Dorothy K Hatsukami

Several speakers have introduced the notion that nicotine replacement should be considered part of a comprehensive treatment for smoking cessation, and I think this notion is an important one. However, I am going to reiterate Jack’s statement that we may want to take a different approach and say that nicotine replacement could be considered as the first line of treatment and ancillary treatment should be provided which augments the effectiveness of nicotine replacement. That is, up to this point, we have typically asked whether nicotine replacement will improve the success of behavioural treatment for smoking cessation. Perhaps we should ask what type of behavioural treatment or information should be provided to the smoker that will augment the success of nicotine replacement. In other words, switch the focus in terms of our research questions.

I want to discuss three other areas concerning nicotine- replacement agents. These three areas are the effects of nicotine replacement on withdrawal symptoms, the use of nicotine replacement in special populations, and finally, the importance of examining group differences in response to nicotine replacement.

One of the primary rationales that’s given for the use of nicotine replacement is the reduction or relief of withdrawal symptoms. However, I think there’s evidence to indicate that there is some other mechanism besides the reduction or relief of withdrawal signs and symptoms which is operative in the benefits derived from nicotine-replacement agents. First, evidence exists showing that the duration of the effect of nicotine replacement on tobacco withdrawal does not indicate the duration of use, and I think most of us who are treating smokers know this. Several studies have shown that nicotine gum, for example, has significant effects on withdrawal during the first month and perhaps only during the first week of smoking cessation. On the other hand, studies have …