Truth About Nicotine Gum, Patches and other Nicotine Replacement "Therapy"
With the New Year approaching, millions of people worldwide are prepping themselves for a confrontation with their addiction to nicotine. Bombarded with advertising from "pharmaceutical" companies selling nicotine as "medicine", many of these smokers will turn to nicotine gum, patches, water, lozenges and other forms of "therapy" in the hopes that it will increase their chances of successfully escaping a drug that has a high probability of killing them early.
Those hawking NRT (nicotine replacement "therapy") cite studies that "demonstrate" that NRT doubles a quitter's chances of quitting. The reality is that the numbers cited are misleading. While study participants who were being given a placebo showed a 6 month success rate half that of those given real nicotine (3% vs. 7%), uneducated cold turkey quitters in the real world show a success rate 3 times greater than study participants given the placebo (10%).
This shouldn't surprise. Consider that nicotine is a drug with a discernable effect on the brain. Imagine yourself in a study on the effects of wine, and winding up being one of the participants who was given placebo wine (without alcohol). How long would it take you to realize that you weren't getting any alcohol. Is it even remotely plausible to pose that a smoker who's inhaled nicotine for 10 minutes of every waking hour of his life for 5, 10 or 20 years would not quickly notice that they were not getting their fix?
Now consider that with education and support, quitting cold turkey shows success rates far greater than 10%. For some cold turkey nicotine cessation programs, the 1 year success rate approaches 50%; far greater than the 7% 6-month success rate for NRT users.
Think about it. How many people do you know who have successfully quit smoking? Now, ask yourself how they did it. If you don't know, ask them. According to the American Cancer Society's 2003 Cancer Facts and Figures, 91.2% of all successful long-term quitters quit without using any pills, potions, NRT, herbals etc. They did it entirely on their own.
It makes sense. Nicotine is a highly addictive drug. In what other circumstances is it recommended to treat addiction to a highly addictive drug by administering the same drug via a different pathway? Would you treat a heroin smoker by switching him from the pipe to the needle? Would a cocaine addict be treated by switching her from free basing to snorting?
The truth is that until a drug ceases to be in a user's system, the cycle of physical withdrawal that propogates the dependency will continue. Nicotine takes 72 hours to exit the system. At about the 72 hour mark, physical withdrawal peaks and then subsides. Physical withdrawal only recurs if the drug is reintroduced to the addict's system.
NRT continues to add nicotine to the user's system, but in amounts less than what the user requires to stave off withdrawal. So, instead of a 72 hour period of acute withdrawal, the user is subjected to weeks or months of chronic withdrawal, the continuing presence of nicotine guaranteeing that it will persist. At 2 weeks, as a cold turkey quitter is learning to break the psychological bonds to nicotine in the absense of physical withdrawal, the NRT user is 2 weeks into a slow torture regime. Far from helping a quitter, NRT is actually sabotaging the person's chance for success, and demotivating that person from further attempts.
Yet, the industry continues to sell the myth that cold turkey quitting is too difficult for the average person. To my mind, this is criminal. Millions of people, earnest in their desire to free themselves of a deadly drug are being duped into an approach that is almost sure to fail. Millions of these people will die young. That's not overstating it; it's just reality.
So, as you approach your New Year's resolution, take some time to look into it a bit. Learn as much as you can about your addiction, and what your options are for quitting. I highly recommend WhyQuit.com and its sister support site Freedom from Tobacco for free, no-B.S. education and support. It's volunteer-run. There are no gimmicks, obligations or other kinds of strings attached. One of the managers has run a highly successful live nicotine cessation clinic in Illinois for almost 30 years.
Here is some information from Whyquit on NRT:
The websites and commercials of those marketing the NRT patch, gum, inhaler and lozenge continue to hide the fact that a March 2003 study, conducted by NRT industry consultants, combined and average all seven over-the-counter NRT patch and gum studies and found that only 7% of study participants were still not smoking at six-months. Their web sites and commercials keep secret the fact that it's actually worse, in that the same industry consultants published a November 2003 study which found that as many as 7% of successful gum quitters and 2% of patch users were still hooked on the gum or patch at six months. Obviously these were to entirely different studies but even so the math screams for answers.
Does NRT really double a smoker’s chances? While real-world quitting surveys find no advantage, their simplicity has been attacked as unscientific by double-blind clinical trial NRT researchers. Now the clinical trial's integrity is in question as a new study reports blinding failures in 71% of NRT studies assessing blindness...
...The study found that only 7% of OTC patch and gum users and 3% of placebo group quitters were still not smoking at six months. Although it again provided NRT with its much heralded "double your chances" victory margin, according to June 2000 U.S. Clinical Practice Guideline evidence tables, the 3% placebo rate is at least three times lower than historic six-month "on-your-own" quitting rates.
Edited to add: I am not a doctor. This post shouldn't be construed as medical advice or replace the advice of your physician. The post IS intended to shed light on the studies the pharmaceutical industry cites to support its claims about the Nicotine Replacement Therapy, and to point the way to a highly successful alternative.
I deleted your comment, because there are a couple of common (and understandable) misconceptions that came through in it. Because it is possible that smokers might be reading this, and considering their options, I want to make sure that what is communicated gives them the best information to make their decisions.
