If you’re a smoker trying to quit, the good news is that there are a number of things that can help you kick the habit. The bad news is that they may not work long term.
A new study confirms what many smokers already know — that quitting is really really hard, and even the latest smoking cessation strategies like gums and patches can’t curb the nicotine craving for very long.
Researchers report in the journal Tobacco Control that nicotine gum and nicotine patches designed to help smokers quit aren’t any more effective than going cold turkey when it comes to keeping smokers off cigarettes for longer than a few months. Beyond that, their ability to curb the need for cigarettes isn’t as clear.
“We were disappointed,” says Gregory Connolly, director of the Center for Global Tobacco Control at Harvard School of Public Health and a co-author of the paper. “We didn’t get the results we hoped we would get.”
Connolly and his colleagues studied 787 adult smokers in Massachusetts who had recently quit smoking. They were followed between 2001 and 2006, and answered questionnaires at three different times about whether they had started smoking again. At each of the three survey periods, one third of the participants had relapsed, and they were relatively evenly distributed among those who had used nicotine replacement, those who combined nicotine replacement with counseling, and those who didn’t use nicotine replacement strategies at all. (The trial did not include many participants using the most recently approved pill-based nicotine replacement drug varenicline (Chantix), since it only became available in 2006. But other studies have shown that varenicline may not be an effective first line drug for smoking cessation.)
“The findings say that we are pretty good at getting people to quit, but not great at getting people to stay quit,” says Connolly. Granted, nicotine replacement therapies aren’t smoking cessation drugs per se — they’re treatments that provide small amounts of nicotine to ease the brain and body from withdrawal from the larger hits from cigarettes. Still, Connolly was hoping that therapies would show some long term benefit for smokers, especially in the context of social interventions such as smoking bans in public places and higher prices on cigarettes. “We thought that if we changed social norms, that would drive people toward treatment [with nicotine replacement therapies] and that the individual treatment effect would be enhanced by the synergy of the two,” says Connolly. “We didn’t see that. Our study showed that Marlboro Light 100s are far more effective at inducing relapse than Nicorette gum is in preventing relapse.”
If they don’t do much good, how did the nicotine replacement therapies get approved in the first place? In studies, smokers who used nicotine replacement doubled their chances of quitting for more than six months. But it’s worth noting that clinical trials may not accurately reflect real world conditions. The study participants, for example, may have been more motivated to see the products succeed and therefore may have been more compliant with chewing the gum (which many smokers agree isn’t a really pleasant experience) or applying the patches. In fact, says Connolly, there is evidence that in his study, smokers weren’t as vigilant about using the nicotine replacement, and may not have applied the patches correctly or chewed the gum as directed.
In addition, the studies all measured smoking rates over a relatively short time period of several months to a year.
So what does work in helping smokers to quit for good? Societal changes, such as bans on lighting up in public places (including outdoors), and taxes and price hikes on cigarettes, seem to be the strongest deterrents to smoking so far. Connolly hopes that his study results, while disappointing, help to steer the Food and Drug Administration, which since 2009 has the authority to regulate tobacco products, to consider other ways of curbing the cigarette habit. Taking a hard look at nicotine replacement products would be one strategy, and possibly holding them to a higher standard of efficacy. Altering the nicotine content of cigarettes to lower its addictive properties might be another. “We have made an awful lot of progress toward a smoke-free society,” he says. “But we still have a lot of work to do to get there.”