Skip to main content
NCBI home page
The BMJ logoLink to The BMJ
. 1994 Jan 1;308(6920):21–26. doi: 10.1136/bmj.308.6920.21

How effective is nicotine replacement therapy in helping people to stop smoking?

J L Tang 1, M Law 1, N Wald 1
PMCID: PMC2539178  PMID: 8179658

Abstract

OBJECTIVE--To assess the efficacy of nicotine replacement therapy in helping people to stop smoking. DESIGN--Analysis of the results of 28 randomised trials of nicotine 2 mg chewing gum, six trials of nicotine 4 mg chewing gum, and six trials of nicotine transdermal patch. SUBJECTS AND SETTING--Subjects were self referred (responding to advertisements or attending anti-smoking clinics) in 20 trials and invited (general practice or hospital patients) in 20. Therapists in self referred trials were generally experienced in helping people stop smoking but not in invited trials. MAIN OUTCOME MEASURE--Efficacy was defined as difference in percentages of treated and control subjects who had stopped smoking at one year. RESULTS--Efficacy was highly significant (P < 0.001) for both gum and patch. Nicotine 2 mg chewing gum had an overall efficacy of 6% (95% confidence interval 4% to 8%), greater in self referred subjects than in invited subjects (11% v 3%). Efficacy depended on the extent of dependence on nicotine as assessed by a simple questionnaire; it was 16% (7% to 25%) in "high dependence" smokers, but in "low dependence" smokers there was no significant effect. The 4 mg gum was effective in about one third of "high dependence" smokers. The efficacy of the nicotine patch (9% (6% to 13%) overall) was less strongly related to nicotine dependence, perhaps because the patch cannot deliver a bolus of nicotine to satisfy craving. CONCLUSIONS--Both gum and patch are effective aids to help nicotine dependent smokers who seek help in stopping. Among the most highly nicotine dependent smokers (those craving a cigarette on waking) the 4 mg gum is the most effective form of replacement therapy; it could enable one third to stop. In less highly dependent smokers the different preparations are comparable in their efficacy but the patch offers greater convenience and minimal need for instruction in its use. Overall, nicotine replacement therapy could enable about 15% of smokers who seek help in stopping smoking to give up the habit.

