It is difficult to quit smoking, but, building on the discoveries of Dr. Tim Baker, a new study has shown that taking the right medication at the right time can make a difference.
According to new research in the journal Addiction, when compared to only using a nicotine patch, varenicline significantly reduced craving and anticipated smoking enjoyment before a quit attempt, and a combination of nicotine lozenge and patch kept craving, anticipated smoking enjoyment, and negative emotions in check during the attempt itself.
“Understanding if, how, and when different stop-smoking treatments affect key predictors of smoking, like craving, helps us compare and refine our treatments,” said Dr. Danielle McCarthy, who worked with lead author Dr. Nayoung Kim on this paper.
“Looking at what explains, or mediates, treatment effects on successful quitting gives us important clues about how well our treatments are hitting their intended targets,” McCarthy said. “This also helps us see if we are looking at the right targets.”
The study enrolled 1051 participants from Madison and Milwaukee who smoked daily and were motivated to quit, then randomly split them into three groups: 230 of them used only nicotine patches for twelve weeks, starting on the target quit day; 407 took varenicline for twelve weeks, starting one week before the target quit day; and 421 took a combination of lozenge and patch for that same period of time, starting on the target quit day. All three groups also received counselling to help them quit.
Participants were asked both before and during their quit attempts to rate each of the following on a scale from one (being “not at all” or “don’t agree”) to seven (being “extremely” or “agree”): craving, positive emotion, negative emotion, difficulty concentrating, hunger, anticipated smoking enjoyment, cessation fatigue, and quitting motivation.
These check-ins happened daily, starting one week before the target quit day, and then ended four weeks after.
The researchers were able to pull a few key things out of these data: first, they identified trends that were useful for predicting whether someone would stay off smoking once they quit. Things like high and/or increasing levels of quitting motivation before and during a quit attempt, as well as high and/or increasing levels of positive emotion, typically led people to stay smoke-free; things like high and/or increasing levels of anticipated smoking enjoyment and craving tended to indicate someone would not.
Second, they found that the quit-medications they tested had preventative effects on the factors that were typically associated with an unsuccessful quit attempt.
Varenicline, for example, was associated with a reduction in craving and anticipated smoking enjoyment before a quit attempt; two things that, when unchecked, were usually associated with an unsuccessful quit attempt.
In addition, the combination of lozenge and patch was associated with preventing craving, anticipated smoking enjoyment, and negative emotions—all important factors for a successful quit attempt—from increasing during the attempt itself.
Finally, using that information, the authors determined that identifying when a quit smoking medication is most effective (before or after the target quit date) as well as how well it suppresses craving, is essential. What’s more, keeping tabs on the level of anticipated smoking enjoyment helps gauge how well certain medications are working.
“This could lead us to develop smoking cessation treatments more strategically,” says Dr. Nayoung Kim, lead author.
“It spurs treatment refinement, adaptive treatment planning, and, most importantly, it shows us how we can improve quitting success.”
Kim N, McCarthy DE, Piper ME, Baker TB. (2020) Comparative Effects of Varenicline or Combination Nicotine Replacement Therapy versus Patch Monotherapy on Candidate Mediators of Early Abstinence in a Smoking Cessation Attempt. Addiction. September 4, 2020.