(relaxing electric guitar music)
- My name is Doctor Mary Brunette.
I'm an addiction psychiatrist
and I'm an associate professor of psychiatry
at the Geisel school of medicine at Dartmouth.
I'm here to talk with you
about nicotine replacement therapy.
Nicotine replacement therapy includes nicotine
that comes from tobacco.
It is delivered in safe, FDA regulated forms
in known doses that reduce withdrawal.
Many forms are available over the counter in drug stores
depending upon how much people use
the cost is about $100 a month.
Usually less than people spend on their cigarettes.
Many state telephone counseling lines,
called quit lines,
will provide free nicotine replacement therapy
to people who want to try to quit.
I will focus, today, on forms
of nicotine replacement therapy
that are available over the counter in drug stores.
There is a patch that people put on their arm each day,
there's gum that people put in their mouth and chew,
or there's a lozenge that's like a cough drop.
Using one patch on the arm each day
in combination with gum or lozenge
at times when you know urges will occur
is the most effective method of using
nicotine replacement therapy.
Now many people who have tried it
feel that it didn't work for them,
but this may be because they didn't use it correctly,
or they didn't use a high enough dose.
Nicotine replacement therapy really works quite well
when people use it correctly.
It increases people's will power as they try to quit.
Let's talk about the patch first.
The patch comes in 21 milligram doses
that are used for people who smoke
more than half a pack a day.
The package states to use a patch on the arm
each day starting on your quit day
for six weeks.
Then taper down by using 14 milligram patches each day
for two weeks.
Then the seven milligram patch each day for two weeks.
The directions now say people can keep using the patch
even if they slip and have a cigarette
and they can use them for longer periods of time
if needed to quit.
People put the patch on first thing in the morning
after washing and drying the area of skin
where they plan to put the patch.
It can be placed anywhere on the upper body
between the neck and the waist,
but the best place is on a part of the arm
that doesn't have much hair.
Take a patch out of the box,
open it's package,
peel off the cover, place it on the arm
and press for 10 seconds to make sure it's sticking fully.
People who smoke during the night
should leave the patch on all day
and all night and take it off in the morning
before they put on a new one.
People who find they have vivid dreams at night
while using the patch should take it off
before they go to bed.
The patch is designed to deliver most of it's nicotine
through the skin over the course of one day.
It takes about an hour or more for the nicotine
to slowly build up in the body in contrast
to when you smoke and you get a really rapid burst
of nicotine.
For that reason, the patch is not addictive.
Now, people who smoke first thing in the morning,
may want to set their alarm early
to put the patch on or use a gum or lozenge
right when they get up in the morning
so that they avoid smoking first thing in the morning.
Now it's not uncommon for the skin under the patch
to turn a little red or to be a little itchy
from the nicotine or from the adhesive.
If a person gets some irritation on their skin
they can try putting each patch
on a different part of the body each day
or they can try a lower dose of the patch.
Now let's talk about nicotine replacement gum
and lozenge.
They come in two milligram and four milligram doses.
People who smoke more than half a pack a day
or who smoke within 30 minutes after the get up
should use the four milligram dose.
The gum and the lozenge should be used
at least nine times a day
and they can be used every hour.
People should avoid drinking or eating
15 minutes before they use the gum or lozenge
because anything acidic in the mouth,
like coffee or orange juice,
will prevent the absorption of nicotine
through the lining of your mouth.
To use the gum, people can chew the gum for a little bit
until they feel a tingly flavor coming out.
Then they park the gum between their gum
and their cheek for a few minutes.
Nicotine coming out of the gum
will be absorbed through the lining of the cheek
into the bloodstream over the course of around 10 minutes.
It builds up gradually, unlike cigarettes,
so again, gum and lozenge are not addictive.
When a person can no longer taste the tingly nicotine
coming out of the gum,
they chew it again until they have that taste
coming out and then they park the gum again
and let it sit for a while.
People repeat this process for about 15 minutes.
Again it takes 10 or 15 minutes for the nicotine
to really build up in the bloodstream,
which is different from the cigarette
which gets into the bloodstream immediately.
People should move the gum or the lozenge
around in their mouth to avoid irritation
in any one part of the mouth,
and here's an important point.
Many people don't realize they're not supposed
to shallow the nicotine that comes from the gum.
If you shallow it the nicotine just goes into your stomach
and causes stomach upset
and it gets broken down rather than
absorbed in your bloodstream.
So it's important to let that nicotine sit in your mouth
and get absorbed through the lining of your cheek.
Now the lozenge is like a cough drop
or a hard candy.
To use it the person sucks on it
until they taste some nicotine coming out of it
then they also park that between their gum
and the lining of their cheek.
Just like the gum the nicotine
is going to come out of the lozenge
and get absorbed through the lining of the cheek.
If people leave the gum or lozenge in one spot
of their mouth it can cause irritation.
So it's best to move it around to different parts
of your gum and cheek.
The lozenges are good for people
who have sensitive teeth or dentures
or who don't like gum.
Lozenges and gum both come in a variety of flavors.
Using two kinds of nicotine replacement therapy
is more effective than just one.
People should try using a patch on their arm
every day and a gum or lozenge in their mouth
throughout the day as they experience urges.
Also, people should use the gum or lozenge
a half hour before they expect to be in situations
that will trigger urges.
Remember it takes an hour or two
for the patch to kick in
and it takes 15 or 20 minutes for the gum or lozenge
to really kick in.
People should have a patch at their bedside
to put on in the morning and pop a lozenge
or gum in their mouth right away
in order to avoid that first cigarette in the morning.
People can start using gum or lozenge
to replace cigarettes any time they want.
People start using the patch on their quit day.
Many people wonder whether nicotine replacement therapy
is really safe.
When it first came out a person using it
had smoked while they had the patch on
and had a heart attack,
so people were really worried
that is might cause heart attacks
if you smoke while you're using the patch.
To figure out if this was really true,
researchers brought smokers into a lab
and hooked them up to heart monitors.
They placed three nicotine patches
on their arms and they had them smoke heavily.
What they found was that the nicotine
in the bloodstream did not cause heart attacks,
but it did increase people's blood pressure
and their heart rate.
So all smokers get the effect of having their blood pressure
and heart rate increased by the nicotine
in cigarettes,
and nicotine replacement therapy also will have that effect.
If a person has very high blood pressure
or a very high heart rate,
they should get treatment from their doctor right away
and quitting smoking will be really important
for their health.
Using nicotine replacement therapy is now proven
to be perfectly safe,
including for people with heart diseases.
However, if people use too much nicotine,
either by smoking or by using nicotine replacement therapy
or by both,
they may feel sick to their stomach
or dizzy or have a fast heart rate.
If that happens, they simply need to stop.
Either stop smoking or remove the patch
or remove the gum or lozenge.
Nicotine replacement therapy is a safe method
to reduce urges to smoke and withdrawal symptoms
while people cut down and quit.
It improves people's chances of quitting for good,
but most people still have to put effort into changing
their smoking habit.
Education and counseling can help people
learn skills to do that.
If you haven't seen my video on nicotine
and nicotine withdrawal,
you should check it out.
It will help you understand why nicotine replacement therapy
works so well.
Nicotine replacement therapy reduces nicotine withdrawal
while it replaces the nicotine as people cut down
and quit smoking.
Nicotine replacement therapy makes quitting
more tolerable for people
and it probably helps people remember
to use coping skills when they have urges to smoke.
However, nicotine replacement therapy
won't suppress all thoughts about smoking
so people will need to figure out strategies
to cope with urges in addition
to using nicotine replacement therapy.
Check out my other videos to learn more.
Thanks for joining me.