Nicotine replacement therapy (NRT)

Nicotine replacement therapy (NRT) can help with the difficult withdrawal symptoms and cravings that 70% to 90% of smokers say is their only reason for not giving up cigarettes. Using NRT reduces a smoker's withdrawal symptoms.

Many smokers can quit smoking without using NRT, but most of those who attempt quitting cannot do it on the first try. In fact, smokers usually need many tries -- sometimes as many as 8 to 10 -- before they are able to quit for good.

Lack of success is often related to the onset of withdrawal symptoms. And most quitters go back to smoking within the first 3 months of quitting. So don't be discouraged if you start smoking again. Just try to stop again and make your attempt more successful by adding another method or technique to help you quit. You can reduce withdrawal symptoms with NRT and reduce their impact with support techniques. This gives you a better chance of quitting and staying quit.
Getting the most from nicotine replacement

Nicotine replacement therapy (NRT) only deals with the physical addiction. It is not meant to be the only method used to help you quit smoking. You should combine it with other smoking cessation methods that help the psychological (emotional and habitual) part of smoking, such as a stop smoking program. Studies have shown that this approach -- pairing NRT with a program that helps to change behavior -- can double your chances of quitting and staying quit.

The US Agency for Healthcare Research and Quality (AHRQ) Clinical Practice Guideline on Smoking Cessation in 2000 recommended NRT for all adult smokers except pregnant women and people with heart or circulatory diseases. But more recent data suggest that NRT (specifically the nicotine patch) can be used safely under a doctor's careful monitoring, even in people who have heart or blood vessel (cardiovascular) disease. These studies have found the benefits of quitting smoking outweigh the risks of NRT in people with cardiovascular disease. When looking at these situations, the benefits of quitting smoking must outweigh the potential health risks of NRT for each person. As of mid-2009 there is still not enough good evidence one way or the other to know if NRT is safe in pregnant women. One 2009 US study found that NRT use during pregnancy led to a higher risk of low birth weight babies and pre-term birth. Of course, these are just some of the risks to the baby if a woman smokes while pregnant. Clearly it is best to quit smoking before getting pregnant, but quitting in early pregnancy can still greatly reduce the risks to the baby. Pregnant smokers should talk with their doctors to get help in choosing the best way for them to quit smoking.

The best time to start NRT is when you first quit. Many smokers ask if it's OK to start a program of NRT while they are still smoking. At this time the companies that make NRT products say that they should not be used if you are still smoking. There is some research being done with smokers using NRT while still smoking, but it is still too early to tell if this is dangerous to your health. The most important thing is to make sure that you are not overdosing on nicotine, which can affect your heart and blood circulation. It is safest to be under a doctor's care if you wish to try smoking and using NRT while you are tapering down your cigarette use.

Often smokers first try to quit on their own then decide to try NRT a day or more into quitting. This method does not give you the greatest chance of success, but do not let this discourage you. There are still many options available for quitting smoking and staying quit.

Note that NRT has not yet been proven to help people who smoke fewer than 10 cigarettes per day. You may want to talk with your doctor about a lower dose of NRT if you smoke less than half a pack per day but feel you need nicotine replacement.
When may I begin using nicotine replacement therapy?

You may start using NRT as soon as you throw away that last cigarette. You do not need to wait a certain length of time to put on the patch or start using the gum, lozenge, nasal spray, or inhaler. You should double-check this information with the instructions on your chosen method of nicotine replacement, but in general there is no need to wait to start using NRT.
How do I know if I'm a light, average, or heavy smoker?

Some NRT products make their recommendations based on what kind of smoker you are. But there is no formal category in any textbook or a group that defines a light, average, or heavy smoker. In general, a light smoker is someone who smokes less than 10 cigarettes per day. Someone who smokes a pack a day or more is a heavy smoker. An average smoker falls in between.

Sometimes a doctor will use the term pack year to describe how long and how much a person has smoked. A pack year is defined as the number of packs of cigarettes a person has smoked every day multiplied by the number of years he or she has smoked. Since 1 pack is 20 cigarettes, a person who has smoked 20 cigarettes a day for a year is considered to have smoked 1 pack year. Someone who has smoked 30 cigarettes a day (1½ packs) for 3 years has smoked 4.5 pack years (1½ x 3), and so on. This is just another way to figure out how high your risk of smoking-related disease might be.