Gum, patches, computers ... do they work?

Quitting smoking is easy. I've done it hundreds of times." The wit of Mark Twain. But when you think about it, quitting is easy. You simply snuff out your cigarette, and as of that moment you are an exsmoker. If you go for an hour without a cigarette (a major accomplishment for some addicts), you are still an ex-smoker. But how long you go without a cigarette is the catch.

Most people recognize that responsibility for ridding themselves of a well-entrenched habit (addiction) rests with them. After all, if you don't want to smoke anymore, the only person who is going to stop you from putting that cigarette in your mouth is you.

But why do some of us have such a difficult time quitting for good?

A trusted friend. A smoker quickly learns that, in a real sense, a cigarette is a very close friend. When experiencing emotional upheaval, stress, or anxiety, a smoker typically reaches for a cigarette to produce a calming effect; when sad or depressed, a smoker reaches for a cigarette to help cope with the blues; and when happy, elated, the smoker reaches for a cigarette to help celebrate the moment. The cigarette is always there to do whatever the smoker wants it to do--celebrate or cope. In either case it rarely disappoints.

Is it any wonder that kicking the habit is such a monumental task? In effect, quitting is tantamount to stripping the smoker of a close friend that never talks back, never fails to comfort, and always provides pleasure and gratification. Who wouldn't want a friend who did all that? And who wouldn't experience anxiety or depression---even hostility--if that friend were suddenly taken away?

Chemical dependency. Smokers who have used cigarettes in sufficient amounts (10 or more a day over many years) are addicted both physically and psychologically. This extremely powerful dependency makes quitting seem close to impossible for many smokers.

Smoker, beware.

When faced with the arduous task of quitting smoking, one question often surfaces: Is there a product out there that will put an end to this habit? A word of caution: there is no elixir, no panacea. no magic bullet that will stop a smoker from smoking. In the final analysis, there's only one way to quit, and that is to have a firm commitment to quit. You must strongly want to be a nonsmoker and be willing to persevere in whatever effort that requires.

What smoking-cessation aids do is help you deal with an admittedly difficult task, but they won't work unless you really want to quit. Also, there isn't one that works for everyone. If there were, there would be only one aid! The fact is, some of them work for some smokers, some of them don't.

Dr. Gerry Hyner, of Purdue University, who has many years of clinical experience with smokers, believes that "smokers should try as many different aids as they think will help until they find the one that works ." Some smokers have been served well with the help of a simple rubber band; others require drug therapy.

Herbs, spices, mouthwashes.

Products to help a smoker quit have been around since before 1900. Early ones consisted of herbs, spices, and mouthwashes that produced a disagreeable taste for the smoker. Other products aimed at diminishing the sensory drives (smell, taste) or creating a dry mouth. In 1982 the Food and Drug Administration concluded that products such as "chewing gum, mouth sprays, and tablets containing silver acetate were not effective as aids to smoking cessation." So much for those early products.

More sophisticated drugs (such as sedatives, tranquilizers, and anti-convulsants) have also been employed with varying degrees of success, but none have stood the test of time as reliable.

What'S new? The newer products on the market have the same objective as the older ones--to reduce both the psychological and physiological cravings for tobacco and to minimize symptoms of withdrawal. Among the more popular products in recent years are nicotine chewing gum, the patch, the E-Z Quit cigarette holder, and the LifeSign QuitSmoking Computer.

Nicotine chewing gum. Nicotine polacrilex (Nicorette) was the earliest of products (introduced in 1984) that offered some hope to the smoker committed to stopping. Nicorette is a prescription drug in the form of chewing gum. It contains 2 milligrams of nicotine bound by an ion exchange resin that allows for a gradual release of nicotine when chewed.

Physicians usually advise patients to use the gum for at least three to four months. About 7 percent of exsmokers who use Nicorette to quit smoking are still chewing the gum one year after quitting. This doesn't pose as serious a health threat as smoking, but most experts advise discontinuing the gum as soon as possible after the initial four-month period.

Studies at the University of Minnesota indicate that a smoker can avoid withdrawal symptoms associated with abrupt discontinuance of the gum by gradually discontinuing use.