Full text

PDF
21

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abelin T., Buehler A., Müller P., Vesanen K., Imhof P. R. Controlled trial of transdermal nicotine patch in tobacco withdrawal. Lancet. 1989 Jan 7;1(8628):7–10. doi: 10.1016/s0140-6736(89)91671-1. [DOI] [PubMed] [Google Scholar]
  2. Areechon W., Punnotok J. Smoking cessation through the use of nicotine chewing gum: a double-blind trial in Thailand. Clin Ther. 1988;10(2):183–186. [PubMed] [Google Scholar]
  3. Belcher M., Jarvis M. J., Sutherland G. Nicotine absorption and dependence in an over the counter aid to stopping smoking. BMJ. 1989 Mar 4;298(6673):570–570. doi: 10.1136/bmj.298.6673.570. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Benowitz N. L., Jacob P., 3rd Intravenous nicotine replacement suppresses nicotine intake from cigarette smoking. J Pharmacol Exp Ther. 1990 Sep;254(3):1000–1005. [PubMed] [Google Scholar]
  5. Benowitz N. L., Jacob P., 3rd, Savanapridi C. Determinants of nicotine intake while chewing nicotine polacrilex gum. Clin Pharmacol Ther. 1987 Apr;41(4):467–473. doi: 10.1038/clpt.1987.58. [DOI] [PubMed] [Google Scholar]
  6. Benowitz N. L. Nicotine replacement therapy during pregnancy. JAMA. 1991 Dec 11;266(22):3174–3177. [PubMed] [Google Scholar]
  7. Blöndal T. Controlled trial of nicotine polacrilex gum with supportive measures. Arch Intern Med. 1989 Aug;149(8):1818–1821. doi: 10.1001/archinte.1989.00390080080018. [DOI] [PubMed] [Google Scholar]
  8. Campbell I. A., Lyons E., Prescott R. J. Stopping smoking. Do nicotine chewing-gum and postal encouragement add to doctors' advice. Practitioner. 1987 Jan;231(1423):114–117. [PubMed] [Google Scholar]
  9. Daughton D. M., Heatley S. A., Prendergast J. J., Causey D., Knowles M., Rolf C. N., Cheney R. A., Hatlelid K., Thompson A. B., Rennard S. I. Effect of transdermal nicotine delivery as an adjunct to low-intervention smoking cessation therapy. A randomized, placebo-controlled, double-blind study. Arch Intern Med. 1991 Apr;151(4):749–752. [PubMed] [Google Scholar]
  10. DerSimonian R., Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986 Sep;7(3):177–188. doi: 10.1016/0197-2456(86)90046-2. [DOI] [PubMed] [Google Scholar]
  11. Fagerström K. O. A comparison of psychological and pharmacological treatment in smoking cessation. J Behav Med. 1982 Sep;5(3):343–351. doi: 10.1007/BF00846161. [DOI] [PubMed] [Google Scholar]
  12. Fagerström K. O. Effects of nicotine chewing gum and follow-up appointments in physician-based smoking cessation. Prev Med. 1984 Sep;13(5):517–527. doi: 10.1016/0091-7435(84)90020-3. [DOI] [PubMed] [Google Scholar]
  13. Fagerström K. O. Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment. Addict Behav. 1978;3(3-4):235–241. doi: 10.1016/0306-4603(78)90024-2. [DOI] [PubMed] [Google Scholar]
  14. Fee W. M., Stewart M. J. A controlled trial of nicotine chewing gum in a smoking withdrawal clinic. Practitioner. 1982 Jan;226(1363):148–151. [PubMed] [Google Scholar]
  15. Fernö O. A substitute for tobacco smoking. Psychopharmacologia. 1973 Jul 19;31(3):201–204. doi: 10.1007/BF00422510. [DOI] [PubMed] [Google Scholar]
  16. Fiore M. C., Jorenby D. E., Baker T. B., Kenford S. L. Tobacco dependence and the nicotine patch. Clinical guidelines for effective use. JAMA. 1992 Nov 18;268(19):2687–2694. [PubMed] [Google Scholar]
  17. Gilbert J. R., Wilson D. M., Best J. A., Taylor D. W., Lindsay E. A., Singer J., Willms D. G. Smoking cessation in primary care. A randomized controlled trial of nicotine-bearing chewing gum. J Fam Pract. 1989 Jan;28(1):49–55. [PubMed] [Google Scholar]
  18. Hall S. M., Tunstall C. D., Ginsberg D., Benowitz N. L., Jones R. T. Nicotine gum and behavioral treatment: a placebo controlled trial. J Consult Clin Psychol. 1987 Aug;55(4):603–605. doi: 10.1037/0022-006X.55.4.603. [DOI] [PubMed] [Google Scholar]
