Theoretical background and clinical use of nicotine chewing gum.

In our view, nicotine chewing gum is the most significant single advance achieved so far in the whole field of smoking cessation. It is the only treatment that has yet been shown to have a specific effect over and above that of attention-placebo factors, and this has been demonstrated repeatedly by several research groups in different countries. It is suitable for use as an adjunct both to intensive psychological methods of treatment and to minimal and largely self-help types of intervention. In either case, it approximately doubles the success rates achieved by intervention without the use of gum. It can be administered effectively by psychologists and family physicians and no doubt by other adequately trained health professionals too. The efficacy of nicotine chewing gum is not limited to the smokers who use it. Its incorporation into a treatment or intervention programme revitalises and maintains the morale of therapists. Until the advent of nicotine gum it has required either a research interest, financial reward, or a degree of masochism to remain for long at the sharp end of the business of helping people to give up smoking. Without a treatment capable of reducing withdrawal symptoms, therapists become drained by having constantly to give out encouragement and support to help their clients to tolerate withdrawal long enough for the difficulties gradually to wane. The rapid and tangible effect of the gum in relieving withdrawal symptoms is a boost to the morale and confidence of client and therapist alike. It is perceived as helpful even by those who fail. This encourages people who relapse to return for further therapy. A discouraging feature with other treatments has been the tendency for those who relapse to avoid contact with their therapists even to the extent of not responding to data collection at long-term follow up. In view of its efficacy, its potential for use in many settings, its minimal demands on therapists' time, and its synergistic effect in encouraging and boosting the confidence of clients and therapists alike, it is possible that over a period of years nicotine chewing gum could have a significant impact on national smoking prevalence. But to achieve this, it is essential that it be used correctly.