You said that "it is the hardest thing in the world to quit a habit that you love doing." 3 things about this statement reflect a misunderstanding of the nature of addiction that, in the mind of a smoker considering quitting, are dangerous.
1) Quitting is hard. No point in sugar coating it. However, it is not nearly as hard as many believe. Nor does it remain difficult for very long, as long as the quitter refrains from ALL nicotine on a permanent basis.
The myth about quitting's difficulty is bolstered by the ways in which many people attempt quitting. Primarily... they don't quit. Quitting successfully is an all or nothing proposition. There is no in between. The physical nature of addiction mandates that as long as a drug is present in the addict's system, withdrawal symptoms will persist. When that drug persists in smaller amounts than the user needs to stave off withdrawal, withdrawal will be more severe. Only by either using to capacity, or by completely abstaining, can an addict rid himself of the physical withdrawal that propogates the addiction to the drug.
A whole lot of people out there, encouraged by a world that tells them quitting is hard, seek an easier road, and in doing so, unwittingly take a much more difficult (nearly impossible) path. Essentially, they continue feeding the withdrawal cycle, either through NRT, by using the "cut-down" process, or by sneaking one now and then. Each time the addict uses, regardless of the administration method, they're resetting the clock on their escape from physical withdrawal. I would imagine I'm not the first to think of it, but I believe that we could extract a lot of information from captives if we simply cut back their tobacco usage to the point of severe withdrawal, and then offered cigarettes as rewards for cooperation. While that would be, in reality, torture, world conventional wisdom might conclude that we were doing them a favor by cutting back their smoking.
The belief that quitting is one of the hardest things in the world keeps many people from attempting to quit, and leads many quitters (cold turkey
ones) to conclude during the first week or two (when it often IS very hard) that the situation will never resolve, and that life as a non-smoker will be the torture they've experienced during the first days of recovery. It is important for people who are considering quitting to know that while quitting is difficult, it is not nearly as difficult as people imagine, and there is a light at the end of the tunnel, where (and this is almost inconceivable to the active user) days will pass without so much as the thought of tobacco.
2) Smoking as a habit. Another dangerous misconception. A bad habit is biting your fingernails or not washing the dishes. For addicts (over 90% of people who smoke become addicts. This is the highest addiction rate of any known drug), smoking is an activity used to feed an ADDICTION to nicotine.
Nicotine addiction is driven first, by the physical withdrawal cycle. Different for each individual, essentially, as nicotine levels fall as the period between the last cigarette and now grows, withdrawal symptoms set in. Withdrawal symptoms stem from different causes, including (but not limited to) blood sugar declines (nicotine causes the release of blood sugar into the system... in effect hijacking the sytstem's normal release patterns) and dopamine release effects (I used to be able to describe nicotine's effects on the dopamine release, and still know where I can find an article if you're interested). Dopamine is a major player in regulating our moods.
Nicotine addiction is secondarily driven by a psychological association of nicotine use with various situations. To this extent, it more closely resembles a "habit". However, for the quitter, these associations are very dangerous because of the physical addiction that underlies them. An addict who's been quit for 2 weeks, 2 months or 2 years will encounter a situation in which they used to smoke, and if they haven't encountered that situation before (say a wedding reception), they will likely have a psychological urge. If the moment is allowed to pass without using, then it will fade, and the next time the person encounters that situation, he will either not have the aurge, or the urge will be much less powerful. If, however, the addict uses nicotine, regardless of how long they've been off, they reestablish the physical dependency to the drug. That's a whole different kettle of fish.
Actually, that's one of the best tools for explaining how serious this addiction is: not how hard it is to quit; but how easy it is to lose the quit. There is a post at Freedom containing the stories of various quitters with stories of losing long-term quits to the myth of "one puff". It's a litany of frightening instances of people who had been comfortably living their lives as non-smokers for 6 months, 5 years, 20 years, returned almost immediately to their old consumption levels (half a pack, 1 pack, 2 packs per day) after attempting to break the "law of addiction": that the readministration of an addictive substance to the addict's system will reestablish that addiction for that person. Here's a link to that post.
3) Finally, love for cigarettes. This is another common misconception among smokers. They believe they love smoking. In truth, while it certainly seems that way, smoker's hate not smoking. This is because of withdrawal. Nicotine creates its own stress via withdrawal. As 20 minutes or so pass since the last cigarette, (length of time is different for different people), withdrawal will begin to have effects. The person will start to feel stressed, tense, fidgety, agitated, emotional, hot around the collar, etc. Reapplication of nicotine to the system relieves (temporarily) these symptoms (while simultaneously ensuring that they will recur in a timely manner, once the nicotine levels subside again). So, in reality, smokers only think they love smoking. What they really love is the relief that nicotin provides from its own withdrawal. They hate NOT smoking more than they love to smoke.
This is one of the hardest points to get through to a long-term smoker. Many smokers have been smoking for 30 or 40 years, and since they were kids. The belief that they love smoking is deeply engraved in their psyches.
Again, I strongly encourage anyone considering quitting, or wondering how they can help their friend or family member quit, to visit whyquit.com.
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