Better Than Turkey: Using NRT to Manage Cravings

[Dr_Hays]

After last week’s blog exploring “cold turkey”, I’d like to share some information about a treatment method that has been proven to help people stop.  This particular approach is referred to as combination nicotine replacement therapy (NRT) and can be very effective in managing symptoms of withdrawal when properly planned with a healthcare provider.  This blog is meant to be informational and not intended to diagnose or provide treatment. 

What does combination NRT mean?

Combination nicotine replacement therapy means using the nicotine patch, a “long-acting” replacement, with one of the shorter, faster-acting nicotine medications such as the gum, lozenge, inhaler or nasal spray.  The idea behind this is that the patch will provide a baseline of coverage from withdrawal symptoms and cravings.  While the patch is doing the “heavy lifting” throughout the day, a person can use the faster-acting NRT during triggering situations to manage “break-through cravings”.  As smoking habits and cues fade, individuals can taper their nicotine use until they feel comfortable being nicotine- and tobacco-free.

I feel it is important to note that medications are no silver bullet.  Stopping smoking is a process that involves multiple factors including: changing behaviors, having the right mindset, getting support from others, and finding ways to manage the withdrawal process.  Medications can be a game-changer in helping people control cravings which is why it is always recommended to speak with a care provider in determining the best approach for you. 

You can learn more about the stop smoking medications from my old friend and colleague, Dr. Richard Hurt, through the BecomeAnEx video series on medications.

References

Stead LF, Perera R, Bullen C, Mant D, Hartmann-Boyce J, Cahill K, Lancaster T. Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD000146. DOI: 10.1002/14651858.CD000146.pub4

[JonesCarpeDiem]

"As smoking habits and cues fade, individuals can taper their nicotine use until they feel comfortable being nicotine- and tobacco-free."

Anyone who becomes psychologically dependent on the drug to keep their quit will continue using it .

[JonesCarpeDiem]

or go back to smoking

[YoungAtHeart]

How does this method help a person relearn life without feeding the nicotine addiction? 

Nancy

[Jennifer-Quit]

I used the patch for 6 weeks - no regrets at all.  The Arkansas quit line suggested that I also use nicotine gum.  I chose not to.   But  I did make a deal with myself that I would use the gum first if I decided to start smoking again.  We are all individuals and what works for one does not necessarily work for someone else.  The number one most important thing to be a successful quitter is getting your head in the right place and keeping it there.   That is just my opinion.   A good attitude will take you far!

[MarilynH]

I quit smoking with sugar free mints, carrots and celery sticks plus lots of water and that worked for me .

[bonnie-12-28-14]

Chantix!  Was hooked on the gum for over 10 years and used many times and always went back.  The trick is to find what works for you.  

[joyeuxencore]

I know NRT has worked for some people but I believe it is just another scheme worked up by the drug companies for profit. 

[JonesCarpeDiem]

I used the patch.

Two things I realized.

1.  NRT's do not make you think of smoking any less.  The urge to smoke is driven by routine as much as nicotine. When you stop using nicotine and change your routine you can unlearn the psychological connection and be free.

2. They will not keep you from smoking.

Implying they will do these two things is patently false and leads to people becoming psychologically dependent on the NRT expecting it do do the work of quitting for them.

[YoungAtHeart]

I think perhaps I was unclear.  Each person is different and may require a different approach.    I support use of the patch, or Rx drugs or any method where the addict does not control the dose.  The nicotine is out of your body in 72 hours once you stop putting it in.  Then, your body has to adjust to life without it.  I understand doing that gradually.  I don't like the idea of popping gum or lozenge or using an inhaler in addition for a crave.  How about distracting instead?  A crave will go away whether you smoke or not.  Using additional nicotine, I think, only prolongs the addiction to it. 

jmo!

Nancy

[dchege]

The patch has been very helpful it has been two weeks now for me, and I found that the last two days I forgot to put one on and I am doing great. I think since I forgot about it, the determination and habit of not smoking and the ability to disassociate myself from smoking, while the patch assisted me with the urges those first weeks made a huge difference. I am a professional and have to maintain a very cool even temperament, I think that the patch really did the trick. Thanks everyone.

[crazymama_Lori]

I used the patch for 2 1/2 months.  I was more emotionally tied to smoking and deleting the nicotine was too much for me.  But I have been off the patch for 3 weeks and hanging in there.  I don't think I would have made it without it.  I had to have it for that time to get my thinking in order.

[bubica]

i ustu stop smoking for 2 years using nicotin inheler (only for 3 monts) after that i will have on me inheler in case i have urge to smoke.Worked for me.Than I make stuped move.I got 1 cigarete  than 2 and on and on ..Become smoker again..Now i cant bread, pain in chest, cough a lott but now I cant stop smoking?? It"s so hard to even make desision?Whay please someone to help me somehow Thank You and congrats for people whoo stop smoking

[bubica]

I forgot to say I am 63 years ald start smoking when I was 15..May health is bad and smoking make it even worst..Do not know how and what to do to stop smoking  I think I am very week and dependet on nicotin what else

[Dr_Hays]

@Bubica Congratulations on your past success!  Two years is an incredible feat when it comes to stopping smoking and it sounds like you must have been using a number of positive coping skills to manage cravings and withdrawal.  I can read from your notes that quitting smoking is important to you in order to maintain your overall health.  While you mention that you feel weak, I would suggest that you are quite strong based on your stop smoking history!

The frustrating nature of tobacco dependence is that even a few cigarettes can re-trigger the addiction after quitting.  However, it is possible to turn things back around.  It will just take some planning along the way.  

While I cannot offer treatment or make diagnoses over the internet, I would encourage you to speak with your primary care provider and try to connect with a tobacco treatment specialist in your area (http://attud.org/treatment-providers.php).  Think back to the two years that you did so magnificently - what were you doing to get through routine triggers? How did you not smoke over two years in moments of stress? Sadness? Celebration?  It may take a bit of memory jogging, but you were on the right track and we want to get back there.

An important piece in all of this is to continue reaching out for support like you did in your comments above, Bubica.  There are highs and lows to quitting and having a support network can offer the boosts of confidence we'll need along our journey.  Make connections, "friend" people on their profiles, and stick with the winners.  There are a lot of them here on Ex and we want you to feel like one too.

Best of luck,

Dr. Hays