For some time, nicotine replacement therapy (nicotine patches and gum) has been the sine qua non of pharmacological treatment for addiction. NRT’s pedigree is unassailable — if smoking addiction is due entirely to maintaining cellular nicotine levels, then replacing nicotine through non-smoking means is the cure for smoking.

NRT fits neatly into a number of industries. First, of course, is the National Institute on Drug Abuse‘s and the American Board of Addiction Medicine‘s “addiction as brain disease” model, premised on the belief that we will discover pharmacological cures for chemically-based addictions. Then there are the drug companies that manufacture and heavily market chemical cures for smoking. This is an industry whose revenues have increased nearly tenfold in the last decade and to whom most of the leading researchers in the field are beholden for support.*

Ironically, one other industry that favors NRT includes the most radical critics of current addiction practices — drug policy reformers. Such reformers are among those who favor so-called harm-reduction techniques like NRT. Harm reduction indicates that addicts can improve their lives without quitting their addictions, which NRT does by creating an alternative nicotine addiction that doesn’t involve inhaling tobacco smoke.

But research on nicotine replacement has always shown quite a few iffy spots — like the spots smokers develop on their lungs. For, although clinical trials show NRT patients do better at quitting cigarettes, surveys of smokers who have quit or tried to quit typically do not find any advantage for those who rely on NRT. Here is one such study that found self-quitters succeeded twice as often as pharmacologically-treated smokers.

Thus, a new study that prospectively (over time) followed 800 smokers trying to quit who either employed NRT or who quit without it has drawn intense interest. The results — reflected in the title, “A prospective cohort study challenging the effectiveness of population-based medical intervention for smoking cessation” — were that recipients of NRT did no better than those quitting unaided. Indeed, heavily-dependent smokers who resorted to NRT actually had twice the likelihood of relapsing as those who did it on their own.

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