Dear Alice,

I have a very addictive personality. Fortunately, I am married and have a family and because of the added responsibility of taking care of my family I stay away from a lot of the harmful vices. However, for some stupid reason I decided to try out nicorette. I quit smoking about 12 years ago and thought I would just try out nicorette to see if I could get a buzz. Well two years later I am totally hooked on the stuff and wondering if I should start smoking/chew/patch to get off the stuff. How bad is nicorette for you and is it better than smoking?

— The idiot.

Dear The idiot.,

Quitting smoking is no small feat, and since you've successfully quit and stayed away from cigarettes for the past twelve years, you're likely to have the same success with smoking's intended cure, nicotine replacement therapy. So no, don't start smoking again! Although nicotine is a drug, addictive like many others, nicotine gum (Nicorette), is still less harmful than smoking because there's no inhalation of tobacco smoke, or the harmful additives that go into many cigarettes.

But while Nicorette is better for you than smoking, it can have damaging side effects if taken for too long or in dosages that exceed what is recommended. Nicorette is intended to be used for a maximum of twelve weeks. Longer use is discouraged by its manufacturers, who also recommend limiting your dosage to no more than 24 pieces of 4 milligrams (mg) gum per day, or 30 pieces of 2 mg gum.

When used beyond its recommended time or amounts, nicotene gum has been shown to break down into a substance that causes abnormal cell growth, dental problems, and physical dependence. Even though you've been chewing the gum for longer than twelve weeks, you could follow Nicorette's steps for weaning yourself off the stuff. Tips to help you gradually reduce use of nicotine gum include:

  • Decrease the chewing time with each piece from the normal 30 minutes to 10 to 15 minutes for 4 to 7 days.
  • Decrease the total number of pieces used per day by about 1 piece every 4 to 7 days. Substitute one or more pieces of sugarless gum for an equal number of pieces of nicotine gum.
  • Replace 4-mg gum with 2-mg gum and apply any of the previous steps.
  • Consider stopping use of nicotine gum when your craving for nicotine is satisfied by one or two pieces of gum per day.

If the act of chewing gum has become a habit connected to a nicotene buzz, you may try weaning yourself off nicotene by using methods other than gum. As you mentioned, the patch, inhalers, nasal spray, and lozenges all contain nicotine. There is the possibility that with these methods you could run into the same problem you are having now, as these products all have the same twelve week recommended limit for use.

Given the limits of other forms of nicotine replacement products, you might talk to a health care provider about varenicline, a prescription medication frequently known under the brand name Chantix. It has a different working mechanism in the body from other nicotine dependence medications. Specifically, varenicline works in the brain to reduce the action of nicotine and block some of the common nicotine withdrawal symptoms. If varenicline is not right for you, bupropion might be another possible option. Often sold under the brand name Zyban, bupropion is a prescription stop-smoking aid that is non-addicting, doesn't contain nicotine, and can help control nicotine cravings. It is often used for seven to twelve weeks, beginning one to two weeks before you plan to quit smoking (or chewing).

Nicotine gum manufacturers recommend that if you feel the need to continue using the gum after twelve weeks, it would be wise to contact your health care provider for help with quitting. Since you've already reached that time frame, you might want to make an appointment. You could also consider Nicotine Anonymous, a 12-step group program that helps people kick the addiction. You can also read the related Q&As, which deal with nicotine addiction and withdrawal in additional detail.

It's great that out of dedication to your family you've stayed away from many of your vices, including smoking. Drawing on the same dedication that's kept you smoke-free, you could soon have this lingering vice out of the way as well.


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