Crutches to Quit Smoking

 Shaking, sweating, confusion, disorientation and the depths of despair: the withdrawal symptoms peaked 24 hours after I came off nicotine. Not that I'd smoked for five years, you understand. Instead, I went cold turkey last month when I abandoned the nicotine lozenges that had become my crutch - and an even harder addiction to break. I'd been hooked on the cure for at least the past two-and-a-half years, and the withdrawal was worse than anything I'd experienced coming off cigarettes.

Nicotine replacement therapy (NRT) and cigarettes have been compared to the difference between heroin and its substitute, methadone, which is said to be far harder to be weaned off. Yet I was embarrassed that the debilitating withdrawal symptoms that left me a basket case for three days and jittery for almost a week were not the result of a class-A drug but a sweet flavoured lozenge or gum available in every supermarket.

A month on, I still have the empty, insecure feeling associated with nicotine withdrawal that every former smoker will understand - except I have no interest in cigarettes and only miss the tablet substitutes.

But in the wake of Scotland's smoking ban, sales of NRT products have increased: indeed, according to Asda's figures, they have trebled. Some even display nicotine gums next to ordinary chewing gum.

Allen Carr, the most famous anti-smoking guru of our times and author of the bestselling book, The Easyway to Stop Smoking, believes my experience is just the tip of the iceberg. He fears it is only a matter of time before NRT makes the leap from drug to confectionery. Nicotine-replacement toffee, coffee and chocolate are said to be in testing. "I wonder if these flavours are designed to help smokers quit or are being created for the next mass market of NRT users: our children," says Carr.
As an adult who got hooked on NRT, I dread what it would be like if a child were given the sweet shots of a highly addictive drug. Yet NRT can legally be given to children as young as 12; in an initiative in County Durham, pupils at six secondary schools are being offered nicotine patches as part of an initiative to stop them smoking.

Somehow I didn't stop to consider that by ditching cigarettes for lozenges or gum I was moving on to something equally addictive. But, unlike cigarettes, there are no prominent warnings on these packets.

"The problem facing us today," says Carr, "is not just the tobacco industry but the nicotine industry, which is made up of two major players - the tobacco industry and the pharmaceutical industry. Both have a vested interest in perpetuating addiction to nicotine, not curing it. We have more and more people attending our clinics to get NRT, which does not cure addiction to nicotine - it perpetuates it."

He insists that those who stop smoking by using it do so despite it, not because of it.
I quit my 20-a-day habit easily enough when I fell pregnant for the first time, but after a blip when I smoked for a few days after the birth of my second son, I was desperate not to start again and turned to NRT.

Microtabs, designed to be placed under the tongue, gave me a persistent sore throat. Then I chewed gum until my jaws ached, before moving on to lozenges.

They were a revelation. Suddenly, I was able to get the nicotine buzz of a cigarette with no unpleasant side-effects such as the smoke, or the smell or the tar. Popping them like sweeties, I could get the pleasure of nicotine at times when I'd never have been able to smoke, like bathing the kids or in the cinema. They were discreet: no-one knew the sweet I was sucking was giving me a head-rushing buzz and I was congratulated for not succumbing to cigarettes again.

But within the three months that it's recommended you take NRT such as gum, lozenges, microtabs or patches, I was hopelessly hooked.

Little wonder, considering the tablets, available in 4mg or 2mg of nicotine strengths, were far stronger than the packets of Silk Cut I used to puff, at 0.1mg of nicotine. Even the lowest strength is stronger than "heavy" cigarettes such as Camel, which measure 0.9mg nicotine per cigarette.

But, of course, I wasn't smoking - which means I wasn't inhaling tar or toxins from a cigarette. So, was I in any danger? Could I have stayed sucking the lozenges happily forever?

The pharmaceutical company GlaxoSmithKline, which manufactures lozenges, said in a statement that "long-term use of NRT does not seem to be associated with any significant harmful effects".

It added: "Nicotine from smoking cigarettes is addictive in large part because smoking delivers high doses of nicotine to the brain very quickly - within seconds of taking each puff. In contrast, NRT provides nicotine more slowly and doesn't give the same 'hit'."

The statement added that the prevalence of abuse (use for reasons other than smoking cessation) and of dependence (that is, difficulty stopping) with currently available nicotine medications, was nil for the nicotine patch or very low (less than 10% of users) for nicotine gum, nasal spray and inhaler.

It added: "Even if dependence on nicotine medications develops, there is likely to be an overall health benefit if the individual is no longer smoking cigarettes."

It said that NRT "typically" provided less nicotine than cigarettes. Questioned about why levels of nicotine are so high in NRT, more than the strongest cigarettes at 0.9mg of nicotine, the company's explanation was that "cigarettes actually contain much more nicotine than this - about 10 times more - but the 0.9mg figure is what the tobacco companies say the smoker will inhale. This is based on measurements from a smoking machine. Unfortunately, real smokers do not behave in the same way as the machine". Smokers take more or deeper puffs, and consciously or subconsciously block ventilation holes in the filter.

