Precessation treatment with nicotine patch significantly increases abstinence rates relative to conventional treatment.
BACKGROUND
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.


CONCLUSIONS
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.
Rose
Jed E
JE
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA. rose0003@mc.duke.edu
Herskovic
Joseph E
JE
Behm
Frederique M
FM
Westman
Eric C
EC
D000279:Administration, Cutaneous; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000008:administration & dosage*; D018733:Nicotinic Antagonists / Q000008:administration & dosage*; D011292:Premedication / Q000379:methods*; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy*; D014029:Tobacco Use Disorder / Q000188:drug therapy*; D016896:Treatment Outcome; D055815:Young Adult
D018733:Nicotinic Antagonists; D009538:Nicotine