What therapies/medications can help me quit smoking?

There are a variety of medical and alternative therapies that can be used to fight nicotine addiction. The following are brief descriptions of several treatment options. In addition to your physician, there are numerous quit-smoking specialists in the Boston Area and Web sites that can help you decide what option is best for you.

Please note: The following information is not a replacement for medical advice. Our goal is to connect people with resources that can help them quit smoking. It is important to talk with your doctor before choosing a quit-smoking plan. Not all treatment options will be covered under all insurance plans, and some options require a doctor's prescription for use.

	Questions to think about before choosing a treatment option Pharmacotherapy/Medications: The Nicotine Patch Nicotine Gum Nicotine Nasal Spray Nicotine Inhaler Zyban Alternative Therapy: Hypnosis Acupuncture Other

Here are some questions you may want to ask yourself before choosing a method:

• Do I have any health concerns that may limit my treatment options (pregnancy, heart problems, skin rashes, allergies, seizures, etc.)?
• How often do I smoke?
• Why do I smoke?
• What is the cost of the treatment?
• Will it be covered under my insurance?
• Do I have to take the medications at certain times of the day?

Pharmacotherapy/Medications

The Nicotine Patch (Nicotrol, Nicoderm) (Over-the-Counter)
The nicotine patch is worn (usually) on the upper arm and/or shoulder once a day and comes in various doses. (You can wear two patches at the same time, depending on how much you smoke.) The patch releases low doses of nicotine to your body throughout the day to lessen withdrawal symptoms. Someone who is interested in using the patch should be prepared to stop smoking when beginning this treatment option. It is a treatment option for people who have been smoking regularly (i.e., every 2 hours). The patch is worn for 6-8 weeks and costs approximately $50/box of 14 patches. (Many treatment programs offer the patch for a reduced cost.) Most common side effects include skin allergy and insomnia (difficulty sleeping). People with heart conditions, sensitive skin or skin diseases should consult their doctors first before using this treatment (5).

The Nicotine Gum (Nicorette) (Over-the-Counter)
Nicotine gum is chewed and "parked" (positioned along the gumline like you would chewing tobacco) every couple of hours or when cravings occur. The gum releases low doses of nicotine to the body to lessen cravings as they happen. Someone who is interested in using the gum should be prepared to reduce the number of cigarettes smoked, or completely stop smoking before beginning this treatment option. This treatment is well-suited for people who smoke at certain times of the day (i.e., after dinner). It is used for one- to-three months and costs approximately $50-57/box of 108 pieces. Most common side effects include soreness of mouth and hiccups. The gum is not a recommended treatment option for people who wear dentures or other dental appliances and those with severe jaw problems (5).

The Nicotine Nasal Spray (Prescription Only)
The nicotine nasal spray is sprayed into the nose 1-2 times every hour or when cravings occur. The spray releases doses of nicotine that are absorbed through the nasal membranes. This treatment is well-suited for those people who smoke at certain times of the day (i.e., after dinner) because it provides immediate nicotine when you chose to use the spray. Someone interested in this treatment option must have a doctor's prescription to use it. It is used for 8 to 12 weeks and costs approximately $54/10ml bottle. Most common side effects include nose and throat irritation, watery eyes, sneezing, and cough. The spray is not a recommended treatment option for people with allergies, asthma, or chronic nasal disorders (5).

The Nicotine Inhaler (Prescription Only)
The nicotine inhaler is puffed through the mouth 6-16 times a day or whenever cravings occur. The inhaler provides doses of nicotine that are absorbed by the lining of the mouth. Someone interested in the inhaler as a treatment option must have a doctor's prescription to use it. It is used from 8 to 12 weeks and costs approximately $56 for 42 cartridges. Most common side effects associated with use include mouth and throat irritation. The inhaler is not a recommended treatment option for people who have allergies to menthol (5).

Zyban (Prescription Only)
Zyban is a pill that is taken by mouth initially once a day for the first few days, then twice a day for the remainder of the therapy. (This is to ensure tolerance to the side-effects.) To be effective, Zyban must be taken 1-2 weeks before quitting to work. Zyban is a non-nicotine medication that decreases withdrawal symptoms. Persons interested in using this treatment option must have a doctor's prescription. It is used between 7 and 12 weeks and costs approximately $103 per month, but this cost is often covered by insurance. Zyban can also but used with the nicotine patch. Studies have shown that taken together, Zyban and the nicotine patch yield better quit rates that Zyban alone or the patch alone. Most common side effects associated with Zyban include dry mouth, insomnia, shakiness, and skin rash. Zyban should not be used by people who are suffering from seizure disorders or eating disorders (e.g. anorexia, bulimia) or are currently taking certain anti-depressant medications (5).

Alternative Therapy

The use of alternative therapy, particularly hypnosis and acupuncture, has been an increasingly popular approach in helping people quit smoking. A disadvantage, however, is that little research has been done on the effectiveness of alternative therapy in the treatment of nicotine addiction. Like any quit-smoking method, alternative therapy should be discussed with a specialist or your healthcare provider as a potential treatment option to be used in combination with other treatment options.

Hypnosis
During hypnosis, a person works with a therapist who gives suggestions that stay in the mind after the therapy session ends. Hypnosis works to give a person the skills to relax, to make them feel more positive about his/her ability to quit and to cope with stress and other triggers that keep them from quitting smoking. The duration of use and cost vary. It is unclear if there are side-effects from hypnosis (6).

Acupuncture
Acupuncture uses small, flexible needles or pressure balls that are placed (usually) on the ear to help lessen cravings for cigarettes. Acupuncture works to reduce withdrawal symptoms from tobacco addiction. Many individuals find it to be painless other than the initial needle pricks. The duration of treatment and cost vary. It is unclear if there are side-effects from acupuncture (6).

Other Methods
There are of course many other options to help you quit smoking. These options include, but are not limited to the following: quitting on your own (also known as "quitting cold turkey"), reducing the number of cigarettes smoked, changing smoking habits, quit-smoking groups, individual counseling, and the use of books, tapes, and/or videos. Whatever method you choose, be sure to discuss it with a specialist or your healthcare provider.