Some Quitting Tips and Devices [01/19-3]

Excerpts from FITNESS FILE / WANT TO STOP SMOKING? /
THERE ARE MORE WAYS THAN EVER TO QUIT

Newsday (New York, NY) [01/19/98]

Although other, less extreme methods for quitting have become available in the intervening years, smokers who want to stop now will have a much greater choice in finding the "great cure," from well-known gum and transdermal patches to the lesser-known aids like nicotine-free cigarettes and nicotine-laced sprays, inhalers and even anti-depressant medication.

The market for such products is booming. An estimated 45 million people in this country are addicted to cigarettes and about 80 percent of them, or 36 million smokers, would like to quit, according to the National Cancer Institute, based in Bethesda, Md.

Since no two smokers are alike, it's a good thing there are so many products available. But quitting cigarettes is devilishly more complicated than just breaking a nicotine addiction, and so one must alter the most mundane patterns of daily life, says Elbert D. Glover, director of the Tobacco Research Center at the West Virginia University School of Medicine. "People develop behavioral cues around smoking," he says. "They associate it with a favorite chair, alcohol or tense situations, and so smoking becomes inculcated into their way of life."

Of course, some of the new products on the market are better than others. But the most controversial is the nicotine-free cigarette produced by an Atlanta-based company called Safer Smokes Corp. It's made of lettuce leaves and cured with enzymes and flavorings. "It immediately breaks nicotine intake," crows Len Stein, a company spokesman. "It allows people to slowly wean themselves off the psychological addiction to the whole smoking ritual."

Along those lines, R.J. Reynolds and Philip Morris are introducing "smokeless cigarettes" into test markets in a few southern and western states. Their main purpose is to cut down on second-hand smoke, but some smoking cessation experts say that the devices may make the experience of smoking unfamiliar enough to help some people quit. Moreover, smokeless cigarettes boast lower levels of tar and nicotine (0.2 milligrams of nicotine and 3 milligrams of tar) than those found in full-strength smokes. However, they still carry the same harmful cancer-causing substances as regular cigarettes.

There is skepticism about both the nicotine-free cigarettes and their smokeless cousins in helping smokers to kick the habit. Cutting out nicotine is essential to quitting, Glover says. That's why he believes the nicotine-free cigarettes won't fulfill their claims. "If it weren't for nicotine people wouldn't keep smoking," he says.

"These products are a sham," adds Dr. Edward Fisher, author of a new book recently released by the American Lung Association called "Seven Steps to a Smokefree Life."

Luckily, a plethora of other aids have had good results, among them transdermal patches. They work by easing smokers' cravings for nicotine by releasing the chemical into the bloodstream through the skin. Novartis Consumer's Habitrol, Lederle's Prostep, McNeil Consumer's Nictrol Transdermal and SK Beecham's Nicoderm are very similar. Smokers can stave off cravings for nicotine by wearing a series of patches over a period of weeks. Each successive patch administers lower doses of nicotine, starting with a patch that has 21 milligrams of nicotine and typically tapering off to one with only seven milligrams.

The patch has the advantage of being very easy to use. The downside is that it is a passive system that takes away smokers' active involvement in their own treatment, Glover points out. "When smokers make an effort, think about what they're doing, they're much more successful," he says.

That's why some smokers may prefer an aid like Nicorette Gum, also produced by SK Beecham. It is intended to be used over a period of weeks, with the strength of the gum depending on how strong the person's craving is for nicotine. The amount of gum allowed each day decreases over time.

Another promising bet is Nicotrol's nasal spray. The spray, which became available by prescription in recent months, contains small amounts of nicotine (0.5 milligrams / spray.) Smokers can tailor the use of the spray to their nicotine cravings, just the kind of active involvement that can lead to success, Glover says. The spray has been shown to quickly alleviate the discomfort of withdrawal symptoms, like tension, frustration and nervousness.

The downside is that there can be short-term side effects associated with the spray, including irritation of the throat, watery eyes and runny nose.

In the spring, Nicotrol plans to offer a product called the Nicotrol Inhaler, available by prescription. It is fashioned in the shape of a cigarette with cartridges, each containing 10 milligrams of nicotine, that are inserted into the inhaler. During product tests, smokers tended to use between four to six cartridges a day, the company says.

Again, smokers take an active role in deciding when to use the inhaler. And since it mimics the shape of a cigarette and involves a preparation ritual, it has been found to be a good substitute for the cigarette habit, Glover says.

However, testers complained that the inhaler can be difficult to draw on. And the amount of nicotine delivered through the device has been shown to increase at higher temperatures, making overdosing possible, Glover adds.

Researchers have recently found that cigarette smoking is higher among people who suffer from depression. A desire for nicotine is associated with low levels of a neurotransmitter in the brain called dopamine, researchers believe.

Last year, doctors began prescribing Zyban, an antidepressant drug produced by Glaxo Wellcome, to some of their patients who smoke. But, again, the treatment is not right for everyone. As is true for any drug, there are side effects, experts say. "People who suffer from seizures, for example, can't use it," says Mara Bernstein, administrative director of outpatient pulmonary services at Winthrop-University Hospital. And none of these aids can be used indefinitely, she adds. "Whether it's the patch or Zyban, eventually you have to be weaned and fly on your own," Bernstein says.

The new products on the market hold out new hope for addicted smokers. But none are foolproof, experts warn.

To quit a smoker "has to want to do it," says Lorna Katz, a clinical psychologist and specialist in cognitive behavioral therapy at Long Island Jewish Medical Center in New Hyde Park. "Motivation is vital." Echoes Dr. Raja Jaber at University Hospital and Medical Center at Stony Brook's smoking cessation clinic, "The readiness to change is one of the most important factors when a person tries to quit."

That's why these products are often used in conjunction with behavior modification programs, along the lines of Manvich's smoking cessation program.

Smoking cessation programs focus on everything from hypnotic suggestion, to relaxation techniques to just plain, old-fashioned moral support. The key is to modify one's habits, says Joyce Tanzer, a behavioral psychologist at Long Island Jewish. "These people need to see themselves as non-smokers," she says. "They have to accept the fact that they can live without smoking and still enjoy life."

SWITCHING TO LIGHT CIGARETTES to cut back on the tar, nicotine and carbon monoxide in regular-strength smokes? Think again, say researchers at Pennsylvania State University.

Recent studies show the seemingly healthier alternative may not be. Filters on light cigarettes are perforated with more "air dilution" vents. That's why a puff of a light cigarette is about 83 percent air, and tastes like it, says Lynn Kozlowski, head of the school's department of biobehavioral health.

To boost satisfaction smokers unwittingly defeat the vents - by blocking the air holes with their lips. Instead of getting one to two milligrams of carbon monoxide per stick, they can get twice that. Still, lights may seem like a good deal: A full-strength cigarette packs 16 milligrams of carbon monoxide.

To compensate, however, smokers light up more and inhale deeper, Kozlowski says.

PILLS, PATCHES and sprays can help ease the craving for nicotine, but experts say that motivation is the key ingredient for success.

That's why smokers are urged to join some kind of smoking cessation group.

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