Ask Doctor K: The role of nicotine in quitting cigarettes

DEAR DOCTOR K: I’ve decided to quit smoking. Do you think low-nicotine cigarettes could be a good stepping-stone to kicking the habit completely?

DEAR READER: I’m always glad when readers ask about how to quit smoking. It causes so many health problems and so much misery. And while it’s not easy, people can quit smoking. Yet millions of adults and teenagers continue to smoke. The main reason is nicotine. Nicotine is a stimulant that makes smokers feel calm and relaxed. It is also the addictive substance found in all tobacco products. The more you smoke, the more you need to smoke to feel good. It’s the pull of nicotine that makes quitting so difficult.

Recently a team of researchers set out to answer a similar question to the one you asked. They wanted to know: If you could reduce the amount of nicotine in cigarettes, would it help people quit? Or might it cause them to smoke more to compensate?

The researchers followed more than 800 adults who smoked at least five cigarettes a day. These study volunteers had no desire to quit smoking. They were asked to either continue smoking their regular brand of cigarette or to smoke one of six types of investigational cigarettes. These cigarettes contained varying amounts of nicotine, ranging from 15.8 milligrams of nicotine per gram of tobacco (the amount found in most commercial brands) to 0.4 mg per gram. The smokers were followed for six weeks.

The results were unexpected. The people given the lower-nicotine cigarettes smoked 23 percent to 30 percent fewer cigarettes per day than those who smoked the cigarettes with 15.8 mg of nicotine per gram. And, the low-nicotine cigarette smokers also had reduced dependence on nicotine – and fewer cravings for cigarettes when they weren’t smoking.

This study lasted six weeks. We’ll need longer trials to study if low-nicotine cigarettes are a “safer” option for people who are trying to quit.

If you want to quit, nicotine replacement therapy can help you overcome the physical addiction of nicotine. NRT can include patches, lozenges, gum and nasal sprays.

Prescription drugs like bupropion (Zyban) and varenicline (Chantix) can also help smokers quit. They reduce physical cravings and make smoking less enjoyable. These methods work especially well when combined with behavioral supports, such as talk therapy.

My patients who are contemplating quitting often get hung up on a misconception. They ask, “The damage already is done, so what’s the use of quitting?” In fact, here’s what happens after you smoke your last cigarette. After 12 hours, your tissues are better able to get needed oxygen from your blood. Within one month, your lungs begin to recover. After one year, your risk of a having a heart attack, a stroke or getting lung cancer begins to fall.

It isn’t easy, but you can quit: There are more ex-smokers in the United States today than there are smokers.