Re: a health dilemma.

From: Anders Sandberg (
Date: Mon Jan 21 2002 - 04:34:43 MST

On Mon, Jan 21, 2002 at 01:14:19AM -0700, animated silicon love doll wrote:
> i've been smoking off and on since i was about fifteen (four years, or so). about two thirds
> of that time i've smoked cloves. i want, and need, to quit. i don't have much faith in
> patches or gum; if nicotine is more addictive than heroin, like they tell us, then a gradual
> decrease will probably not work.

Actually, the problem with addiction to smoking is that the "high"
appears so quickly when you light a cigarette. This creates a very
short lag between action and reward, and that is why smoking is so
addictive (similar with intravenously injected drugs). Taking a gum
or dermal patch will create a far slower buildup of nicotine, and
this will not have the same reinforcing effect while allowing you to
avoid withdrawal symptoms.

The patches and gum seem to work, although they *help*, they do not
do the job for you:

Nicotine replacement therapy for smoking cessation (Cochrane Review).

Silagy C, Lancaster T, Stead L, Mant D, Fowler G.

BACKGROUND: The aim of nicotine replacement therapy (NRT) is to
replace nicotine from cigarettes. This reduces withdrawal symptoms
associated with smoking cessation thus helping resist the urge to
smoke cigarettes. OBJECTIVES: The aims of this review were to
determine the effectiveness of the different forms of nicotine
replacement therapy (chewing gum, transdermal patches, nasal spray,
inhalers and tablets) in achieving abstinence from cigarettes, or a
sustained reduction in amount smoked; to determine whether the effect
is influenced by the clinical setting in which the smoker is
recruited and treated, the dosage and form of the NRT used, or the
intensity of additional advice and support offered to the smoker; to
determine whether combinations of NRT are more effective than one
type alone; and to determine its effectiveness compared to other
pharmacotherapies. SEARCH STRATEGY: We searched the Cochrane Tobacco
Addiction Group trials register in April 2001. SELECTION CRITERIA:
Randomized trials in which NRT was compared to placebo or no
treatment, or where different doses of NRT were compared. We excluded
trials which did not report cessation rates, and those with follow-up
of less than six months. DATA COLLECTION AND ANALYSIS: We extracted
data in duplicate on the type of subjects, the dose and duration and
form of nicotine therapy, the outcome measures, method of
randomization, and completeness of follow-up. The main outcome
measures was abstinence from smoking after at least six months of
follow-up. We used the most rigorous definition of abstinence for
each trial, and biochemically validated rates if available. Where
appropriate, we performed meta-analysis using a fixed effects model
(Peto). MAIN RESULTS: We identified 108 trials; 94 with a non NRT
control group. The odds ratio for abstinence with NRT compared to
control was 1.73 (95% confidence interval 1.62-1.85), The odds ratios
for the different forms of NRT were 1.66 for gum, 1.76 for patches,
2.27 for nasal spray, 2.08 for inhaled nicotine and 1.73 for nicotine
sublingual tablet. These odds were largely independent of the
duration of therapy, the intensity of additional support provided or
the setting in which the NRT was offered. In highly dependent smokers
there was a significant benefit of 4 mg gum compared with 2mg gum
(odds ratio 2.67, 95% confidence interval 1.69 to 4.22). There was
weak evidence that combinations of forms of NRT are more effective.
Higher doses of nicotine patch may produce small increases in quit
rates. Only one study directly compared NRT to another
pharmacotherapy, in which bupropion was significantly more effective
than nicotine patch or placebo. REVIEWER'S CONCLUSIONS: All of the
commercially available forms of NRT (nicotine gum, transdermal patch,
the nicotine nasal spray, nicotine inhaler and nicotine sublingual
tablets) are effective as part of a strategy to promote smoking
cessation. They increase quit rates approximately 1.5 to 2 fold
regardless of setting. The effectiveness of NRT appears to be largely
independent of the intensity of additional support provided to the
smoker. Provision of more intense levels of support, although
beneficial in facilitating the likelihood of quitting, is not
essential to the success of NRT. There is promising evidence that
bupropion may be more effective than NRT (either alone or in
combination). However, its most appropriate place in the therapeutic
armamentarium requires further study and consideration.

Anders Sandberg                                      Towards Ascension!                  
GCS/M/S/O d++ -p+ c++++ !l u+ e++ m++ s+/+ n--- h+/* f+ g+ w++ t+ r+ !y

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