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How often do your patients who smoke say that when they attempt to quit smoking, they eventually lapse and smoke again?
While it may seem logical to attribute those lapses to the habit of smoking itself, research indicates that physical dependence is not easily separated from the habit of smoking.1 The desire to smoke is caused by both nicotine abstinence (withdrawal cravings) and smoking-associated habitual triggers (situational cravings).2 These situational cravings are periodic, and may be cue-induced—that is, triggered by stress, cigarette smoking, alcohol, and other behavioral or environmental cues which smokers may be unable to avoid.
During periods of abstinence, the situational cravings can reoccur long after withdrawal cravings have subsided.3 Even in smokers whose withdrawal cravings are adequately controlled by therapy, situational cravings can be intense.4
In fact, situational cravings are a main cause of lapse back to initial smoking.5 Willpower alone may not be enough to relieve situational cravings. And left untreated, situational cravings can cause lapse within as little as 11 minutes. This is why controlling situational cravings is critical to prevent certain lapses.5
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Recent brain imaging studies provide a physiologic basis for distinguishing cue-induced situational cravings from withdrawal cravings. In a recent brain imaging study of neural response to drug cues in smokers, exposure to smoking cues elicited brain activity patterns different from those seen during abstinence.1
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Yet, there is hope for patients who smoke and would like to quit. Recent laboratory studies have demonstrated that the administration of medicinal nicotine, via nicotine gum or lozenge, can significantly reduce situational craving.6-8 This suggests that acutely-delivered nicotine in the form of a gum or lozenge can “take the edge off” cue-induced cravings, and can possibly prevent them from progression to relapse.
Two such products are Nicorette® Gum and COMMIT® Lozenge.
Either COMMIT Lozenge or Nicorette Gum—both of which were proven in major clinical trials to quickly relieve situational cravings7,8—can help patients cope with these cravings during abstinence, and improve the odds of long-term success.9 COMMIT Lozenge is clinically proven to provide relief from situational cravings in only five minutes.8
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Sources:
1. West, R, Shiffman, S, Smoking Cessation Fast Facts, Health Press, page 42-51, 2004.
2. West R, Shiffman S. In: Fast Facts- Smoking Cessation. Oxford, England: Health Press Limited; 2004:42-51.
3. Shiffman S, Engberg JB, Paty, et al. A day at a time: predicting smoking lapse from daily urge. J Abnorm Psychol. 1997; 106:104-116.
4. Tiffany ST, Cox LS, Elah CA. Effects of transdermal nicotine patches on abstinence-induced and cue-elicited craving in cigarette smokers. J Consult Clin Psych. 2000;86:233-240.
5. Shiffman S, Paty JA, Gnys M, Kassel JA, Hickox M. First lapses to smoking: within-subjects analysis of real-time reports. J Consult Clin Psych. 1996;64:366-379.
6. Niaura R, Sayette M, Shiffman S, Glover ED, Nides M, Shelanski M, Shadel W, Koslo R, Robbins B, Sorrentino J (2005) Comparative efficacy of rapid-release nicotine gum versus nicotine polacrilex gum in relieving smoking cue-provoked craving. Addition 100(11):1720-30.
7. Shiffman S, Shadel WG, Niaura R, Khayrallah MA, Jorenby DE, Ryan CF, Ferguson CL (2003) Efficacy of acute administration of nicotine gum in rerlief of cue-provoked cigarette craving. Psychopharmacology 166(4):343-50.
8. Durcan MJ, De’Ath J, Targett D, Marsh H, Chan R, Ong TJ (2003) Efficacy of the nicotine lozenge in relieving cue provoked cravings. Poster presented at the annual European meeting of the Society for Research on Nicotine and Tobacco, Padua, Italy.
9. Shiffman, S, et al, Efficacy of a nicotine lozenge for smoking cessation, archives Internal Medicine, 2002; 162; 1267-1276.
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