Chewing Through a Smoking Habit

Jan. 31, 2009— -- Okay.

It was your New Year's resolution.

You were going to quit smoking but did not stick to it very long.

Not only that, you've tried many times in the past and haven't quit.

In fact, you've tried the nicotine gum, the nicotine patch, Zyban, Chantix, maybe even hypnosis or acupuncture -- some of which helped a little, maybe, some of which did not help at all.

You were constantly nagged by the need for a "nicotine fix," the craving that hampers smokers' ability to stop smoking.

"Dang it! I need a cigarette!"

You finally relented.

You're not alone. You are what I call, in my smoking cessation clinic, the "I've-tried-everything" patient.

The good news is you have lots of company.

The even better news?

Stopping smoking is something you can do, and many, many smokers just like you have done it.

Maybe you just need a novel way to do it, something to help start the ball rolling, something to ease you into becoming 100 percent smoke-free.

A new study published in the February issue of the American Journal of Preventive Medicine by Dr. Saul Shiffman and colleagues at the University of Pittsburgh might just be what it takes this time.

Shiffman and his co-workers noticed that many smokers want to quit smoking, but stopping abruptly -- even if they use stop-smoking medications -- is just too hard for them.

So they designed a study in which smokers gradually began using the nicotine gum and gradually cut down on the number of cigarettes they smoked over the course of eight weeks.

The study was "controlled," meaning that that the subjects were randomly assigned either "real" nicotine gum or "placebo" ("dummy") gum designed to look and taste the same as the real thing.

Neither the participants nor the researchers knew who was taking what until the end of the study. This made it a much stronger study design because it factored out the "placebo effect" -- the thought that, "I am taking something, so it must be helping me."

The study was set up to simulate using the gum over the counter. Participants were allowed to choose which dose of gum they wanted to use -- 2 mg or 4 mg -- based on the instructions of the printed materials typically provided with nicotine gum you might buy at the drug store.

The 3,297 smokers were instructed to start reducing smoking by giving up their usual first cigarette of the day, and use a piece of nicotine gum instead. On each subsequent day, they were instructed to add an additional hour of abstinence and an additional piece of gum.

Once they gradually had given up all their cigarettes for 24 hours, they were then instructed to use one or two pieces of gum every one to two hours, gradually cutting down on the amount of gum they chewed over a 12-week period.

The results were interesting.

First, smokers using the "real" nicotine gum were nearly three times more likely to have quit at four weeks and at six months compared to smokers using the placebo gum.

Although it would seem obvious, success at six months was even higher among those who finally made it to a full 24 hours without cigarettes by the fourth week.

Even at week two, smokers using the nicotine gum had reduced their smoking to a greater extent than those using the placebo gum.

Moreover, smokers who had cut down their smoking by one-third at week two were nearly 10 times more likely to have quit totally at four weeks.

Two decades ago, we doctors were concerned about smoking at the same time as using the nicotine gum and patch. While no one can honestly tell you that nicotine is without health effects, we were concerned back then about possible heart attacks.

Nonetheless, in this study, serious adverse effects from smoking and using the nicotine gum did not occur. While nearly half of the nicotine gum patients experienced some form of a side effect, most of these were mild, and common with nicotine gum use -- such as nausea, hiccups and heartburn.

This confirms what we have known since the 1990s from studies in which nicotine gum was found to be safe and unrelated to any cardiovascular illnesses or other serous side effects.

The authors of the current study concluded that "smokers wanting to quit by gradual reduction can substantially increase their success by using nicotine gum [and that] nicotine gum helped smokers reduce smoking, achieve initial abstinence and maintain abstinence."

You might be an "I've-tried-everything" smoker who wants to quit, but have you tried this?

Cut out one cigarette each day and add one piece of nicotine gum each day.

See what happens.

Dr. John Spangler is director of tobacco intervention programs and a professor of family medicine at Wake Forest University School of Medicine in North Carolina.