THE NICOTINE PATCH
                           More than a Band Aid?
                                   by
                       James A. Peters, M.D., Dr. P.H.
                                   

     Are the new nicotine patches a cure-all for serious addicted smokers? Or 
are they simply another little Band-Aid? Because of the long and successful 
history of St. Helena's Smoking Cessation Program, people are asking for our 
opinion on "the patch."
                          
     The majority of people who stop smoking do not use medication while 
they're quitting. But, strange as it sounds, of all the medications tried, 
nicotine is the most helpful in the treatment of nicotine addiction! It has 
been shown to be of value for many, especially those who are strongly 
addicted.

     Nicotine taken by gum or skin patch is absorbed more slowly than when it 
is inhaled.  This accounts for its being less satisfying than smoking. In 
fact, this is one of the reasons why nicotine works in the treatment of 
tobacco recovery---it does not satisfy.

     Nicotine replacement therapy is prescribed to lessen the intensity of the 
withdrawal symptoms--not to mimic the smoking habit--allowing the person to 
focus on the psychological and behavioral aspects of nicotine dependence 
without the distractions of withdrawal. Because withdrawal symptoms are 
frequently responsible for relapse within the first three months, nicotine 
medications may help some people.

     For those who are apprehensive about gaining weight after they stop 
smoking, nicotine medications may minimize initial weight changes. Gaining may 
still be a concern for those who have underlying weight problems, but while 
on nicotine therapy it is less likely to be a major issue.

     Nearly 90 percent of people who stop smoking have only minor weight 
changes--six to eight pounds--and it's usually possible for them to handle 
minor weight variations by simple lifestyle changes after they quit smoking.

     Nicotine transdermal patches have been available by prescription since 
the end of 1991. Presently three pharmaceutical companies offer patches. Two 
of them, Ciba-Geigy (Habitrol) and Marion Merrell Dow (Nicoderm) offer the 
patches in three strengths (21,14 and 7 mg.), allowing the person to gradually 
decrease the nicotine concentration over a period of one to four months. 
Lederle (Prostep) patches are available in two strengths (22 and 11 mg.). 

     Any of the patches transfer nicotine across the skin and into the blood, 
and the success rates for this therapy are equivalent to other behavioral 
treatment methods. Studies also show that the treatment with the patch alone 
is not better than traditional behavioral treatment programs. However, if one 
combines a behavior modification program with nicotime replacement therapy, 
the success rate is better than with the patch alone. 

     Transdermal nicotine patches have few reported side effects. However, 
those with skin sensitivities or skin disease may not be able to tolerate 
patch therapy. It is important to note that one should never smoke when using 
nicotime replacement therapies.

     Nicotine therapy is an adjunct to the traditional treatment approaches 
for smoking cessation. We have repeatedly found that in a group setting---
especially a residential setting such as St. Helena's- withdrawal symptoms are 
usually more tolerable than they are for people who are going "cold turkey"
in their home enviroment. This is why very few patients require medication 
treatment when participating in our program. But we do not withhold 
medication if our assessment determines that a patient would do better with 
medication.

     If previous attempts to stop smoking have been sabotaged by difficult 
withdrawal symptoms, talk to your physician. Transdermal nicotine may be 
helpful to you.
                                   **

     *Taken from "Lifestyle", a quarterly publication from St. Helena Hospital
and Health Center. Deer Park, California 94576.

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