One of the major problems with Nicorette is how the smoker uses the product. For the gum to be effective, it is necessary for the smoker to chew several times and then "park" the gum (stop chewing) to allow the nicotine to be absorbed into the bloodstream through the mucous membrane of the mouth. The purpose of the gum is to maintain a certain blood nicotine level. That purpose is defeated if the smoker disregards the park phase and chews the product in much the same way as he or she would regularly chew gum.

When the park phase is ignored, the nicotine is swallowed (instead of being absorbed through the mouth) and inactivated by enzymes during passage through the liver. In other words, the nicotine doesn't get into the bloodstream, and the smoker continues to experience a craving.

Another problem rests with the prescribing physician who may fail to provide clear instructions on proper use and limitations of the product. Adequate instruction and counseling are important.

Also, there is some evidence, cited in the Journal of the American Medical Association, that the effectiveness of Nicorette is undermined when the user drinks coffee, cola, or other acidic beverages. These drinks change the chemical balance of the mouth and effectively block the action of the gum (i.e., the nicotine isn't absorbed into the bloodstream).

The patch. We've all seen it advertised on television: "The Transdermal Nicotine Delivery System, you know, the Patch." The patch has all but replaced nicotine chewing gum as the first line of defense against smoking withdrawal symptoms. The reason is quite simple--the smoker doesn't have to do anything except put the patch on. Unlike the chewing gum, where active participation is required, the patch gradually releases nicotine through the skin (transdermal) directly into the blood stream and hence does a better job of maintaining blood nicotine levels.

According to one clinician, Dr. Michael Fiore of the Center for Tobacco Research and Intervention at the University of Wisconsin Medical School, nicotine patches produce smoking-cessation rates that range from 18 percent to 77 percent. These rates are about twice as good as those of patients who are treated with a placebo.

When abstinence is defined as six months without a cigarette, success rates range from 22 percent to 44 percent, compared with 5 to 28 percent for placebo patients. There is also some evidence that the patch may reduce negative moods associated with cessation. Again, counseling from the prescribing physician is important to the success of the product. At least one source (The Medical Letter on Drugs and Therapeutics, Apr. 17, 1992) has questioned the long-term results of the patch. In a study of 145 treated patients, only 12 percent were still abstinent two years later.

Also, some users have skin irritation where the patch is placed. Some experience insomnia or nervonsness.

The E-Z Quit cigarette holder Among the nonprescription products available, the E-Z Quit cigarette holder, and the LifeSign Quit-Smoking Computer "may be among the best," according to the research of smoking cessation expert Dr. Tom Ferguson. His NoNag, No Guilt, Do-It-Your-Own-Way Guide to Quitling Smoking (formerly titled The Smokers'Book of Health) contains an excellent review of products, aids, and devices.

The E-Z Quit cigarette holder is a simulated tortoise shell cigarette holder with a plastic cigarette containing a peppermint-menthol flavor capsule. The smoker is free to puff away whenever the urge dictates without the harmful effects of nicotine, carbon monoxide, or tar.

In a survey conducted by Dr. Ferguson, smokers gave the E-Z Quit system "the highest rating of any nonprescription quit-smoking aid." But a disadvantage is that it may not be effective for those addicted to nicotine.

The LifeSign Quit-Smoking Computer. For technologically minded smokers, this tiny computer (about the size of a thick credit card) is programmed to help them taper away from addiction to cigarettes.

The mechanism keeps track of how many cigarettes you smoke during the first week of usage, then tells you when you may smoke during the second week with an audible beep. It starts the smoker out with usual smoking rates (usual for that smoker as determined during the first week), then gradually increases the interval between cigarettes until on your chosen quit day the computer flashes "no smoking." As with the E-Z Quit holder, an advantage to this product is that no prescription is required, but again, a disadvantage is that it may not work if you're addicted to nicotine.

Remember what it takes. Of course there are many other devices and therapies that I haven't mentioned. But the important point to remember is that none of them will work by themselves. Also, keep in mind that most people quit cold turkey without the use of aids. You must have a firm commitment to quit. And along with the commitment must come persistence.

Millions of smokers have quit. Millions of others will. If you're a smoker, don't give up! You can abandon the single most preventable cause of illness and premature death in this country today.

D. Craig Huddy, Ph.D., CH.E.S., is an assistant professor in the Department of Health, Leisure, and Exercise Science, at Appalachian State University, Boone, North Carolina. He teaches and conducts research in health behavior change strategies, weight management, smoking-cessation programs, and alcohol treatment programs.