Why does nicotine replacement therapy seem to do nothing for me?
January 21, 2013 6:21 PM   Subscribe

Nicotine replacements seem to do nothing to abate my cravings. Any thoughts on what the heck might be going on?

I have read all the questions about smoking since I am trying to quit. But my question is a a bit odd. I quit smoking the first time three years ago and started (after a death in my family) smoking again about a year ago. I want to stop again.

Last time, I quit cold turkey and just white-knuckled it -- and boy was I ever crabby for the first month.

This time I am trying nicotine replacements -- gum and lozenges -- and they seem to do nothing. It's so strange, I could have a lozenge and not feel much of anything and them have a cigarette right after and only then feel the craving gone.

Any idea what is happening? Anyone else feel nothing from the nicotine replacements? I am using the correct strength (wrt the amount I smoke) as suggested on the labels.
posted by Lescha to Health & Fitness (24 answers total) 5 users marked this as a favorite
It could be the psychological craving rather than the physical one -- i.e., the feeling of something in your hand, occupying nervous energy, something in your mouth... there's a reason it's common to gain weight after quitting smoking.

I know a few people who have used e-cigarettes to quit -- perhaps the similarity of that to a real cigarette would work better for you.
posted by DoubleLune at 6:24 PM on January 21, 2013 [7 favorites]

Perhaps with the routine that you are really missing, or something about the actual cigarette and/or the drag? I've heard great things about The E-Cigarette.
posted by two lights above the sea at 6:27 PM on January 21, 2013 [1 favorite]

I think t is really helpful to use the replacements on a schedule, don't try and hold off until you have a craving because then it is too late. Stay ahead of it and it is so much easier.
posted by InkaLomax at 6:28 PM on January 21, 2013

Looks like you can buy them here.
posted by two lights above the sea at 6:29 PM on January 21, 2013

Don't know, but you could use Zyban (bupropion) to reduce your cravings instead.
posted by dontjumplarry at 6:40 PM on January 21, 2013

I'm with DoubleLune -- my cravings were (are) all psychological rather than physical after the first two weeks.
"Bored, time for a cig."
"Finished a project, time for a cig."
"Heading home, time for a cig."

The only time I tried nicotine replacement, I did nothing to address my other triggers, and it failed miserably.
posted by Etrigan at 6:41 PM on January 21, 2013 [1 favorite]

Hello. Same shit happened to me. I quit for two years, cold turkey. Crabby as hell, but it worked. Then I decided to have a cigarette. Let's just say quitting this time around has been damn near impossible. I'm the kind of person that smokes on the patch and loves smoking on Wellbutrin/Zyban.

But then I found e-cigarettes. They're pretty great. I'm not going to sit here and ignorantly extol the virtues of e-cigarettes, but it has to be a hell of a lot better than smoking. You completely get the nicotine hit, the oral fixation - and it's a ton cleaner. You don't have the disgusting smell and emotional hangover of an actual cigarette. Plus you can take one hit and be done with it.
posted by phaedon at 6:51 PM on January 21, 2013 [1 favorite]

in addition to the psychological factor, you're not perfectly replicating cigarettes with the gum. both the delivery method and the actual substances you're ingesting are different. so, you may not really be fulfilling what your body craves by using the gum. (nicotine is only one of the many chemicals in the cigarettes that affect your brain -- here's a snippet that touches on it from nida:
posted by Tandem Affinity at 7:03 PM on January 21, 2013

First, congratulations and best wishes. I've been there and wish you well on this journey.
This area is my current field of employment, but of course I am not your healthcare provider. Let me suggest a few general ideas?

For NRT gum, put it in your mouth and "park it" in your gum line. After about 5 minutes, you can toss it as the nicotine has been absorbed. But don't move it around-the best nicotine absorption will be if you leave it in one place. For lozenges, you can use it as any cough drop and move it from side to side until dissolves. It can take a few minutes for the nictotine to register in your brain, and in the beginning it is especially important to use the lozenge or gum regularly, as Inkalomax suggests. If you have a craving, take the gum or lozenge, and then distract yourself for 10 minutes.

