- Both the nicotine patch and nicotine gum are effective pharmacotherapies for smoking
- The nicotine patch may be easier to use than the gum in most clinical settings.
Make culturally and educationally appropriate materials on cessation techniques readily
available in your office.
Offer intensive smoking cessation programs
If your patient prefers intensive treatment or you think such a program is appropriate, refer him
or her to an intensive smoking cessation program administered by a specialist. Always followup
with the patient about quitting.
- Intensive programs are strongly correlated with cessation success.
- Information obtained in the assessment (e.g., comorbidity, stress level) is useful in
- Many different types of clinicians (e.g., nurses, dentists, psychologists) are effective in
increasing quit rates.
- Intensive programs should offer 4-7 sessions, each at least 20-30 minutes in length,
lasting at least 2 weeks.
- Counseling should offer problem solving and skills training as well as social support.
- Counseling should reinforce motivation to quit and relapse prevention. Individual and
group counseling are both effective.
- Every smoker should be offered nicotine replacement therapy (patch or gum), except
when medically contraindicated.
If a smoker doesn't want to quit, clinicians should ask questions at each visit that help the
patient identify (1) reasons to quit and (2) barriers to quitting. Pledge to assist the patient when
he or she is ready to quit.
Key Treatment Strategies
Three treatment strategies are particularly effective:
Nicotine replacement therapy—Should be encouraged for most patients. Although
patch and gum are both effective, the patch is associated with fewer compliance problems and
requires less effort to train patients in its use.
- Patch: Plan on 8 weeks of therapy. Starting on the quit day, place a new patch, each
morning, on a relatively hairless place between the neck and the waist. Consult the
package insert for dosing suggestions and precautions.
- Gum: Use for up to 3 months. Patients often do not use enough gum to get
benefit. Use one piece every 1-2 hours. Chew and "park" gum (between cheek and gum)
intermittently for about 30 minutes to allow nicotine absorption. Use 4 mg (vs. 2 mg)
dose for highly dependent smokers.
Clinician-provided social support—Should communicate caring and concern by
open to the patient's fears and difficulties.
- Nasal Spray: Recently approved by FDA. Consult package insert for dosing and