Q: I've been trying to quit smoking and have been using nicotine gum. Can I become addicted to the gum?

A: While uncommon, there is a very small chance of developing nicotine gum addiction. However, even in the unlikely event of doing so, this form of nicotine replacement therapy (NRT) is much safer than the nicotine absorbed from smoking cigarettes. That’s because each inhalation from the burning of tobacco creates over 4,000 chemical compounds (ammonia, carbon monoxide, tar, etc.), including at least 43 with the potential to cause cancer (benzene, formaldehyde, etc.).

Why is nicotine addictive?

Nicotine is the drug that keeps people smoking. While each cigarette contains about 10 milligrams of nicotine, a smoker only absorbs 1–2 milligrams, as not all of each puff of smoke is delivered to the lungs. However, this is still a big dose and ends up reaching the brain within eight seconds. The end result is an alteration of brain chemicals that triggers the desire for more nicotine.

To put this into perspective, a smoker usually gets at least 10 "hits" of nicotine per cigarette. Multiply this by 20 for a person smoking one pack per day, and the end result is over 200 hits of nicotine per day. Needless to say, this cycling of nicotine highs (while smoking) and lows (between cigarettes) hooks the smoker into a desire for that nicotine high, stimulating cigarette cravings, as well as symptoms of withdrawal, between cigarettes.

How does nicotine replacement therapy work?

NRT has helped many people decrease or even stop their dependence on cigarettes. In fact, incorporating nicotine gum or some other form of NRT almost doubles the chance for success in a person who is truly addicted to smoking cigarettes. What these forms of therapies have in common is the slow release (compared to the rapid release from the "hits" of cigarettes) of a reduced strength of nicotine, whose aim is to reduce nicotine cravings. However, it's important to realize that the separation from you and the tobacco habit is best achieved by the dual approach of NRT and behavioral modification.

First, the craving for cigarettes must be controlled. This is where NRT comes in handy. Since everyone is different and smokes at various levels, the use of  "continuous" (patch) or "as-needed" (lozenge, gum, etc.) nicotine delivery systems helps to control or suppress withdrawal symptoms like these:

• Nervousness
• Difficulty concentrating
• Headaches
• Dizziness
• Fatigue
• Difficulty falling asleep or maintaining a restful and full night's sleep
• Irritability
• Increased appetite
• Moodiness or depression

Next, the behavorial aspect of smoking should be addressed. You may be programmed to smoke when you wake up, when you meet friends socially, or when you drink alcohol. Psychological triggers like nervousness, depression, or anxiety are common. Using support groups, friends, family, or tobacco "quit" telephone support lines can be helpful in minimizing the need for a cigarette. The "weaning period" is when the use of NRT is slowly decreased until the "need" for a tobacco product is more easily avoided.

Fortunately, there are different forms (and dosage strengths) of nicotine replacement therapy since one size does not fit all. For example, while the nicotine patch may help some, the nicotine lozenge may be more beneficial for others. That said, it's important to remember that these products should only be used as directed, and only used for the shortest length of time needed to break the nicotine habit. Also, check with your physician or pharmacist, as the product you choose may require you to completely quit cigarette smoking before its use.

NRT options

When looking for a NRT, consider these options:

• Nicotine lozenges are often used as part of a 12-week program. Nicotine is slowly released as each lozenge dissolves in the mouth.
• Nicotine patches are applied to the skin on a daily basis and commonly used over a two- to three-month time frame.