My experience indicates that individuals respond to different types of NRT. You personally may be responsive to the NRT patch more than gum or lozenge. A couple of common, off-label practices used with often good results are to 1) to begin using NRT in whatever form 2 weeks prior to a quit attempt, and/or 2)use two types of NRT, such as patch and gum, or patch and lozenge. There are studies (which I can refer you to) that have shown these activities result in a higher percentage of a successful quit.

Be sure to call your local quit line (1800QuitNow if you are in the US) as you can often receive free NRT depending upon your state's resources. I could go on and on, but keep trying, and focus on titrating down if that is what you can do right now. If you go from 20 to 10 to 5 to 1 and it takes you a while, you will still get there.
And as everyone talks about, you can address the physical and the psychological at the same time. Try to vary it up. If you are still smoking, put barriers up to make it more difficult. If you normally smoke in your car, don't do it. If you smoke in your house, don't anymore. Take that chair on your backporch away. Start making it more and more difficult to smoke. By the time I quit smoking, I was only allowed to do it in my alley when taking out the trash. Not very inviting.
Feel free to memail me if you have questions about NRT or want some resources. I am actually creating a list of resources for organizations to use, and am happy to send you a few if you think that websites or other forums might help. Good luck!
posted by Kitty Cornered at 7:05 PM on January 21, 2013 [3 favorites]

Coming from the views that abound in the e-cigarette forums and their users there can be some other things going on. There are many other things in cigarettes besides nicotine vapers (e-cigarette users) tend to call these Whole Tobacco Alkaloids (WTA) and apart from the usual 'just nicotine' liquids there are some vendors that provide nicotine liquids that still contain the WTA and some vapers swear by them. So you may be craving the other chemicals/tobacco bits that are in cigarettes but not in the replacements. The other big thing is delivery, a cigarette with its fine particles directly into the bloodstream via the lungs is an instant fix. Other delivery methods are not so much so. You can vape a strong e-cig and feel nothing immediate and vape more and more and then 20 minutes later have a 'OMG I just smoked 4 strong unfiltered cigarettes and my head is buzzing and I feel sick' because it took so long for the nicotine to get into your system vs smoking a cigarette and getting it immediately.
posted by zengargoyle at 7:13 PM on January 21, 2013

I also came in here to mention e-cigarettes. My mother was like you, unable to quit smoking with the gum or patches. I recently bought her a e-cigarette and she has had next to no cravings. She's slowly weened herself off of the ones that contain nicotine at all and now just smokes drug-less flavored e-cigarettes.
posted by royalsong at 7:13 PM on January 21, 2013

And anyone considering e-cigarettes should research a bit, two lights above the sea's link is on the OMG ripoff side $$-wise. Those kits are worth about $30 at most from reputable vendors.
posted by zengargoyle at 7:23 PM on January 21, 2013

Popping in to say thank you. Want to mark all of these as favorites! Lots to consider and a few things to try.
posted by Lescha at 7:33 PM on January 21, 2013

Try the patch. I found them to be the most effective because they prevent the craving from ever happening. However, they didn't last a full 24 hours for me. It was more like 18 hours and then I was bouncing off the walls. Especially at the highest dose, I was happier than a pig in shit. Who needs to smoke when you feel this great? As the doses tapered, it obviously got harder. But by then, I hadn't been smoking for X weeks, and it was much easier to ignore the cravings with a few weeks under my belt.

But yeah, there is going to be some anxiety moments. Smoking gets very intertwined into your lifestyle. I found that to be the hardest part of quitting. Kicking nicotine isn't all that hard, especially if by using the patch, you have already put a good dent into your psychological fixations regarding smoking. The trick is to use that anxious, "time to smoke" feeling as a reminder to do something else. Go get a glass of water, or put the laundry into the dryer or something like that. (Not candy or food, just a quick setting change.) Because for many smokers, that "craving" moment has always been a part of you, and at some point you used cigarettes to satisfy that hunger. Figuratively and literally.
posted by gjc at 7:55 PM on January 21, 2013 [1 favorite]

Route of administration has a significant impact on the reward/reinforcement properties of a drug. In general, faster onset produces a greater "high". Consider that crack cocaine and powder cocaine have the same active ingredient, but the former is more addictive because it's smoked rather than insufflated (snorted), which results in faster absorption. Similarly, injected oxycodone is more addictive than insufflated oxycodone, which in turn is more addictive than oral oxycodone.

