Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

126 III. SUBSTANCES OF ABUSE& Henningfield, 2001). Four NRT medications have been approved by theFDA (gum, transdermal patch, nasal spray, and oral inhaler), and a lozenge hasrecently entered the U.S. market (Shiffman et al., 2002).Nicotine replacement medications enable the tobacco-dependent personto abstain from tobacco by replacing, at least partially, the nicotine obtainedfrom tobacco. As noted by Sweeney and colleagues (2001), there appear to beat least three major mechanisms by which NRT medications enhance smokingcessation. They (1) reduce either general withdrawal symptoms, or at leastprominent ones, enabling people to function normally while they learn to livewithout a cigarette; (2) reduce the reinforcing effects of tobacco-delivered nicotine;and (3) provide some effects for which the patient previously relied oncigarettes, such as sustaining desirable mood and attention states, and making iteasier to handle stressful or boring situations.The efficacy of NRT products for smoking cessation has been demonstratedin a number of placebo-controlled studies. The gum, transdermal patch,nasal spray, and oral inhaler yield initial and long-term quit rates that morethan double those generated by placebo products, and, when combined withbehavioral counseling and follow-up, quit rates as high as 40–50 after 1 yearhave been reported (Fiore et al., 2000). Physicians in a busy office setting, withminimal time available for counseling and follow-up, may generate 1-year quitrates as high as 10% (Hughes, Gust, Keenan, Fenwick, & Healey, 1989), andover-the-counter (OTC) sales of the gum, patch, and lozenge have markedlyincreased the number of quit-smoking attempts and the number of people usingNRT (Shiffman et al., 1997). Although a recent meta-analysis suggests thatOTC NRT products yield initial quit rates of the same magnitude as NRT productsprescribed by a physician, and twice the quit rate obtained by use of placeboproducts (Hughes, Shiffman, Callas, & Zhang, 2003), other analyses havequestioned the long-term efficacy of OTC NRT products (Pierce & Gilpin,2002). A survey in California showed that smokers who reported using NRTproducts to quit smoking were just as likely to relapse after 1 year as those whodid not use NRT products (Pierce & Gilpin, 2002; Walsh & Penman, 2000).In 20 cities that participated in COMMIT, 12.8% of smokers (1 out of 8)used the transdermal nicotine patch, making it the most popular method forstopping smoking (Cummings, Hyland, Ockene, Hymowitz, & Manley, 1997).By comparison, 1 out of 10 smokers used nicotine gum, 1 out of 13 attended astop-smoking program, 1 out of 16 went to a hypnotist or acupuncturist, and 1out of 20 used some other commercially available stop-smoking device. Amongsmokers who made an attempt to quit smoking, the likelihood of successfulquitting was more than twice as high among patch users than among nonusers.Among patch users, the highest quit rates were observed among those who usedthe patch between 1 and 3 months (Cummings et al., 1997).Compared to nonusers, patch users in COMMIT were more likely to befemale and white, to have higher annual incomes, to be more motivated to stop