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The Detroit News

Health & Fitness
Beyond The Nicotine Patch

From new drugs to hypnosis, help is out there to quit smoking

By Sally Squires
Washington Post
(Edited & Reprinted)

When it comes to quitting cigarettes, Denise Scott knows a lot about failure. “Every time I put out a cigarette, I wanted to quit,” says Scott, 42, of Chesterfield Township. “Every morning when I would wake up hacking, reaching for my cigarettes, I wanted to quit.”

She started smoking around age 13, became a regular puffer when she was 18, and eventually graduated to a pack-a-day habit. Scott quit twice cold turkey when she was pregnant, but after the birth of each child, she lit up again.

Last year, Scott went to her doctor to discuss methods to assist in quitting. She opted for the patch, which, Scott says, gave her the bridge she needed. She has been smoke-free since Sept. 1.

About 40% of America’s 50 million smokers will; try to kick the habit at least once this year, according to the Federal Centers for Disease Control and Prevention. On each attempt, fewer than one in ten will succeed. However, nicotine addiction researchers say those failures pave the road for breaking dependence on tobacco – something that about half of smokers ultimately achieve, according to federal treatment guidelines.

“Most people have to try to quit probably five to seven times before they succeed,” says John Hughes, professor of psychiatry at the University of Vermont. “It’s just like swimming – it’s important to keep jumping in the water to learn.”

And as experts like to note, there has never been so many scientifically validated options to help smokers reduce the pangs of nicotine withdrawal and the craving for cigarettes.

Ten years ago, “all we had to offer was going cold turkey or nicotine gum,” says Michael C. Fiore, Chairman of a federal panel that issued treatment guidelines two years ago calling for nearly every smoker who wanted to quit to use medications to support their efforts. Today, there are seven drug treatment choices, as well as many smoking-cessation programs and individual counseling services that also boost chances that smokers will manage to quit.
New Strategies

Four safe and proven nicotine replacement methods – gum, a patch that delivers nicotine through the skin, an inhaler that mimics the effect of smoking and a spray that provides a quit burst of nicotine to nasal passages – can deliver gradually declining doses to take the edge off cravings and withdrawal. They have minimal side effects, a low risk of addiction and are free of the nearly 4000 harmful substances that cigarette smoke delivers.

An anti-depressant medication – bupropion, marketed for depression under the brand name Wellbutrin and for smoking cessation as Zyban – can also help break cigarette addiction, though the scientific process by which this occurs is still not understood. There have been reports of serious adverse effects, including some deaths, from Zyban in Europe. “It’s unclear if the events are related to the medication,” Hughes says.

Two other options for especially difficult cases of smoking addiction are the blood pressure medication clonidine and the anti-depressant nortriptyline. While the evidence of their value is not as extensive as that for nicotine replacement drugs, a government panel advised recently that these medications be tried if other drugs have failed. (Neither is approved for this use by the Food and Drug Administration.)

Trouble is, a lot of smokers try to quit the wrong way. Since smoking is often viewed as a weakness, many smokers tend to tough it out, going cold turkey. Or, they mistakenly use minimal amounts of the nicotine replacement drugs and other medications proven to help assuage the strong physiological symptoms of withdrawal.

“That is why there is such a high relapse rate,” explains David Sachs, clinical associate professor of pulmonary and critical care medicine at Stanford University School of Medicine in California. “It’s like killing all four engines on a Boeing 747 where you are 2000 feet above the runway. You crash and burn and then people start beating up on themselves.”

“Most people have a very pleasurable association with smoking, “says Rena Greenberg, a certified hypnotist who has worked with hundreds of people through several Metro Detroit hospital systems. “For most smokers, it is the only time they relax. We retrain the subconscious association from pleasurable to painful. What people should remember is that not anyone method works for everyone. For some people, the patch or gum will work. We provide behavior modification.”