The latest news for smokers who want to quit is that a variety of nicotine replacement therapies are available. People who want to free themselves from cigarettes can now consume nicotine in less harmful forms, such as sprays or gums, and gradually wean themselves from the drug altogether.

This does not mean, however, that we have a magic bullet for nicotine addiction. True, people do quit smoking by going "cold turkey" or by using nicotine replacement as their only form of help. But the highest quit rates occur among people who combine nicotine replacement with some form of behavior therapy. In addition, the Twelve Steps of Alcoholics Anonymous can offer powerful tools for people who want to stay smoke-free.

All nicotine replacement therapies aim to diminish the symptoms of withdrawal for people attempting to quit. These therapies work by (1) allowing people to consume nicotine in controlled, steadily decreasing doses and (2) providing nicotine without the toxic chemicals found in cigarette smoke.

Less than a decade ago, nicotine replacement therapy included just two basic options: the nicotine patch and nicotine gum. The patch releases nicotine in a steady dose through the skin and into the bloodstream. Patches can deliver various doses of nicotine, making it possible to individualize this treatment. Nicotine gum works on the same principle and is designed to be "parked" at a spot on your gums.

Since 1996, the US Food and Drug Administration has increased the options for nicotine replacement. For one, it approved over-the-counter forms of nicotine gum and the patch. Formerly these products were available only by prescription. The FDA also approved two new products: a nicotine nasal spray and nicotine inhaler. What's more, the agency approved bupropion hydrochloride (or Zyban), an antidepressant, as a medication for nicotine withdrawal.

Currently, guidelines from the Agency for Health Care Policy and Research and the American Psychiatric Association advise that all these medications be offered to smokers who want to quit. Interestingly, those guidelines do not state that all smokers should get counseling as a form of treatment.

"Many studies have shown that less than 10 percent of smokers will attend 'talking therapy,'" said John Hughes, M.D., a professor of psychiatry at the University of Vermont in Burlington who helped write the guidelines.

Even so, Hughes adds that "doing both medication and talking therapy gives the best outcome." He also points to 80 controlled studies showing that behavior therapy works for people who want to quit smoking.

Patients who come to Hazelden for their alcoholism are offered a nicotine cessation program concurrent with their alcoholism treatment. In addition, a separate seven-day residential program for smokers called Your Next Step offers a holistic, multidisciplinary approach to nicotine cessation. It blends Twelve Step principles, lectures, group and individual counseling, stress management, acupuncture and massage and offers nicotine replacement for those who want it.

Though use of the Twelve Steps for smokers is not yet supported by controlled research, clinical experience at Hazelden suggests that they offer a powerful path to recovery from nicotine addiction. Forty-three percent of Your Next Step participants are smoke-free after 12 months.

Smokers can use the Steps to talk about smoking as a form of addiction. In the context of AA principles, nicotine becomes a drug that is just as "cunning, baffling, and powerful" as alcohol.

"One of the things the Steps do is give a framework for looking at smoking as an addiction--specifically the idea of self-deception," says Barry McMillen, supervisor of Nicotine Dependency Treatment Services at Hazelden. "I can't tell you how many people I've met who say: 'I'm quitting smoking. I've been wearing the patch for three days and I'm only having three cigarettes a day instead of two packs a day.' These people haven't quit; they've just changed their route of administering nicotine. They're in the same crazy thinking pattern as the alcoholic who says, 'I'll quit tomorrow.'"

In contrast, smokers can adopt the attitude that AA members take toward alcohol: You either use the drug or you don't. And if you take even one puff from a cigarette, you reinforce your powerlessness over nicotine.

For more information on quitting smoking, contact the American Cancer Society at 800-227-2345 or the American Lung Association at 800-586-4872. A few other resources include Nicotine Anonymous World Services, 415-750-0328, and Hazelden's Your Next Step, 800-257-7810.

--Published November 8, 1999