The company's licence allows for adults to use it unsupervised for up to nine months - after which, it says, they should seek more help and support from the healthcare professionals.

But when I asked pharmacists and doctors for advice, I was told to vary my tablets with normal sweets or gum, which left me as irritable as a smoker denied a cigarette and only compounded my fear that I would never be able to beat the secondary addiction.

Aware that my dependence was far from waning and under increasing pressure from my family to ditch the tablets, I also began to fret about possible side-effects. I had worsening insomnia, not helped by the powerful stimulant I was sucking from dawn to just before bedtime; then I heard about someone with stomach ulcers exacerbated by nicotine gum, and I began to worry about the future risks of mouth cancer.

But I was far from alone and I continually met people at the counter of my usual chemist who said they'd been taking lozenges for months or years. I was even told of one woman on nicotine gum for 23 years.

Anne Penman, a laser therapist whose acupuncture-based treatment eased my withdrawal symptoms, treats people addicted to NRT. "Some people are using both, like wearing patches at work and removing them for a cigarette at breaks and at the end of the day," she says. "Women seem more prone to NRT addiction, partly because of the weight gain associated with stopping smoking.

"What we have now are people who feel too foolish to come forward for help. They feel guilty because family and friends think they are nicotine-free when, of course, they are simply a new type of addict."

I replaced a 20-a-day cigarette habit with a 10-a-day nicotine lozenge habit that cost about £7.50 for a pack of 36, so it was cheaper and without nasty side effects such as the risk of lung cancer or heart disease. But if I ran out, I panicked.

It was a hollow victory over cigarettes and could have been avoided by three days of cold turkey at the very beginning. Instead, many people will now be substituting that with a lifetime of nicotine addiction.

 

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Is cold turkey the only way to quit?

I have seen it written that we have said that the ONLY way to quit smoking is to quit cold turkey. This is not a totally accurate statement. It is not that cold turkey is the only way to quit,; it is just that cold turkey is the method which gives people the best chance of success. It is the method that all but a small percentage of long-term ex-smokers in the world used to successfully quit smoking.

There are people who have quit using alternative approaches. There are some who cut down gradually and actually succeeded at quitting. For every person who did it like this and succeeded, there are many many many many others who tried it and failed. The individual who used the method will think it is great because it worked for him or her, but since it works for so few people it will generally be recognized as a pretty ineffective technique by most people who do "real world" research into how to quit.

By "real world" research I mean by going to long-term ex-nicotine users who you know personally and finding out how they all got off nicotine. Again, you will very rarely find any who did it by gradual withdrawal. If you find a person like this who is now off years, you should never minimize the person's success. He or she quit smoking, likely doing it in a way that made it much more difficult than it needed to be, but still he or she did pull off the quit. The only advice that I would encourage that you share with the person is that now to stay off he or she must understand the bottom line method of sustaining his or her quit. That message is staying cognizant of the addiction and that the only true guaranteed method to stay off now is knowing never to administer nicotine again.

The same principle here applies to people who use NRT products. There are people who have quit this way. Again, it is a small percentage of the long-term ex-users out there, but they do exist. An individual who pulled it off this way will also feel that it is a great method for quitting. But again, this method works for a small percentage of people who try it and if you look into real world long-term quits you will have a very hard time finding many people who actually successfully got off nicotine this way.

I feel it necessary to use that phrase, "got off nicotine," as opposed to saying, "got off smoking." There are some major experts coming out and advocating that people should be given nicotine supplements forever to stay off of smoking. Can this work? Of course it can. If you can give people enough nicotine via supplements it will satisfy their need for nicotine. After all, this is the primary reason they were smoking at the end--to feed a nicotine addiction. If the smoker can just get nicotine for the rest of his or her life via another route, he or she will avoid going through the three days of nicotine withdrawal.

The question needs to be, why should anyone have to pay what is likely to be tens of thousands of dollars to avoid a few days of withdrawal.? On top of this, these people will never be totally free of the moderate withdrawals that such usage is likely to keep going. These people will in fact tout the use of the product as a great aid, but when compared to what people who are totally nicotine free are experiencing, this victory over cigarettes is just a bit hollow.

There are a few people though whom you may encounter over your lifetime that did quit using NRT's as intended, weaning down for week after week and eventually quitting. If the person is now off for years, he or she is pretty much in the same state as a person who had quit cold turkey. He or she is nicotine free, and he or she should be thrilled by that fact. In some ways I look at people like this with a bit of awe, for they in all likelihood stuck with a process that was pretty much a gradual and prolonged withdrawal and yet they succeeded.

Again, debating the merits of their method with them is pretty much a moot point. It worked for them and you are going to have a pretty hard time convincing them that it is an ineffective method. But you do have a message that you can share with them that they do need to know. That message is that even though they are off nicotine for years, they still need to recognize that they are not cured of nicotine addiction and never will be. No matter how they had stopped, they must still understand the bottom line message, that the only way to stay free now is staying totally committed to never administer nicotine again via any nicotine replacement source and to never administer nicotine again from the original source that likely started the whole process by knowing to never take another puff!