Researchers at Duke University Medical Center and the Durham V. A. Medical
Center say the psychological impact of taking even a single puff of a cigarette
on a preset "quit day" means a smoker will probably go back to
smoking within 6 months.
Based on a study of 200 smokers who wanted to quit, the researchers
concluded that people who can't go "cold turkey" likely have
a high physiologic nicotine craving and probably won't be successful quitting
on their own with nicotine patches.
"Few studies have been done to determine which smokers are more
likely to benefit from nicotine patches," said Dr. Eric Westman, the
study's lead author. "This is important because a failed quit attempt
can be demoralizing and discourage many people from trying again. As physicians,
we need to be able to give our patients the best shot at quitting. This
study is a step in that direction."
Although nicotine skin patches double the chances of long-term success
when quitting smoking, only about one in four smokers who use the patch
is still smoke-free after 6 months.
One-Day Observational Test of Nicotine Patch Proposed
Westman, assistant professor of medicine at Duke and medical director
of the Duke-V. A. Nicotine Research Program, and colleagues Frederique
Behm, Dr. David Simel, and Jed Rose, coinventor of the nicotine skin patch,
reported their findings in the February 10, 1997, issue of the Archives
of Internal Medicine. Based on their findings, the researchers propose
a simple one-day observational test to identify which smokers are more
likely to be successful quitting smoking using nicotine skin patches. The
study was supported by the Department of Veterans Affairs.
"We found that people who smoke on their quit day are much more
likely to go back to smoking within 6 months," said Westman. "This
finding contradicts the common idea that people can cheat, even just a
little, and still quit smoking. Our findings indicate that setting a definite
quit date, and sticking to it, is important for long-term success.
In addition, Westman notes, knowing nicotine patches may not work can
save patients considerable money. Over-the-counter nicotine patches cost
an average of $4 a day or $220 for an 8-week treatment.
Previous studies used a 2-week trial period to determine which smokers
are likely to be successful quitting smoking using a nicotine patch, at
an average cost of $56. The Duke study narrows that window to one day,
which could save the smoker both money and frustration.
"If the smoker still craves cigarettes using a single patch after
one day, a physician could suggest adding a second patch, or suggest a
more intensive method," said Westman.
The researchers conducted two sequential studies with healthy smokers
who smoked at least one pack of cigarettes a day and wanted to quit smoking.
The smokers selected a quit date 2 weeks in advance to prepare themselves
for the quit attempt. Smokers completed a daily diary of the number of
cigarettes smoked and any withdrawal symptoms and cravings they experienced.
Any self-reported smoking, even one puff, was counted as smoking in the
The researchers found that 25% of people were still not smoking after
6 months, which is comparable to other such studies. Of these, only 3 of
31 had smoked on the quit date. Conversely, 106 of 173 people who were
unsuccessful had smoked on the quit date. Of those who smoked on the quit
date and also had a high nicotine craving, 98% went back to smoking after
Questions Devised to Help Guide Use of Patches
Based on their findings, the researchers have developed a simple series
of questions to guide smokers and their doctors in determining whether
nicotine patches are for them.
Did the person smoke on the quit date? If so, the odds of being smoke-free
at 6 months are tenfold less than if he or she did not smoke on the quit
date. For example, if a person's chance of quitting smoking at 6 months
is 1 in 4, this drops to 1 in 40 if the person smokes on the quit date.
Does the person smoking have a high or low nicotine craving? If cravings
are low, the person has a fourfold better chance of success. The study
showed that among smokers who didn't smoke on the quit date, 41% of the
low-craving group were still smoke-free after 6 months, as compared with
only 18% of the high-craving group.
The researchers measured nicotine dependence by asking subjects such
questions as how many cigarettes they smoke, how often they smoke, and
how early in the morning they have their first cigarette.
"Now that nicotine skin patches are available over the counter,
many smokers are trying to use them to quit smoking on their own,"
Westman said. "Our study shows that while nicotine patches are an
effective therapy for some smokers, others may need to include counseling
and other therapies as part of their quit attempt."