  19. Harackiewicz J. M., Blair L. W., Sansone C., Epstein J. A., Stuchell R. N. Nicotine gum and self-help manuals in smoking cessation: an evaluation in a medical context. Addict Behav. 1988;13(4):319–330. doi: 10.1016/0306-4603(88)90038-x. [DOI] [PubMed] [Google Scholar]
  20. Heatherton T. F., Kozlowski L. T., Frecker R. C., Fagerström K. O. The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire. Br J Addict. 1991 Sep;86(9):1119–1127. doi: 10.1111/j.1360-0443.1991.tb01879.x. [DOI] [PubMed] [Google Scholar]
  21. Hjalmarson A. I. Effect of nicotine chewing gum in smoking cessation. A randomized, placebo-controlled, double-blind study. JAMA. 1984 Nov 23;252(20):2835–2838. [PubMed] [Google Scholar]
  22. Hughes J. R., Gust S. W., Keenan R. M., Fenwick J. W., Healey M. L. Nicotine vs placebo gum in general medical practice. JAMA. 1989 Mar 3;261(9):1300–1305. [PubMed] [Google Scholar]
  23. Hughes J. R., Gust S. W., Pechacek T. F. Prevalence of tobacco dependence and withdrawal. Am J Psychiatry. 1987 Feb;144(2):205–208. doi: 10.1176/ajp.144.2.205. [DOI] [PubMed] [Google Scholar]
  24. Huhtasaari F., Asplund K., Lundberg V., Stegmayr B., Wester P. O. Tobacco and myocardial infarction: is snuff less dangerous than cigarettes? BMJ. 1992 Nov 21;305(6864):1252–1256. doi: 10.1136/bmj.305.6864.1252. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Jamrozik K., Fowler G., Vessey M., Wald N. Placebo controlled trial of nicotine chewing gum in general practice. Br Med J (Clin Res Ed) 1984 Sep 29;289(6448):794–797. doi: 10.1136/bmj.289.6448.794. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Jarvik M. E., Schneider N. G. Degree of addiction and effectiveness of nicotine gum therapy for smoking. Am J Psychiatry. 1984 Jun;141(6):790–791. doi: 10.1176/ajp.141.6.790. [DOI] [PubMed] [Google Scholar]
  27. Jarvis M. J., Raw M., Russell M. A., Feyerabend C. Randomised controlled trial of nicotine chewing-gum. Br Med J (Clin Res Ed) 1982 Aug 21;285(6341):537–540. doi: 10.1136/bmj.285.6341.537. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Jensen E. J., Schmidt E., Pedersen B., Dahl R. Effect of nicotine, silver acetate, and ordinary chewing gum in combination with group counselling on smoking cessation. Thorax. 1990 Nov;45(11):831–834. doi: 10.1136/thx.45.11.831. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Killen J. D., Fortmann S. P., Newman B., Varady A. Evaluation of a treatment approach combining nicotine gum with self-guided behavioral treatments for smoking relapse prevention. J Consult Clin Psychol. 1990 Feb;58(1):85–92. doi: 10.1037//0022-006x.58.1.85. [DOI] [PubMed] [Google Scholar]
  30. Kornitzer M., Kittel F., Dramaix M., Bourdoux P. A double blind study of 2 mg versus 4 mg nicotine-gum in an industrial setting. J Psychosom Res. 1987;31(2):171–176. doi: 10.1016/0022-3999(87)90073-0. [DOI] [PubMed] [Google Scholar]
  31. Kuwahara A., Cooke H. J. Tachykinin-induced anion secretion in guinea pig distal colon: role of neural and inflammatory mediators. J Pharmacol Exp Ther. 1990 Jan;252(1):1–7. [PubMed] [Google Scholar]
  32. Malcolm R. E., Sillett R. W., Turner J. A., Ball K. P. The use of nicotine chewing gum as an aid to stopping smoking. Psychopharmacology (Berl) 1980;70(3):295–296. doi: 10.1007/BF00427889. [DOI] [PubMed] [Google Scholar]
  33. Müller P., Abelin T., Ehrsam R., Imhof P., Howald H., Mauli D. The use of transdermal nicotine in smoking cessation. Lung. 1990;168 (Suppl):445–453. doi: 10.1007/BF02718163. [DOI] [PubMed] [Google Scholar]
  34. Page A. R., Walters D. J., Schlegel R. P., Best J. A. Smoking cessation in family practice: the effects of advice and nicotine chewing gum prescription. Addict Behav. 1986;11(4):443–446. doi: 10.1016/0306-4603(86)90025-0. [DOI] [PubMed] [Google Scholar]
