If you’re past midlife and have not yet quit smoking, chances are you’d like to quit smoking. Statistics show that most older smokers have tried—and failed—to quit smoking at least once. The addictive nature of nicotine, one of the major chemicals in tobacco, accounts for many of these failures.
“Tobacco delivers explosively high doses of nicotine to the brain,” says Johns Hopkins Professor of Psychiatry Jack Henningfield, Ph.D., “causing neurologic changes that are similar in some ways to the neurologic changes characteristic of heroin and cocaine.”
According to the American Cancer Society, starting nicotine-replacement therapy (NRT) on the day you quit smoking more than doubles the likelihood of success—especially if nicotine-replacement therapy is coupled with behavioral changes that address the psychological component of smoking.
You can choose over-the-counter (OTC) nicotine gum or lozenges, a prescription nasal spray or inhaler, or a skin patch (which is sold with or without a prescription, depending on the dosage required). Which method you select to quit smoking is largely a matter of personal preference. But beware of bogus OTC products that are likely to undermine any attempt to quit smoking.
Benefits of Nicotine Replacement to Quit Smoking
Nicotine-replacement therapy delivers a small, controlled dose of nicotine that diminishes the physical craving for nicotine and reduces the symptoms of sudden nicotine withdrawal—irritability, restlessness, food cravings, anxiety, and, in particular, poor concentration.
“Studies done for the U.S. military show that nicotine gum or the patch nearly always eliminates concentration problems,” Dr. Henningfield says. “People who go ‘cold turkey’ may have poor concentration for a few days to a week.” Nicotine-replacement therapy also eases the other symptoms of nicotine withdrawal when you quit smoking.
Smokers are also psychologically addicted to cigarettes. Because they have learned to enjoy smoking behavior, the desire for a cigarette can be triggered by specific activities (such as finishing a meal) or surroundings (such as a bar or coffee shop) unique to each smoker. These destructive habits must be broken and replaced by new, positive behaviors.
Nicotine-replacement therapy helps smokers address the psychological component of smoking because, with the physical craving for cigarettes under control, they are better able to identify the triggers that make them want a cigarette, learn new behaviors, and seek support from friends, family, a trained counselor, and/or a self-help program.
Anyone who needs additional help overcoming nicotine addiction can combine nicotine-replacement therapy with Zyban (bupropion), a prescription medication that appears to act on the addiction center of the brain. Also sold as the antidepressant Wellbutrin, Zyban can be taken alone or in combination with nicotine-replacement therapy. Nicotine-replacement therapy can also be used in conjunction with hypnosis or acupuncture, two approaches that some people find helpful to quit smoking. Nicotine-replacement therapy, however, should not be taken with Chantix (varenicline), another stop-smoking prescription medication that works similarly to Zyban.
Precautions When Using Nicotine-Replacement Therapy to Quit Smoking
Whatever nicotine-replacement therapy product you choose, be sure to consult a doctor if you have a medical problem, particularly heart disease or high blood pressure, or if you take any other medication, especially drugs for asthma or depression. Some forms of nicotine-replacement therapy may increase blood pressure or heart rate. In addition, the dosage of any medication you take may require adjustment, regardless of whether or not you are on nicotine-replacement therapy, because of the physical changes that occur when you quit smoking. An increase in blood pressure also is a frequent side effect of Zyban and Chantix.
Nicotine-replacement therapy products are generally sold in more than one dose to accommodate light to heavy habits and to reduce the possibility of an overdose. Overdose symptoms include headache, dizziness, upset stomach, vomiting, diarrhea, mental confusion, weakness, and fainting.
“If these symptoms appear and persist, reduce the nicotine-replacement therapy dose,” Dr. Henningfield advises. “If you lapse and have a cigarette, stay on treatment and try to get back to abstinence, but if you resume daily smoking, discontinue nicotine-replacement therapy until you are ready to pick a new quit smoking day.”
Some medical problems should steer you away from certain nicotine-replacement therapy products. The gum may not be appropriate for those with temporomandibular joint (TMJ) disorder, a condition characterized by pain and tightness in the jaw, or for those with dentures. The patch may be inadvisable for those with skin problems or allergies to adhesive tape. The inhaler should be used cautiously by people with asthma or other bronchospastic illnesses. The spray is not generally recommended for those with nasal or sinus conditions, allergies, or asthma. Lozenges may be inappropriate for people with persistent indigestion.
Nicotine-Replacement Therapy Products to Avoid
All legitimate nicotine-replacement therapy products are approved as smoking cessation aids by the Food and Drug Administration. Don’t be taken in by herbal products or supplements promoted for this purpose or by low-nicotine or nicotine-free cigarettes. None of these products has been proven effective to help quit smoking—although it’s sometimes difficult to tell from their promotional material. In addition, certain recently marketed oral products that contain nicotine—including wafers and mints—are forms of smokeless tobacco. They are not effective as quitting aids and should not be used as such. Finally, bottled water, lip balm, and lollipops that contain nicotine are illegal.
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