Quit Smoking

Why do nicotine replacement products fail to help so many people stop smoking?

General practitioners throughout the world, and the National Health Service in the UK, are very active in promoting the use of nicotine replacement products as a smoking cessation aid. These products are usually referred to as nicotine replacement therapy, or NRT, although the National Smoking Cessation Institute does not recognise this description, as a product that can be bought over the counter from a pharmacist, or even a supermarket, does not qualify as a therapy, and for this reason we use the term NRP.

What exactly is the function of an NRP?

The manufacturers, and doctors, suggest that the function is to help the smoker wean themselves off nicotine, but this is medically incorrect. It is not possible to wean yourself off a drug – you are either addicted or you are not, and there is no half-way stage. If it were possible to wean yourself off nicotine, smokers would do this by smoking fewer and fewer cigarettes, but they don’t do this because it doesn’t work.

In fact, the concept of weaning yourself off nicotine is promoted because it sells pharmaceutical products. It’s rather like doctors prescribing methodone to heroin addcts. Methodone doesn’t stop them being addicted, but it does enable pharmaceutical companies to earn money from heroin addiction whilst making it appear that the medical profession is doing something to help drug addicts.

Similarly, doctors need, especially in the UK where we have a state-provided medical service, to be seen to offer something to smokers. This suits the pharmaceutical companies perfectly, because the National Health Service doesn’t concern itself with the efficacy of the products. In fact, a level of efficacy is claimed for these products, but there is little reliable scientific evidence to support these claims.

So, why don’t NRPs help people to stop smoking? Well, of course sometimes they do, although it is known that the biggest single reason for any success is the placebo effect. Some smokers will stop because their doctor tells them the product he has just prescribed is going to work. The reason for this is of course that every smoker can stop anyway. They just have to believe it, and being given a product the doctor believes is in enough for some smokers to succeed.

But back to my question. The primary issue is the reason why smokers can’t stop, and this is addiction. So, the drug companies say, this is where we can help. We can wean the smoker off the drug. But of course we know it doesn’t work like that, as I said earlier. So then what exactly do NRPs do?

An NRP has one function, and one function only. It is to MAINTAIN the addiction to nicotine, while the smoker breaks the habit of lighting cigarettes. NRPs, are therefore, a habit breaking tool. The product presupposes that habit is the primary or only reason why the smoker cannot stop.

But since habit is never the reason why smokers can’t stop, taking the drug through the skin, or any other way, as a way to break the habit, is not going to help quite simply because it is tackling a non-existent problem.

About the Author

I am the Operations Director of the National Smoking Cessation Institute. The Institute is part of the National Smoking Cessation Co-operative, the not-for-profit body in the UK that researches new ways to help smokers to stop that the National Health Service is unable to provide. My published works include ‘Stop Smoking for Good’ (Hodder 1995), ‘How Can You Expect to Stop Smoking if You Eat Tomatoes?’ (NSCI 2007) and ‘The NSCI Stop-Smoking Handbook, International Edition’ (NSCI 2011).

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