Progressive reduction using nicotine gum as a prelude to quitting.

INTRODUCTION: This uncontrolled study examined the outcome of a program of progressive cigarette reduction, using nicotine gum, as a prelude to complete cessation among 116 smokers (70 men, 46 women; mean age = 45.7 years, SD = 12.65; mean baseline smoking = 28.3 cigarettes/day) who sought treatment in a smokers' clinic but did not want to quit abruptly.

METHODS: Subjects participated in a two-stage program consisting of a 4-month reduction phase followed by a 6-month abstinence phase. The aim was to reduce the number of cigarettes smoked daily by at least 50% by Week 8 and to quit at the end of Week 16. During the reduction phase, subjects used nicotine gum (2 or 4 mg) to progressively decrease smoking. During the abstinence phase, subjects used any type of nicotine replacement therapy (NRT) to remain smoke free. Psychological treatment and NRT were provided at no cost to participants.

RESULTS: At Month 2, 76 subjects (68%) achieved the target of 50% reduction. At the target quit date in Week 16, 66 subjects (57%) achieved carbon monoxide-validated abstinence and 45 subjects (39%) maintained continuous abstinence at the 6-month follow-up. No symptoms of nicotine overdose were detected.

DISCUSSION: A program of progressive cigarette reduction using nicotine gum is feasible in practice and may be a useful strategy for smokers who are unable or unwilling to quit by abrupt cessation.