Nicotine & Tobacco Research Advance Access published online on June 30, 2009
Nicotine & Tobacco Research, doi:10.1093/ntr/ntp103
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Precessation treatment with nicotine patch significantly increases abstinence rates relative to conventional treatment
Jed E. Rose, Ph.D., Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
Joseph E. Herskovic, Ph.D., Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
Frederique M. Behm, C.R.A., Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
Eric C. Westman, M.D., Department of Medicine, Duke University Medical Center, Durham, NC
Corresponding Author: Jed E. Rose, Ph.D., Duke Center for Nicotine and Smoking Cessation Research, 2424 Erwin Road, Suite 201, Durham, NC 27705, USA. Telephone: 919-668-5055; Fax: 919-668-5088; E-mail: rose0003{at}mc.duke.edu
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Abstract |
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Introduction: Previous studies have reported that smoking abstinence rates are increased when nicotine skin patch treatment is initiated prior to the target quit smoking date, as compared with conventional treatment beginning on the quit date. We hypothesized that smoking in the presence of continuous levels of nicotine would attenuate the reinforcing effects of cigarette smoking and lead to a decline in dependence on inhaled nicotine, thus facilitating cessation.
Methods: This study involved four groups of smokers (n = 100 per group) who received either nicotine patch (21 mg/24 hr) or placebo patch treatment for 2 weeks before the quit smoking date, and during this period, smoked their usual brands of cigarettes or switched to low-tar and nicotine cigarettes: a 2 (nicotine patch) x 2 (cigarette type) factorial design. From the quit date on, all groups received standard nicotine patch treatment, consisting of 6 weeks of 21 mg/24 hr, 2 weeks of 14 mg/24 hr, and 2 weeks of 7 mg/24 hr. Abstinence was defined as self-report of no smoking from the quit date on, confirmed by expired-air carbon monoxide.
Results: Continuous abstinence rates were approximately doubled by precessation nicotine patch treatment. The treatment mainly benefited smokers with lower levels of dependence, based on Fagerström Test for Nicotine Dependence score. All treatments were well tolerated.
Discussion: In view of these findings and similar results from previous studies, current labeling of the nicotine patch, which recommends using nicotine replacement therapy only after the quit date, should be reexamined.
Received: October 11, 2008; Accepted: March 6, 2009
Present address: Joseph E. Herskovic, Ph.D., Conagra Foods, Inc., Omaha, NE