Nicotine Gum and Smoking Cessation
By Bob Sherman
All nicotine replacement therapy (NRT) products provide nicotine to your system. They attempt to release nicotine into your blood stream so it can travel to your brain and satisfy the brain's requirements. This reduces your craving for nicotine and the symptoms of that craving.
In addition to cravings due to low nicotine levels in your blood stream, those attempting to quit smoking also experience more intense, episodic craving due to situations that typically cue smoking. Such situations may be noticing smoking paraphernalia, smelling smoke, watching someone smoke, or being in situations associated with smoking.
Nicotine replacement therapy (NRT) medications such as the nicotine patch are intended to raise the nicotine blood concentrations when applied to the skin and maintain a certain concentration throughout the day. The patch cannot provide an incremental dose of nicotine to help reduce the more intense cravings associated with smoking cues.
NRT medications such as nicotine gum, inhaler, nasal spray, and lozenges are more effective in dealing with episodic cravings. They provide a boost in nicotine that can help relieve cue induced cravings.
Nicotine polacrilex gum provides a slow release of nicotine that provides a maximum blood concentration after approximately 20 minutes. While this is effective in many situations, it may cause relapse to smoking when more intense smoking cues are encountered.
When you use nicotine polacrilex gum, you should chew the gum for about 20 minutes to extract the maximum amount of nicotine. When you feel a tingling in your mouth, you should "park" the gum until the tingling goes away. Then resume chewing. Since the nicotine is absorbed in your mouth, excess saliva will cause you to swallow the nicotine, thus lowering your dose and making the gum less effective.
One study had subjects use nicotine gum, nasal spray, and inhalers. Both the 2 mg and 4 mg version of nicotine gum were tried. Nicotine gum was chosen as the easiest and safest to use, and most preferred to use in public. The 4 mg version of the gum was selected as delivering enough nicotine.
In another study, a new rapid release nicotine gum was tested against the traditional polacrilex gum. After being exposed to smoking cues, users of the rapid release nicotine gum described more rapid reduction in craving. In addition, more users of rapid release nicotine gum indicated a meaningful relief of cravings, and they indicated that craving relief can sooner than users of traditional nicotine polacrilex gum.
In a British study, smoking clinic patients were given either psychological treatment or supplied with 2 mg nicotine gum. After one month on 22% of those in the psychological treatment group stopped smoking while 59% of those using the nicotine gum quit. After one year, the numbers had dropped so that 14% of those in the psychological treatment remained abstinent while 38% of those using the nicotine gum remained abstinent.
Most people in the British study using nicotine gum chewed 8 pieces of gum per day after one month. After 3 months 78% of the subjects had quit chewing gum and all had stopped chewing gum after 18 months. The length of time gum chewing persisted was related to the initial concentration of nicotine in the blood; those with higher concentrations persisted in chewing nicotine gum for longer periods of time.
In a study of low income housing unit residents, some housing developments were provided motivational interviewing counseling for smoking cessation and some housing developments were provided counseling about using fruits and vegetables. The smoking cessation groups also received nicotine polacrilex (slow, sustained release) gum and educational materials related to smoking cessation. Those in the fruits and vegetables groups received fresh fruits and vegetables, a cookbook and dietary materials.
At the end of 6 months, the quit rates were 9.3% for the smoking cessation groups and 7.6% or the fruit and vegetable groups. This does not demonstrate a statistically significant benefit for the nicotine gum therapy. Some reasons may be lax adherence to gum use with only 26% of residents using most of the gum and 62% using some of the gum.
Another study of 97 workers (of whom 63 fully participated) who smoked between 14 and 50 cigarettes a day were given nicotine gum and several counseling treatments. The study found that smoking patterns and gum chewing patterns were similar. In particular, the morning time to first cigarette accurately predicted the time to first nicotine gum. In most cases, both smoking rates and gum chewing increased during the day and peaked in the early evening hours.
While it typically takes 3 to 5 minutes to smoke a cigarette, it requires around 20 to 30 minutes to get the maximum nicotine content from chewing gum. Because of this, the number of pieces of gum chewed per day was lower than the number of cigarettes typically smoked per day. This also has the effect of reducing the concentration of nicotine in the blood.
A study of African American light smokers (less than 10 cigarettes per day) showed that 2 mg nicotine gum did not produce significantly higher quit rates than placebo gum. A possible reason for the insignificant effect of nicotine gum in this study may be that African Americans tend to prefer high tar/nicotine and mentholated cigarettes, inhale deeply, and have a slower rate of nicotine metabolism. This causes the blood nicotine concentration to be elevated compared to what would be expected of the non-African American light smokers. Because of these factors, it was thought that 4 mg nicotine gum possibly would have a better effect.
Overall, nicotine gum can be an effective tool to help reduce cravings. It must be chewed according to direction and loss of does due to swallowing saliva should be controlled.
References
- Martin Raw, M J Jarvis, C Feyerabend & M A H Russell, Comparison of nicotine chewing-gum and psychological treatements for dependent smokers, British Medical Journal, 16 August 1980, 481-482
- Kolawole S Okuyemi, Aimee S James, Matthew S Mayo, Nicole Nollen, Delwyn Catley, Won S Choi & Jasjit S Ahluwalia, Pathways to Health: A Cluster Randomized Trial of Nicotine Gum and Motivational Interviewing for Smoking Cessation in Low-Income Housing, Health Education & Behavior, June 15, 2006.
- Marc Mooney, Charles Green & Dorthy Hatsukami, Nicotine self-administration: cigarette versus nicotine gum diurnal topography, Human Psychopharmacology: Clinical and Experimental, 21(8), 539,548.
- Jasjit S Ahluwalia, Kolawole Okuyemi, Nicole Nollen, Won S Choi, Harsohena Kaur, Kim Pulvers * Matthew S Mayo, The effects of nicotine gum and counseling among African American light smokers: a 2x2 factorial design, Addiction v 101, 883-891.
- Raymond Niaura, Michael Sayette, Saul Shiffman, Elbert D Glover, Mitch Nides, Morris Shelanski, William Shadel, Randy Koslo, Bruce Robbins & Jim Sorrentino, Comparative efficacy of rapid-release nicotine gum verser nicotine polacrilex gum in relieving smoking cue-proved craving, Addiction v 100, 1720-1730.
- Nina G Schneider, Scott Terrace, Margaret A Koury, Shilpan Patel, Behram Vaghaiwalla, Regina Pendergrass, Richard E olmstead & Chris Cortner, Comparison of three nicotine treatements: initial reactions and preferences with guided use, Psychopharmacology, v 182 (2005), 545-550.
Take a look at other pages on our site:
| How to Stop Smoking Cigarettes By Bob Sherman The learn how to stop smoking cigarettes, you must understand that your addiction to cigarettes is both physical and phychological.There is no question that smoking is Read more at How To Stop Smoking Cigarettes | Smoking, Nutrition and Supplements By Bob Sherman A single puff on a cigarette introduces more than 1015 (a thousand trillion or 1,000,000,000,000,000) free radicals and other oxidants into the smoker's lungs. This produces oxidative Read more at Smoking And Supplements | Banned TV Cigarette Commercials If you are old enough to remember cigarette commercials on Tv, you will enjoy these memories. Remember these old cigarette commercials?Marlboro CommercialBJECT Read more at Cigarette Commercials | How Menthol Cigarettes Increase Blood Nicotine Levels and Mask Warning Signs of Illness By Bob Sherman What exactly is the purpose of menthol in menthol cigarettes and how does it affect you?Menthol is often found in cough medicines and other preparations for minor throat irritation and Read more at Menthol Cigarettes |