So nicotine inhaled from e-cigarettes or nicotine inhalers is more likely to provide relief than nicotine patches or gum. But since it's providing the same approximate degree of reinforcement, it's not reducing your addiction so much as transferring it to a healthier source.

Good luck and keep fighting the good fight.
posted by dephlogisticated at 8:10 PM on January 21, 2013

Sorry for the shitty e-cig recommendation! I'm not an e-cig user. Perhaps others have better recommendations?
posted by two lights above the sea at 8:22 PM on January 21, 2013

Not necessarily shitty, just some 'starter kits' can be built piecewise or at least bought un-branded for much less. Probably the easiest place to find recommendations is Reddit's r/electronic_cigarette forum. I think somewhat less accessible is the E-Cigarette Forum (ECF) but it can be a landmine of rules and vendor-paid subforums and total information overload.
posted by zengargoyle at 9:39 PM on January 21, 2013 [1 favorite]

Sorry for the shitty e-cig recommendation! I'm not an e-cig user. Perhaps others have better recommendations?

Yeah I didn't follow your link, but the best thing to do is find a store locally that specialized in e-cigarettes. Luckily we have one place like that where I live, but only one. Ideally, you would walk into the store and they would walk you through the different options, and have tons of flavors for you to try out. Do not go to a hookah lounge or a smoke shop that sells one kit and two flavors along with a million other unrelated items. They don't know what the fuck they're doing.

The whole experience can be really enjoyable. I found the information on ECF really daunting, but a short trip to a store and you'll understand what different batteries/kits are available, what atomizers and cartridges and tanks are, how e-liquids are packaged (VG/PG/Nic strength), etc. Once you get a grip on these things and buy a starter kit, shop online.

If you find a store, ideally you'll also be able to try a lot of flavors. Keep in mind, you might find yourself liking certain flavors you wouldn't normally think of buying. If you've tried them, think of flavored blunts, for example. Why do tequila, grape and peach flavored blunts taste amazing? Who the fuck knows. I used to smoke Camel Lights, and I'll tell you, it's hard to find a good tobacco flavored e-liquid. In my circle, people love Arctic Wolf (menthol) and Riptide (blue raspberry). These are very popular flavours. I in no way endorse these vendors, other than to say I have bought these flavors a la carte from them and they deliver on time and the prices online are much better than in-store. Pro tip, hands down the best tobacco flavor I've ever tried - and I've tried many bad ones - is Torque 56.

And while this is always changing, you might end up with an e-cigarette that doesn't necessarily look like a cigarette. Hell, they even have e-cigs that looks like old man smoking pipes and they are so cool! I can tell you a little more about my kit, I personally have something with a larger battery and a larger tank so that I don't have to be constantly recharging and refilling it. I don't take it out in public much because people are constantly asking me what it is. Generally speaking, I find smokers to be the ones that treat e-cigs with the most suspicion. But I promise you, once you make the leap, you won't have much reason to look back.
posted by phaedon at 10:36 PM on January 21, 2013 [2 favorites]

Nthing e-cigs and the ECF. I've been (mostly) "analog" free for almost two years, and I started smoking when I was 15. I'm 45 now. It definitely satisfies the tactile part of it. And while the nicotine "hit" is delayed a bit longer than a real cigarette, it's not as dramatic a delay IMO, as people are saying.

The standard set up nowadays for most folks is some variant of the Ego battery and a Starburst clearomizer. It's the most maintenance free and bang for buck set up, in my (and others') opinion.

Also the quality of liquids is highly variable, so make sure and get good quality artisinal stuff.

