Skip to main content
SpringerLink
Log in

Using Nicotine Replacement Therapy to Assist in Reducing Cigarette Consumption before Quitting

Another Strategy for Smoking Cessation?

  • Leading Article
  • Published:
Disease Management & Health Outcomes

Abstract

Stopping smoking is the most important action that all smokers can take to improve their current and future health. Current smoking cessation treatments produce only modest long-term abstinence rates, and so new cessation methods are required if more smokers are to quit and to avoid relapse. Although most smokers want to quit, only a third make an attempt each year; however, many smokers are interested in reducing their cigarette consumption, and approximately 50% try this approach each year. Such a reduction has questionable health gains; however, it can result in an increase in the likelihood of making a quit attempt and stopping smoking. Results from randomized, placebo-controlled trials in smokers who were not motivated to quit at the time have demonstrated that nicotine replacement therapy (NRT) effectively assists cigarette reduction and, subsequently, helps a small proportion of smokers to eventually quit. Complete smoking cessation remains the ultimate goal, but an NRT-aided reduction strategy may provide a helpful alternative to smokers who want to change their smoking behavior but are not yet ready to stop.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Fig. 1

Similar content being viewed by others

References

  1. Mackay J, Eriksen M. The tobacco atlas: World Health Organization 2002 [online]. Available from URL: http://www.who.int/tobacco/statistics/tobacco_atlas/en/ [Accessed 2006 July 3]

  2. Balfour DJ. Neural mechanisms underlying nicotine dependence. Addiction 1994; 89(11): 1419–23

    Article  PubMed  CAS  Google Scholar 

  3. Balfour D. The neurobiology of tobacco dependence: a preclinical perspective on the role of dopamine projections to the nucleus. Nicotine Tob Res 2004; 6(6): 899–912

    Article  PubMed  CAS  Google Scholar 

  4. Hughes JR. Tobacco withdrawal in self-quitters. J Consult Clin Psychol 1992; 60(5): 689–97

    Article  PubMed  CAS  Google Scholar 

  5. Hajek P, Gillison F, McRobbie H. Stopping smoking can cause constipation. Addiction 2003; 98(11): 1563–7

    Article  PubMed  Google Scholar 

  6. McRobbie H, Hajek P, Gillison F. The relationship between smoking cessation and mouth ulcers. Nicotine Tob Res 2004; 6(4): 655–9

    Article  PubMed  Google Scholar 

  7. Killen JD, Fortmann SP. Craving is associated with smoking relapse: findings from three prospective studies. Exp Clin Psychopharmacol 1997; 5(2): 137–42

    Article  PubMed  CAS  Google Scholar 

  8. Benowitz NL, Gourlay SG. Cardiovascular toxicity of nicotine: implications for nicotine replacement therapy. J Am Coll Cardiol 1997; 29(7): 1422–31

    Article  PubMed  CAS  Google Scholar 

  9. Doll R, Peto R, Boreham J, et al. Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ 2004; 328(7455): 1519

    Article  PubMed  Google Scholar 

  10. West R, Shiftman S. Fast facts: smoking cessation. Oxford: Health Press Ltd, 2004

    Google Scholar 

  11. Hughes JR, Keely J, Naud S. Shape of the relapse curve and long-term abstinence among untreated smokers. Addiction 2004; 99(1): 29–38

    Article  PubMed  Google Scholar 

  12. Royal College of Physicians. Nicotine addiction in Britain. London: Royal College of Physicians, 2000

  13. Sutherland G. Evidence for counseling effectiveness for smoking cessation. J Clin Psychiatry Monograph 2003; 18(1): 22–34

    Google Scholar 

  14. US Department of Health and Human Services. Treating tobacco use and dependence. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research Quality, 2000

    Google Scholar 

  15. Silagy C, Lancaster T, Stead L, et al. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev 2004(3): CD000146

  16. Hughes JR, Stead LF, Lancaster T. Antidepressants for smoking cessation. Cochrane Database Syst Rev 2004(4): CD000031.pub2

  17. West R, McNeill A, Raw M. Smoking cessation guidelines for health professionals: an update. Health Education Authority. Thorax 2000; 55(12): 987–99

    Article  PubMed  CAS  Google Scholar 

  18. Gonzales D, Rennard SI, Nides M, et al. Varenicline, an α4β2 nicotinic acetylcholine receptor partial agonist, vs sustained-release bupropion and placebo for smoking cessation: a randomized controlled trial. JAMA 2006; 296(1): 47–55

