What nicotine replacement options can help me quit smoking?

DEAR DOCTOR K:

I’ve been trying to quit smoking with nicotine replacement patches, but it hasn’t worked. Any suggestions?

DEAR READER:

Smoking may be the toughest unhealthy habit to break, but it is possible. There are more ex-smokers in the United States today than there are smokers.

There are two main obstacles that make cigarettes particularly hard to quit: First is the physical withdrawal from nicotine. Second is the psychological withdrawal from a habit that has become part of your daily routine.

Nicotine replacement is available as patches, gum, sprays, inhalers and lozenges. They can help overcome the physical addiction of nicotine. If that doesn’t work, consider varenicline (Chantix) and bupropion (Zyban). These medications reduce physical cravings and make smoking less enjoyable.

Two new studies support the use of quit-smoking medications plus nicotine replacement for smokers who haven’t been able to quit using nicotine replacement alone.

In one study, researchers compared varenicline plus nicotine replacement with varenicline alone. The combination worked better.

In the other study, researchers recruited 222 smokers who weren’t able to kick the habit with just nicotine replacement. They assigned them to take varenicline alone or varenicline plus bupropion, while continuing to use a nicotine patch. After 12 weeks, 40 percent of those taking both medications were no longer smoking, compared to 25 percent of those taking only varenicline.

These results don’t suggest that smokers take varenicline and bupropion as a first step in smoking cessation. Though they are effective, both drugs can have dangerous side effects. They can increase the risk of depression, hostility and suicidal thoughts. But when nicotine replacement alone hasn’t helped, adding varenicline with or without bupropion may lead to success.

A non-drug strategy that may help you quit is proper planning. Once you have decided to quit, take concrete steps. Set a quit date. Sign up for a stop-smoking support group. Develop strategies for getting back on track if you slip.

Also consider cognitive behavioral therapy (CBT). This type of “talk therapy” will help you change thoughts and behaviors that may be getting in the way of quitting.

Finally, if you don’t succeed on your first attempt to quit smoking, try again when you are ready. The average person makes several attempts before quitting for good.

And remember that it’s never too late to quit. Many of my patients who are longtime smokers have told me that they don’t see the point of quitting. They think smoking for so many years must have led to irreversible damage, so what’s the point of quitting now?

It is obviously true that the sooner a person quits, the better. But it also is true that no matter how much you have smoked in the past, stopping now will increase your life expectancy. That’s true even for smokers over age 65, and those who already have some degree of smoking-related disease, like emphysema.

In fact, if you’ve had a heart attack in the past due, in part, to smoking, stopping now will reduce your risk of another heart attack by 25 to 50 percent.