Is quitting cold turkey ten times more effective than nicotine gum?

It depends upon how you define quitting. Historically, roughly 10% of cold turkey attempts result in freedom from nicotine at six months. A new study just released raises concern that although 7% of nicotine gum users quit smoking for six months, almost all of them may still be hooked on nicotine.

How does the average smoker define quitting, arresting their addiction by breaking nicotine's command and control over more than 200 of their body's neurochemicals, stopping the self-destructive flow of toxic smoke containing more than 40 known carcinogens, or both?

A new study highlights the critical distinction between nicotine cessation and smoking cessation. Studies of nicotine replacement therapy (NRT) products like the patch, gum and lozenge focused almost exclusively on quitting smoking while all but ignoring whether participants actually broke free from nicotine.

"Historically, the literature has seldom examined dependence on NRT," asserts a November study in Tobacco Control, whose primary authors were Dr. Saul Shiffman of the University of Pittsburgh and Dr. J.R. Hughes of the University of Vermont. "We estimate that 36.6% of current gum users are engaged in persistent use."

In March 2003, Hughes and Shiffman published an earlier study in Tobacco Control in which they reviewed, combined and averaged all seven over-the-counter (OTC) nicotine patch and gum studies and concluded that only 7% of users had survived and not relapsed to smoking within six months.

Their November study analyzed UPC product scanning code data from 40,000 volunteer households and found that, at most, 6.7% of nicotine gum users and 1.7% of nicotine patch users continued purchasing NRT for at least six months, three months beyond FDA use recommendations.

Could the 6.7% still using gum in the November study be the same 7% declared to have successfully quit smoking in the March study? If so, do any nicotine gum users actually break nicotine's amazing grip upon the brain's reward, adrenaline, and mood pathways?

If the new study's persistent nicotine patch use rate of 1.7% is accurate, when combined with the March study, as few as 5 in 100 nicotine patch users are both smoke-free and nicotine-free at six months.

Adding additional alarm is limited evidence suggesting that the nicotine patch's already dismal six-month rate may dramatically decline during second or subsequent patch attempts. Only one patch study has directly addressed what experts have labeled "recycling."

Published in a journal entitled Addiction in April 1993, not a single nicotine patch user who had relapsed to smoking during a patch study one year earlier was able to quit smoking during a second patch attempt.    

Hughes and Shiffman's March study discusses an unpublished 1999 OTC study by Koberly in which only 1 of 149 patch users was still not smoking at six months but the authors were at a loss to explain why.

The American Cancer Society's 27th annual Great American Smokeout is Thursday, November 20 and the pharmaceutical industry is expected to again deploy a marketing blitz to try to convince smokers that only superheros can quit cold turkey and that they need to resort to NRT.

But according to the American Cancer Society's 2003 Cancer Facts and Figures report, 91.2% of all successful long-term quitters quit entirely on their own without resort to any form of NRT, hypnosis, acupuncture, magic herbs, Zyban, or nicotine-free tobacco products. Shouldn't we be studying and sharing their secrets?

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About the Author: John R. Polito is a nicotine cessation educator and the 1999 founder of WhyQuit.com, a free cessation forum offering motivational resources, a large library of original nicotine dependency recovery articles, and a unique online peer support forum that is nicotine-free in every respect. E-mail: john@whyquit.com

Fact References:

[1] Shiffman S, Hughes JR, et al, Persistent use of nicotine replacement therapy: an analysis of actual purchase patterns in a population based sample, Tobacco Control 2003 November; 12: 310-316. Link to study abstract - http://tc.bmjjournals.com/cgi/content/abstract/12/3/310

[2] Hughes JR, Shiffman S. et al, A meta-analysis of the efficacy of over-the-counter nicotine replacement, Tobacco Control 2003 March;12(1):21-7. Full text link - http://tc.bmjjournals.com/cgi/content/full/12/1/21?ijkey=5.ko5/Oz4yutI

[3] Tonnesen P, et al., Recycling with nicotine patches in smoking cessation. Addiction. 1993 Apr;88(4):533. Link to abstract - http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8485431&dopt=Abstract

[4] American Cancer Society, Cancer Facts and Figures 2003 - PDF Document, see Table 3 - http://www.cancer.org/downloads/STT/CAFF2003PWSecured.pdf