Memail me and I'll be happy to give you some reputable vendors.
posted by digitalprimate at 7:21 AM on January 22, 2013 [1 favorite]

I dropped my real-cig habit with an e-cig. And I wasn't even trying to quit! I just tried out an e-cig for the convenience (I mean, it's winter, right?) and eventually just stopped smoking real ones. I love this damn thing. You can then taper down the amount of nicotine while still participating in the ritual. Worth a try, if you'd like to experiment. I also love the fact that I don't need to smoke something tobacco flavored. Currently mine is raspberry mint.

I use the Ego-C with a clearomizer. I order all my stuff from Health Cabin, which *seems* kinda sketchy but has been great to me so far.
posted by nursegracer at 9:08 AM on January 22, 2013

I can commiserate; I quit yesterday and am using the patch. As mentioned above, the patch should be able to prevent cravings before they happen, so it really should be a superior solution to gum and other solutions 'in the moment' since you never hit the panic stage. I also found that I had to change it before 24 hours had passed.

My suggestion is to use the patch until you can get an e-cigarette. I've used one in the past and the experience is actually pretty good. You get the draw experience (although without the burning sensation), and the smoky (actually vapour) exhale, and of course the nicotine hit. If it doesn't work for you, I would go back to the patch. I may try this myself...I just think that for me it will work better to let the emotional attachment to real cigarettes subside a bit before I start using something that closely mimics that experience.

I would love to hear from the people above how long they used their e-cigarettes, or if they stopped using them at all (I certainly would NOT consider it a failure if they have kept using).
posted by kitcat at 9:53 AM on January 22, 2013

@KittyCornered has given you the most scientifically-founded advice in this thread. Use two forms of NRT, one that provides a steady dose and one that helps with cravings as they come on. Plan to use the NRT for a lot longer than the label recommends (6 months or more) and then wean yourself off the NRT.

Also, find some way to deal with the emotional/social/habit cues -- depending on what state you are in, 1800QuitNow can help you with that (the amount of counseling you get will vary by state). You might also look into web forums where you can "check in" when you are experiencing a craving, and other quitters can help you through it.

As for e-cigarettes, I agree with the folks above who say that they are probably better than cigarettes. But the science is really nascent in this area, and the fact is that no one really knows. Also, from what I've seen, there are quality control issues with most e-cigarettes that make it difficult for people to get a reliable dose of nicotine from them (and in some cases, that cause them to get too much all at once).
posted by OrangeDisk at 1:16 PM on January 22, 2013

It's another me-too for electronic cigarettes (and the eGo battery plus a variant of a Starburst tank/cartomizer). And, as Inkalomax said, if you are using an on-demand nicotine delivery system (e-cig or lozenge or whatever) then stay ahead of the cravings. I think for me (quitting using an ecig without really trying to quit) a significant factor was that I was puffing on it pretty heavily just for fun (new toy) and kept enough nicotine in my system that I never got cravings for a real one and just kept forgetting to smoke real cigarettes.
posted by K.P. at 4:31 PM on January 22, 2013

I have to say one last thing...don't mean to thread-sit. From the tobacco cessation field, using e-cigarettes is a mixed bag opinion. Referred to as harm-reduction. Having said that, you probably don't care much. I'm the no, no, no place. And here is why.
They aren't FDA approved or regulated. There have been very few scientific journal published studies done, but the few that have been done show that the amount of nicotine that has been advertised has varying compared to actual. The device has caused a couple of injuries by exploding. So just know there is no regulation from the US govt. Be very careful of having the system around children, babies and pets.
However, e-cigs have most definitely helped some people quit. For some, they just help when it is too cold to go outside, or they are in a place where they can't smoke, or it is just more convenient. Meaning, they smoke and use e-cigs. It is still "hand to mouth" behavior and replicates the smoking action. I would try other ways first...that is the advice I give friends. If you need nicotine replacement, I would say use products that have safety tested. Ok...thanks for listening to my two cents!
posted by Kitty Cornered at 7:21 PM on January 22, 2013

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