for example, isn't treated only with medication; behavioural changes, for example, diet and exercise, are also necessary. "The same idea is true for smokers," says Selby. Dr. Paul McDonald, a professor of Health Studies and Teratology at the University of Waterloo in Ontario has been studying smoking cessation intervention for 15 years. He agrees with Selby: "The focus on medicalizing smoking cessation is fundamentally flawed," he says. NRT is a time out from nicotine withdrawal. But smokers need to use this time to change their habits and address their psychological addictions. This is where physicians and counselling come in. McDonald suggests that physicians should take the quadruple "A" approach -- Ask, Advise, Assist and Arrange. Yet less than half of physicians are getting past the first two "A"s.' In 2001, about 49 per cent of smokers in Ontario reported that their physician advised them to quit smoking. This, despite the fact that smokers are more likely to quit when they hear the message from a health care provider, and that additional counselling further improves their chances of quitting. McDonald says physicians do not feel comfortable advising smokers and are not trained to motivate people to seek help. But that doesn't let smokers off the hook. They themselves are unlikely to go to their physicians for advice when they want to quit. "Most people want to quit on their own because they think it's just a matter of willpower," says Pierce. "To some extent they're right, but you can be helped with your willpower. Running is just moving your legs, but if you want to run a race you have to be coached." NRT certainly has its place in smoking cessation. Yet it is important to get back to basics. "NRT is a godsend to dependent smokers," says McDonald, but he adds that NRT must be used in conjunction with behavioural therapy. "Once you are an addicted smoker, you are always vulnerable to relapsing back to smoking," says Selby. "The addiction is the one that must be beaten." Helen Buttery
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This page was last modified on Tuesday, August 5, 2003 3:47 PM
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