Remember, tobacco addiction is both mental and physical. For most people, the best way to quit will be some combination of medicine, a method to change personal habits, and emotional support.
Nicotine replacement therapy
As mentioned earlier, the nicotine in cigarettes leads to actual physical dependence. This can cause unpleasant symptoms when a person tries to quit. Nicotine replacement therapy (NRT) gives you nicotine — in the form of gums, patches, sprays, inhalers, or lozenges — but not the other harmful chemicals in tobacco. It can help relieve some of the physical withdrawal symptoms so that you can focus on the psychological (emotional) aspects of quitting.
How nicotine replacement works
Nicotine replacement therapy (NRT) can help with the difficult withdrawal symptoms and cravings that 70% to 90% of smokers say is their only reason for not giving up cigarettes. Using NRT reduces those symptoms.
Many smokers can quit smoking without using NRT, but most of those who attempt quitting do not succeed on the first try. In fact, smokers usually need many tries — sometimes as many as 8 to 10 — before they are able to quit for good.
Lack of success is often related to the onset of withdrawal symptoms. And most quitters go back to smoking within the first 3 months of quitting. So don’t be discouraged if you start smoking again. Just try to stop again and make your attempt more successful by adding another method or technique to help you quit. You can reduce withdrawal symptoms with NRT and reduce their impact with support techniques. This gives you a better chance of quitting and staying quit.
Getting the most from nicotine replacement
Nicotine replacement therapy (NRT) only deals with the physical dependence. It is not meant to be the only thing you use to help you quit smoking. You will need other methods that help the psychological (emotional and mental) part of smoking, such as a stop smoking program. Keep up with these support systems during treatment with NRT and for at least a few months after you quit. Studies have shown that this approach — pairing NRT with a program that helps to change behavior — can double the chances of quitting and staying quit compared to approaches that used one method alone.
The best time to start NRT is when you first quit. Many smokers ask if it’s OK to start NRT while they are still smoking. At this time the companies that make NRT products say that they should not be used if you are still smoking, and the FDA has not approved them to be used in this way in the United States. But some research has been done with smokers using NRT while still smoking, with the intent to cut down on cigarettes and eventually stop completely.
In 2009, researchers looked at several studies in which smokers were given NRT over the long term. Overall, those who got NRT were more likely to quit smoking than those who got placebo (fake NRT) but all the studies included a lot of support and supervision from the doctor and health team. Side effects were minor in these studies. The most important thing is being sure that you are not overdosing on nicotine, which can affect your heart and blood circulation. It is safest to be under a doctor’s care if you wish to try smoking and using NRT while you are tapering down your cigarette use.
Often smokers first try to quit on their own then decide to try NRT a day or more into quitting. This method does not give you the greatest chance of success, but do not let this discourage you. There are still many options available for quitting smoking and staying quit.
Are there smokers who should not use NRT?
The US Agency for Healthcare Research and Quality (AHRQ) Clinical Practice Guideline on Smoking Cessation in 2000 stated that NRT was safe for all adult smokers except pregnant women and people with heart or circulatory diseases. But the 2008 Clinical Practice Guidelines for treating tobacco dependence says that NRT (in this case, the nicotine patch) can be used safely under a doctor’s careful monitoring, even in people who have heart or blood vessel disease. Studies have found the benefits of quitting smoking outweigh the risks of NRT in people with cardiovascular (heart and blood vessel) disease. When looking at NRT use, the benefits of quitting smoking must outweigh the potential health risks of NRT for each person.
As of late 2011 there is still not enough good evidence one way or the other to know if NRT is safe in pregnant women. A 2011 analysis of 5 studies done on NRT in pregnant women showed no significant differences in ill effects (such as low birth weight and admission to an intensive care unit) between the NRT groups and the groups that didn’t get NRT. Smoking during pregnancy can cause these problems and a lot more, so many doctors think NRT is less harmful than smoking during pregnancy. Also, while NRT exposes the fetus to nicotine, smoking exposes the fetus to nicotine and a number of other chemicals. Nicotine may have unknown effects as the child grows up, and this has not been carefully studied over the long term. With all of this in mind, it is best to quit smoking before getting pregnant. If it’s too late for that, quitting in early pregnancy can still greatly reduce many risks to the baby. Smokers who find themselves pregnant should talk with their doctors right away to get help in choosing the best way for them to quit smoking.
Note that NRT has not yet been proven to help people who smoke less than 10 cigarettes a day. You may want to talk with your doctor about a lower dose of NRT if you smoke less than that but feel you need nicotine replacement.
When may I begin using nicotine replacement therapy?
You may start using NRT as soon as you throw away that last cigarette. You do not need to wait a certain length of time to put on the patch or start using the gum, lozenge, nasal spray, or inhaler. You should double-check this information with the instructions on your chosen method of nicotine replacement, but in general there is no need to wait to start using NRT.
Can you get too much nicotine from NRT?
Nicotine overdose is possible, but rare. NRT products are labeled to match the amount of nicotine you get from NRT to the amount you typically smoked. If used this way, you are getting a nicotine dose fairly close to what you got from smoking. You don’t want to get more than that, because higher doses of nicotine can cause harm. Even just a bit too much can cause some of the milder symptoms below. To avoid this, follow dosing instructions carefully. Also, don’t use heat (like a heating pad or heat lamp) on the skin at your nicotine patch — the extra blood supply could cause you to absorb more nicotine. An overdose can cause death. Because of their smaller size, overdose is more of a problem in children and pets.
Nicotine absorbs through the skin, so you must store and dispose of your NRT safely. Keep NRT and any used gum or patches and empty cartridges, bottles, etc., safely away from children and pets.
It would be very rare for an adult who is following instructions to try to quit smoking to get a serious overdose. But with liquid forms that can absorb quickly through the skin, overdose could happen. All forms of NRT can cause harm if too much is taken in.
Here are some symptoms of too much nicotine:
- Nausea and vomiting
- Belly pain
- Fast or irregular heartbeat
- Cold sweat
- Pale skin and mouth
- Tremors (shaking)
- Disturbed vision and hearing
- Dizziness or faintness due to low blood pressure
- Stopped breathing
Call Poison Control and get emergency help if you suspect an overdose. If you are taking NRT as prescribed and are still having mild symptoms such as headache, vomiting, diarrhea, or sweating, lower your dose and talk to your doctor.
How do I know if I’m a light, average, or heavy smoker?
Most NRT products make their recommendations based on how much you smoke. But there is no formal category in any textbook or a group that defines a light, average, or heavy smoker. In general, a light smoker is someone who smokes less than 10 cigarettes per day. Someone who smokes a pack a day or more is thought of as a heavy smoker. An average smoker falls in between.
Sometimes a doctor will use the term pack year to describe how long and how much a person has smoked. A pack year is defined as the number of packs of cigarettes a person has smoked every day multiplied by the number of years he or she has smoked. Since 1 pack is 20 cigarettes, a person who has smoked 20 cigarettes a day for 1 year is considered to have smoked 1 pack year. Someone who has smoked 30 cigarettes a day (1½ packs) for 4 years is described as having smoked 6 pack years (1½ x 4), and so on. This is another way to figure out how high your risk of smoking-related disease might be.