    Article  PubMed  CAS  Google Scholar 

  19. Jorenby DE, Hays JT, Rigotti NA, et al. Efficacy of varenicline, an α4β2 nicotinic acetylcholine receptor partial agonist, vs placebo or sustained-release bupropion for smoking cessation: a randomized controlled trial. JAMA 2006; 296(1): 56–63

    Article  PubMed  CAS  Google Scholar 

  20. Nides M, Oncken C, Gonzales D, et al. Smoking cessation with varenicline, a selective α4β2 nicotinic receptor partial agonist: results from a 7-week, randomized, placebo- and bupropion-controlled trial with 1-year follow-up. Arch Intern Med 2006; 166(15): 1561–8

    Article  PubMed  Google Scholar 

  21. Oncken C, Gonzales D, Nides M, et al. Efficacy and safety of the novel selective nicotinic acetylcholine receptor partial agonist, varenicline, for smoking cessation. Arch Intern Med 2006; 166(15): 1571–7

    Article  PubMed  CAS  Google Scholar 

  22. Tonstad S, Tonnesen P, Hajek P, et al. Effect of maintenance therapy with varenicline on smoking cessation: a randomized controlled trial. JAMA 2006; 296(1): 64–71

    Article  PubMed  CAS  Google Scholar 

  23. Center for Drug Evaluation and Research, US Food and Drug Administration. Drugs@FDA: FDA approved drug products. Drug details: Chantix, NDA no. 021928 2006 [online]. Available from URL: http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.DrugDetails [Accessed 2006 Oct 2]

  24. Benowitz N, Prochet H, Jacob PR. Pharmacokinetics, metabolism and pharmacodynamics of nicotine. In: Wonnacott S, Russell MAH, Stolerman IP, editors. Nicotine psychopharmacology: molecular, cellular, and behavioural aspects. Oxford: Oxford University Press, 199–0

  25. McRobbie H, Hajek P. Nicotine replacement therapy in patients with cardiovascular disease: guidelines for health professionals. Addiction 2001 Nov; 96(11): 1547–51

    Article  PubMed  CAS  Google Scholar 

  26. Benowitz N, Dempsey D. Pharmacotherapy for smoking cessation during pregnancy. Nicotine Tob Res 2004; 6 Suppl. 2: S189–202

    Article  PubMed  CAS  Google Scholar 

  27. Shiffman S, Gitchell J, Pinney JM, et al. Public health benefit of over-the-counter nicotine medications. Tob Control 1997; 6(4): 306–10

    Article  PubMed  CAS  Google Scholar 

  28. Pfizer. Nicorette® reduce to stop [promotional material]. Pfizer, 2006

  29. Pfizer. Reducing to stop with NRT: a new route to smoking cessation. Pfizer, 2006

  30. McEwen A, West R. Smoking cessation activities by general practitioners and practice nurses. Tob Control 2001; 10(1): 27–32

    Article  PubMed  CAS  Google Scholar 

  31. West R, McEwen A, Boiling K, et al. Smoking cessation and smoking patterns in the general population: a 1-year follow-up. Addiction 2001; 96(6): 891–902

    Article  PubMed  CAS  Google Scholar 

  32. Hughes JR. Reduced smoking: an introduction and review of the evidence. Addiction 2000; 95 Suppl. 1: S3–7

    PubMed  Google Scholar 

  33. Benowitz NL. The use of biologic fluid samples in assessing tobacco smoke consumption. NIDA Res Monogr 1983; 48: 6–26

    PubMed  CAS  Google Scholar 

  34. Kozlowski LT, Mehta NY, Sweeney CT, et al. Filter ventilation and nicotine content of tobacco in cigarettes from Canada, the United Kingdom, and the United States. Tob Control 1998; 7(4): 369–75

    Article  PubMed  CAS  Google Scholar 

  35. Cinciripini PM, Lapitsky L, Seay S, et al. The effects of smoking schedules on cessation outcome: can we improve on common methods of gradual and abrupt nicotine withdrawal? J Consult Clin Psychol 1995; 63(3): 388–99

    Article  PubMed  CAS  Google Scholar 

  36. Carpenter MJ, Hughes JR, Solomon LJ, et al. Both smoking reduction with nicotine replacement therapy and motivational advice increase future cessation among smokers unmotivated to quit. J Consult Clin Psychol 2004; 72(3): 371–81

