Aimee Schiefelbein, Quit Coach, Service Delivery:

Recently, I read a story about President Obama's struggle to quit cigarettes. He is using the nicotine gum to moderate his smoking, but not as a tool to quit completely. The authors of the article discussed how nicotine replacement therapy (nicotine patch, gum, and lozenge) are currently recommended by the FDA as a tool that should be used only when smokers are willing to use it as a replacement to stop smoking completely. In line with President Obama's technique, the authors called the FDA's recommendation outdated, and advocated for this product to be used as a tool for cigarette reduction.

As a Quit Coach I wanted to express my concerns with this viewpoint. I definitely want to be flexible in my approach to helping people quit. It is a process that takes time, support, and willingness to make behavioral changes. Many participants have struggled with simultaneously using the nicotine replacement therapy while smoking, and I have learned alot through watching them strive to leave the cigarettes behind completely.

Some participants will ask, isn't it better to cut down and use the nicotine replacement product to cover some of my urges? Ultimately, what I have learned is that many people who have used both nicotine replacement therapy and cigarettes to taper down can have difficulty quitting the cigarettes completely. When using the two together, participants no longer see the nicotine replacement therapy as a tool to help them quit. They begin to give themselves permission to have just one or two cigarettes a day. Often, the smoking can escalate from there.

Sometimes participants who smoke while on nicotine replacement therapy are adding more nicotine to their body than they were used to receiving through smoking, which further increases their tolerance for nicotine and makes it that much harder to quit completely. Frequently, I talk to people who throughout the whole nicotine replacement therapy continued to smoke one or two a day, only to find that they had run out of the product and hadn't actually ever quit.

Often when I assess participants who are smoking while using nicotine replacement therapy for how much nicotine they were getting through cigarettes versus what they are getting through the nicotine replacement therapy, I often find one of two things: 1) They were not using the nicotine replacement therapy correctly or in an amount adequate for what they were getting through the cigarettes 2) They are struggling with a behavioral urge such as breaking a habit or dealing with stress versus needing more nicotine.

The good news is that Quit Coaches like me at the Quit For Life® Program are here to help. We can assist you in assessing your situation and along with your help, find a solution that works based upon your unique needs.