Nicotine addiction may be one of the toughest addictions to overcome. Smokers' attempts to quit lead to withdrawal symptoms. Symptoms of nicotine withdrawal include irritability, restlessness, nausea, vomiting, and intense cravings for tobacco.
Nicotine Replacement Products
Nontobacco products that replace depleted levels of nicotine in the bloodstream have helped some people stop using tobacco. The two most common nicotine-replacement products are nicotine chewing gum and the nicotine patch, both of which are available over the counter. The FDA has also approved a nicotine nasal spray, a nicotine inhaler, and a nicotine pill to help cigarette smokers stop smoking.
Some patients use a prescription chewing gum containing nicotine, called Nicorette, to help reduce nicotine consumption over time. Under the guidance of a physician, the user chews between 12 and 24 pieces of gum per day for up to six months. Nicorette delivers about as much nicotine as a cigarette does, but because it is absorbed through the mucous membrane of the mouth, it doesn't produce the same rush as inhaling a cigarette does. Users experience no withdrawal symptoms and fewer cravings for nicotine as the dosage is reduced until they are completely weaned.
Some controversy surrounds the use of nicotine replacement gum. Opponents believe that it substitutes one addiction for another. Successful users counter that it is a valid way to help break a deadly habit without suffering the unpleasant withdrawal symptoms and cravings that often lead ex-smokers to resume smoking.
The nicotine patch was first marketed in 1991 for those attempting to quit smoking. It is generally used in conjunction with a comprehensive smoking-behavior cessation program. A small, thin, 24-hour patch placed on the smoker's upper body delivers a continuous flow of nicotine through the skin, helping to relieve the body's cravings. The patch is worn for 8 to 12 weeks under the guidance of a physician. During this time, the dose of nicotine is gradually reduced until the smoker is fully weaned from nicotine. Occasional side effects include mild skin irritation, insomnia, dry mouth, and nervousness. The patch costs the equivalent of two packs of cigarettes a day - about four dollars - and some insurance plans will pay for it.
How effective is the nicotine patch? According to an analysis of 17 studies involving 5,098 people, the nicotine patch was at least twice as effective as placebo (fake) patches. At the end of treatment periods lasting at least four weeks, 27 percent of the nicotine patch wearers were free of cigarettes versus 13 percent of placebo patch users. Six months later, 22 percent of the nicotine patch users were abstinent compared with only 9 percent of the placebo users. The study also showed that the patch was effective with or without intensive counseling.
The nasal spray, which requires a prescription, is much more powerful, and its nicotine reaches the bloodstream faster than that of the gum or the patch. Patients are warned to be careful not to overdose; as little as 40 milligrams of nicotine taken at once could be lethal to some people. It has been reported that the spray is somewhat unpleasant to use. The FDA has advised that it should be used for no more than 3 months and never for more than 6 months, so that smokers don't find themselves as dependent on nicotine in spray form as they were on nicotine from cigarettes. The FDA also advises that no one who experiences nasal or sinus problems, allergies, or asthma should use it.
The nicotine inhaler, which also requires a prescription, consists of a mouthpiece and a cartridge. By puffing on the mouthpiece, the smoker inhales air saturated with nicotine, which is absorbed through the lining of the mouth, not the lungs. This nicotine enters the body much more slowly than the nicotine in cigarettes does. Using the inhaler mimics the hand-to-mouth actions used in smoking and causes the back of the throat to feel as it would when inhaling tobacco smoke. Each cartridge last for 80 long puffs and each cartridge is designed for 20 minutes of use.
Approved in 1997 by the FDA to aid in smoking cessation, Zyban, the smoking cessation pill, offers new hope to many who thought they could never quit. Zyban is thought to work on dopamine and norepinephrine receptors in the brain to decrease both craving and withdrawal symptoms. Because of the way this prescription medication works, it is important to start the pills 10 to 14 days before the targeted quit date; it requires planning ahead.
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