A Patch of Hope for Smokers

By ANDREW PURVIS

Smoking is complex. Just ask the 50 million Americans who continue to do it despite abundant evidence that as a diversion its safety ranks somewhere between bungee jumping and Russian roulette. For the past decade, addiction researchers have struggled to sort through the tangle of biological urges and psychological cravings that stir people to light up, in an attempt to develop better ways to kick the habit. That effort is finally beginning to bear fruit.

Over the next few months, four drug companies will introduce similar versions of the transdermal nicotine patch, a palm-size circular envelope that, when applied to the upper arm or back every 24 hours, releases a steady stream of nicotine into the blood. A study in last week's Journal of the American Medical Association found that the patch, when administered with proper counseling, doubled the odds that smokers will successfully quit over a six-month period. "It's a major breakthrough in medicine by any measure. It could save thousands of lives," said Dr. Jack Henningfield, chief of clinical pharmacology at the National Institute on Drug Abuse.

The idea of using pure nicotine to help smokers stop was first tried in the mid-1980s with the nicotine-laced chewing gum Nicorette. The drug provides relief from the symptoms of physical withdrawal -- anxiety, difficulty concentrating -- so that people can focus on the behavioral side of their addiction. But Nicorette has proved disappointing, largely because heavy smokers have trouble getting a sufficient dose to match their craving. In addition, the gum can cause soreness in the mouth and upset stomach. Patches overcome these shortcomings by steadily pumping the drug directly into the bloodstream. After a month of daily use, ex-smokers wean themselves from the nicotine by applying successively smaller patches.

But experts caution that the device will work only when combined with counseling, which should include advice on setting a "quit date" and on coping with the urges that will persist even with the patch in place. Unfortunately, physicians have a poor record in this regard. Less than half of 2,700 smokers surveyed for a study in last week's Journal said their doctors had ever advised them to kick the habit or even to cut down.

Moreover, scientists are only beginning to understand the factors that drive cigarette addiction. A smoker can take a million puffs during a lifetime, and each of those becomes indelibly linked with a particular activity -- drinking coffee, talking on the phone, driving. In his recent book, Smoking: The Artificial Passion, David Krogh writes, "Addiction and attachment, pharmacology and behavior, personality, culture and genetics all chase each other around like a cat after its own tail when we start to consider the issue of why people smoke."

Inevitably, the new patch will not be able to cure most smokers. According to last week's report, 26% of those wearing the device actually succeeded in abstaining for six months, as opposed to 12% of those using a placebo patch. Still, for smokers the choice seems clear: a 1 in 4 chance of quitting successfully, or the same odds of dying of a tobacco-related disease if they do not.