    Article  PubMed  Google Scholar 

  37. Medicines and Healthcare products Regulatory Agency. Report of the Committee on Safety of Medicines Working Group on nicotine replacement therapy: MHRA, Committee on Safety of Medicines, 2005 [online]. Available from URL: http://www.mhra.gov.uk/home/idcplg?.IdcService=GET_FILE&d-DocName=CON2023239&RevisionSelectionMethod=LatestReleased [Accessed 2006 Jul 3]

  38. Fagerstrom KO, Tejding R, Westin A, et al. Aiding reduction of smoking with nicotine replacement medications: hope for the recalcitrant smoker? Tob Control 1997; 6(4): 311–6

    Article  PubMed  CAS  Google Scholar 

  39. Wennike P, Danielsson T, Landfeldt B, et al. Smoking reduction promotes smoking cessation: results from a double blind, randomized, placebo-controlled trial of nicotine gum with 2-year follow-up. Addiction 2003; 98(10): 1395–402

    Article  PubMed  Google Scholar 

  40. Bolliger CT, Zellweger JP, Danielsson T, et al. Smoking reduction with oral nicotine inhalers: double blind, randomised clinical trial of efficacy and safety. BMJ 2000; 321(7257): 329–33

    Article  PubMed  CAS  Google Scholar 

  41. Batra A, Klingler K, Landfeldt B, et al. Smoking reduction treatment with 4-mg nicotine gum: a double-blind, randomized, placebo-controlled study. Clin Pharmacol Ther 2005; 78(6): 689–96

    Article  PubMed  CAS  Google Scholar 

  42. Etter JF, Laszlo E, Zellweger JP, et al. Nicotine replacement to reduce cigarette consumption in smokers who are unwilling to quit: a randomized trial. J Clin Psychopharmacol 2002; 22(5): 487–95

    Article  PubMed  CAS  Google Scholar 

  43. Rennard SI, Glover ED, Leischow S, et al. Efficacy of the nicotine inhaler in smoking reduction: a double-blind, randomized trial. Nicotine Tob Res 2006; 8(4): 555–64

    Article  PubMed  CAS  Google Scholar 

  44. Hughes JR, Carpenter MJ. The feasibility of smoking reduction: an update. Addiction 2005; 100(8): 1074–89

    Article  PubMed  Google Scholar 

  45. Action on Smoking and Health. Nicotine assisted reduction to stop (NARS): guidance for health professionals on this new indication for nicotine replacement therapy. London: Action on Smoking and Health, 2005 [online]. Available from URL: http://www.ash.org.uk/html/cessation/Smoking%20reduction/NARS051014.pdf [Accessed 2006 Jul 3]

    Google Scholar 

  46. Pfizer Limited. Cut down gradually with Nicorette then stop [online]. Available from URL: http://www.cutdowntostop.cto.uk [Accessed 2006 Jul 3]

  47. Swan GE, McAfee T, Curry SJ, et al. Effectiveness of bupropion sustained release for smoking cessation in a health care setting: a randomized trial. Arch Intern Med 2003; 163(19): 2337–44

    Article  PubMed  CAS  Google Scholar 

  48. Hatsukami DK, Rennard S, Patel MK, et al. Effects of sustained-release bupropion among persons interested in reducing but not quitting smoking. Am J Med 2004; 116(3): 151–7

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

Hayden McRobbie has provided consultancy to, and received travel support and benefits in kind (hospitality, etc.) from, manufacturers of smoking cessation medications (including nicotine replacement therapy). Robyn Whittaker and Chris Bullen have no competing interests to declare. No sources of funding were used in the preparation of this article.

Author information

Authors and Affiliations

  1. Clinical Trials Research Unit, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand

    Hayden McRobbie (Specializes in Smoking Cessation Research and Treatment), Robyn Whittaker & Christopher Bullen

Authors
  1. Hayden McRobbie
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robyn Whittaker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christopher Bullen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hayden McRobbie.

Rights and permissions

Reprints and permissions

About this article

Cite this article

McRobbie, H., Whittaker, R. & Bullen, C. Using Nicotine Replacement Therapy to Assist in Reducing Cigarette Consumption before Quitting. Dis-Manage-Health-Outcomes 14, 335–340 (2006). https://doi.org/10.2165/00115677-200614060-00003

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00115677-200614060-00003

Keywords

Search

Navigation