Smoke-free in small steps – it works

It’s better to do less than not at all, which is often the more attractive option for addicts. In nicotine withdrawal with medications, this strategy may actually work-an option for patients who can’t quit overnight.

By Thomas Mueller Published: 09.03.2015, 05:01

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You don't necessarily have to stop smoking overnight. A slow withdrawal with the help of medicines can succeed

Quitting smoking does not necessarily have to be done overnight. A slow withdrawal with the help of medicines can succeed.

ROCHESTER. If you manage to stop smoking from one day to the next, you can count on a certain admiration from your fellow men and especially from your fellow smokers, but most people find it extremely difficult to take such a step.

Many do not keep up abstinence for long and quickly relapse.

In addiction medicine, the realization is slowly gaining ground that it can already be a success if those affected succeed in consuming fewer drugs. Then it may also be easier to quit completely one day.

One-third succeed in withdrawal after three months

Whether this concept works with smokers, now psychiatrists around Dr. Jon Ebbert of the Mayo Clinic in Rochester reviewed (JAMA 2015; 313(7):687-694).

In a randomized-controlled trial, they studied the cessation drug varenicline in smokers who were unwilling or unable to stop inhaling burnt tobacco immediately, but agreed to smoke less and make at least one attempt to quit the vice completely within three months.

A total of 1510 smokers from ten countries – including Germany – took part in the study.

About half received varenicline (1 mg/d) for six months, the other half placebo. A further six months was spent monitoring the success of the intervention.

Consumption is initially cut by 50 percent

The smokers were asked to cut their consumption by 50 percent in the first month, by 75 percent by the end of the second month and completely by the end of the third month at the latest.

All participants received various brochures and advice on nicotine withdrawal, and they also had a counselor available to assist them by phone or at one of the 18 doctor visits.

For example, he encouraged participants who failed withdrawal or relapsed to try again.

As it turned out, nearly one-third of patients on varenicline (32 percent) remained abstinent from the end of the third month to the end of the sixth month; in the placebo group, only about 7 percent managed to do so.

Patients were considered abstinent if they reported abstaining from smoking and at the same time did not show elevated levels of carbon monoxide in their breath during physician visits.

Abstinence rates were highest in weeks 21 to 24, at the end of withdrawal treatment; during those weeks, nearly 38 percent in the varenicline group kept their hands off cigarettes, cigars or the pipe, compared with only 13 percent with placebo.

After the end of therapy, 27 percent remained abstinent with varenicline treatment and 10 percent with placebo for the entire next six months; overall, abstinence rates were three to four times higher with the partial nicotinic receptor agonist than with placebo.

The goal of reducing nicotine consumption by at least 50 percent within one month was achieved by 47 percent of the patients with varenicline and 31 percent of those with placebo.

After eight weeks, 26 percent of the smokers in the group using the cessation drug had managed to reduce their consumption by three quarters, compared with only 15 percent using the placebo.

Nausea as a frequent side effect

About 28 percent of participants on varenicline reported nausea; only 9 percent did in the placebo group.

Vomiting, constipation, insomnia, and weight gain were also observed significantly more often with the cessation drug than with placebo, but these complaints occurred relatively rarely overall.

Serious side effects were observed in 3.7 percent of patients with varenicline and in 2.2 percent with placebo; study physicians noted treatment discontinuations due to side effects with similar frequency in both groups (at 8.4 and 7.0 percent, respectively).

For Ebbert and his team of psychiatrists, the results of the study are proof that even smokers who are unwilling or unable to stop smoking abruptly – as required by guidelines – are able to quit.

Drug-assisted cessation could therefore be an attractive option for a large group of smokers.

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