  35. Pirie P. L., McBride C. M., Hellerstedt W., Jeffery R. W., Hatsukami D., Allen S., Lando H. Smoking cessation in women concerned about weight. Am J Public Health. 1992 Sep;82(9):1238–1243. doi: 10.2105/ajph.82.9.1238. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Puska P., Bjorkqvist S., Koskela K. Nicotine-containing chewing gum in smoking cessation: a double blind trial with half year follow-up. Addict Behav. 1979;4(2):141–146. doi: 10.1016/0306-4603(79)90048-0. [DOI] [PubMed] [Google Scholar]
  37. Russell M. A., Feyerabend C., Cole P. V. Plasma nicotine levels after cigarette smoking and chewing nicotine gum. Br Med J. 1976 May 1;1(6017):1043–1046. doi: 10.1136/bmj.1.6017.1043. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Russell M. A., Jarvis M. J., Feyerabend C., Fernö O. Nasal nicotine solution: a potential aid to giving up smoking? Br Med J (Clin Res Ed) 1983 Feb 26;286(6366):683–684. doi: 10.1136/bmj.286.6366.683. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Russell M. A., Merriman R., Stapleton J., Taylor W. Effect of nicotine chewing gum as an adjunct to general practitioner's advice against smoking. Br Med J (Clin Res Ed) 1983 Dec 10;287(6407):1782–1785. doi: 10.1136/bmj.287.6407.1782. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Russell M. A., Stapleton J. A., Feyerabend C., Wiseman S. M., Gustavsson G., Sawe U., Connor P. Targeting heavy smokers in general practice: randomised controlled trial of transdermal nicotine patches. BMJ. 1993 May 15;306(6888):1308–1312. doi: 10.1136/bmj.306.6888.1308. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Segnan N., Ponti A., Battista R. N., Senore C., Rosso S., Shapiro S. H., Aimar D. A randomized trial of smoking cessation interventions in general practice in Italy. Cancer Causes Control. 1991 Jul;2(4):239–246. doi: 10.1007/BF00052140. [DOI] [PubMed] [Google Scholar]
  42. Sutherland G., Stapleton J. A., Russell M. A., Jarvis M. J., Hajek P., Belcher M., Feyerabend C. Randomised controlled trial of nasal nicotine spray in smoking cessation. Lancet. 1992 Aug 8;340(8815):324–329. doi: 10.1016/0140-6736(92)91403-u. [DOI] [PubMed] [Google Scholar]
  43. Sutton S., Hallett R. Randomized trial of brief individual treatment for smoking using nicotine chewing gum in a workplace setting. Am J Public Health. 1987 Sep;77(9):1210–1211. doi: 10.2105/ajph.77.9.1210. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Sutton S., Hallett R. Smoking intervention in the workplace using videotapes and nicotine chewing gum. Prev Med. 1988 Jan;17(1):48–59. doi: 10.1016/0091-7435(88)90071-0. [DOI] [PubMed] [Google Scholar]
  45. Tønnesen P., Fryd V., Hansen M., Helsted J., Gunnersen A. B., Forchammer H., Stockner M. Effect of nicotine chewing gum in combination with group counseling on the cessation of smoking. N Engl J Med. 1988 Jan 7;318(1):15–18. doi: 10.1056/NEJM198801073180104. [DOI] [PubMed] [Google Scholar]
  46. Tønnesen P., Fryd V., Hansen M., Helsted J., Gunnersen A. B., Forchammer H., Stockner M. Two and four mg nicotine chewing gum and group counselling in smoking cessation: an open, randomized, controlled trial with a 22 month follow-up. Addict Behav. 1988;13(1):17–27. doi: 10.1016/0306-4603(88)90021-4. [DOI] [PubMed] [Google Scholar]
  47. Tønnesen P., Nørregaard J., Mikkelsen K., Jørgensen S., Nilsson F. A double-blind trial of a nicotine inhaler for smoking cessation. JAMA. 1993 Mar 10;269(10):1268–1271. [PubMed] [Google Scholar]
  48. Wald N. J., Idle M., Boreham J., Bailey A. Serum cotinine levels in pipe smokers: evidence against nicotine as cause of coronary heart disease. Lancet. 1981 Oct 10;2(8250):775–777. doi: 10.1016/s0140-6736(81)90187-2. [DOI] [PubMed] [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES