Re: symptoms of nicotine withdrawal

[Anonymous]

Of smokers who use a pharmacological aid, such as NRT, 10–30% are able to stop smoking for at least six months6. This represents a significant improvement over the success of self-help and brief advice from a physician. NRT, in fact, has been found consistently to double a smoker’s chances of successful quitting with or without concomitant behavioral therapy.
A recent review of over 100 trials of NRT with follow-up periods from 6 months to 1 year concluded that NRT helps about 7% of smokers who would not have quit had they used a similar approach without NRT.
NRT products are used primarily to quit smoking and effectively treat the symptoms of nicotine withdrawal and are not prescribed or recommended for any other purpose. Other issues to consider are the health implications of long term use of NRT alone, and the implications of the mixed use of NRT and cigarettes. A recent review of the risks and benefits of NRT reported several significant pieces of evidence regarding these products. If used appropriately, NRTs are comparatively safe products. They emit no tar or carbon monoxide, and they produce lower blood nicotine levels than cigarettes. The use of nicotine products in individuals who are tolerant is not likely to be associated with any acute behavioral toxicity,
In Hughes, Pickens, Spring, and Keenan’s16 (1985) study, smokers trying to quit self-administered more nicotine gum than placebo gum when told they may receive either gum. However, when the placebo gum was described as a new nicotine gum with fewer side effects, or when the nicotine gum was described as a placebo gum with more side effects than the nicotine gum, participants did not self-administer the nicotine gum more than the inactive gum. These studies suggest that smokers’ beliefs and expectations can influence the short-term effects of nicotine delivery devices.
Another population-based survey found that fewer than 15% of smokers who visited a physician were offered smoking cessation assistance, and only 3% were scheduled for follow-up appointments to monitor their tobacco use. This lack of assistance in quitting cigarette smoking is particularly problematic for women, as research indicates that physicians are less likely to ascertain women’s smoking status and to advise women to quit smoking , and women seem to have more difficulties in quitting cigarette smoking than men.
Smoking during pregnancy also has a well-documented negative effect on the health of the mother and her baby. Numerous studies have shown increased risks of pregnancy complications and adverse neonatal outcomes associated with maternal smoking, including placental abruption, spontaneous abortion, stillbirth,fetal growth restriction, preterm delivery,low birth weight, and sudden infant death syndrome . Pregnancy is often a strong motivator for women to stop smoking. It is estimated that 18% to 25% of women who smoke manage to quit when they become pregnant.Nevertheless, many women continue to smoke during pregnancy despite the known adverse consequences for their health. Therefore, effective strategies for reducing maternal smoking during pregnancy are clearly needed.
The efficacies of pharmacotherapies for smoking cessation have been examined in 3 previous meta-analyses. In one, the Tobacco Use and Dependence Guideline Panel performed a meta-analysis of both pharmacologic and behavioural interventions to provide the necessary evidence to update the Smoking Cessation Clinical Practice Guideline of the Agency for Healthcare Research and Quality (AHRQ). The authors did not limit their analysis to studies in which smoking abstinence was validated biochemically. They identified more than 180 articles for possible inclusion in their meta-analysis. Based on these studies, they found that bupropion, nicotine gum, nicotine inhaler, nicotine nasal spray and transdermal nicotine were more efficacious than placebo and recommended their use as first-line therapies for smoking cessation.
Jorenby and colleagues conducted a direct comparison of sustained-release bupropion and transdermal nicotine in a small randomized trial. In this study, 893 patients were randomly assigned to receive sustained-release bupropion, transdermal nicotine patch, combination therapy or double placebo. The authors found significantly higher rates of smoking abstinence at 12 months with the combination therapy (35.5%) and bupropion alone (30.3%) than with transdermal nicotine alone (16.4%) or placebo (15.6%).
Anthonisen et al. (1994) showed that a combination of intensive, specialized care, NRTs, behavioral modification, and relapse prevention training achieved the highest rates of cessation success, with 35% of the intervention group succeeding versus 9% of the controls. However, this intervention was in a group of adults with early signs of lung disease. The program was resource-intensive, expensive, and not applicable to general populations. Even with such intensive therapy, 65% of smokers did not quit, and of those that did, 37% had relapsed within 5 years. In the United Kingdom, trained pharmacists provide information and support for smokers who seek NRT; interventions provided through pharmacists have increased counseling and improved cessation rates.