Addiction specialists and other health professionals have a range of medication-based options for helping people affected by alcoholism. However, even when they receive one of these medications, some recovering alcoholics still lapse back into heavy alcohol consumption. In a study published in April 2014 in the journal Alcoholism: Clinical & Experimental Research, researchers from three German institutions assessed the effectiveness of individualized psychotherapy in recovering alcoholics who don’t respond sufficiently to medication-based treatment. Specifically, the researchers examined the usefulness of a form of individualized therapy called cognitive behavioral therapy.

What Medications Can Help Alcoholics?

As of 2014, the U.S. Food and Drug Administration has approved a trio of medications for use in people recovering from alcoholism: naltrexone (Vivitrol), disulfiram (Antabuse) and acamprosate (Campral). Naltrexone is an anti-opioid medication that also blocks the chemical reactions responsible for triggering pleasurable sensations and alcohol cravings in drinkers. Disulfiram deters alcohol consumption by exaggerating the unpleasant chemical reactions associated with the breakdown of alcohol inside the body. Acamprosate makes chemical changes inside the brain that typically lessen the intensity of the alcohol withdrawal symptoms that commonly contribute to relapse risks in recovering alcoholics. Doctors also sometimes use a fourth medication, called topiramate (Topamax), not initially intended for use in alcoholism treatment. This anti-seizure compound also makes changes in the brain’s chemical environment that can help lower the odds that recovering alcoholics will take a drink.

Cognitive Behavioral Therapy

Practitioners of cognitive behavioral therapy (CBT) help their patients/clients identify the underlying feelings, perceptions and actions that contribute to dysfunctional behavior in stressful situations. After making this identification, the individual can gradually learn a new set of feelings, perceptions and actions that don’t help trigger destructive behaviors. In the context of addiction treatment, CBT practitioners specifically help their patients/clients learn to do such things as anticipate the situations likely to increase the urge to use drugs or alcohol, learn how to cope with those situations without using drugs or alcohol, identify substance-using urges as soon as possible and accurately weigh the pros and cons of using drugs or alcohol.

Cognitive behavioral therapy is suitable for use in both individualized and group formats. In addition, the therapy can be used on its own or in combination with medication-based addiction treatment. In addition to alcoholism, forms of addiction addressed by CBT include addiction to the stimulants methamphetamine and cocaine, marijuana addiction and addiction to the nicotine contained in cigarettes and other tobacco products.

Usefulness In People Not Helped By Medication

In the study published in Alcoholism: Clinical & Experimental Research, researchers from Germany’s Freiberg University, Tubingen University and Heidelberg University used an examination of 109 individuals to assess the effectiveness of an individualized cognitive behavioral approach in helping recovering alcoholics who don’t receive enough benefit from medication-based treatment. All of these individuals were alcohol program participants who had experienced severe relapses back into drinking after taking an alcoholism medication, or after receiving a placebo that mimicked the appearance of an alcoholism medication. During the study, half of the participants continued to receive a standard combination of medication and medical symptom management. The other half received a combination of medication, medical symptom management and cognitive behavioral therapy conducted on an individualized basis.

The researchers analyzed the effectiveness of individualized CBT in all of the participants originally assigned to the therapy group, as well as the effectiveness of the approach in all of the participants who actively engaged in therapy. After completing these analyses, they concluded that the recovering alcoholics who actively engaged in the CBT process received a substantial benefit from the therapy and experienced improved treatment outcomes when compared to the recovering alcoholics who received only medication and medical symptom management.

The chief measurement used to compare the effectiveness of the combination of medication and individualized cognitive behavioral therapy to the effectiveness of medication without CBT was the number of days recovering alcoholics could successfully avoid experiencing another severe relapse. The authors of the study published in Alcoholism: Clinical & Experimental Research concluded that those program participants who actively embrace the goals of individualized CBT can potentially increase the number of days between relapses if they combine the therapy with an alcoholism medication. In line with this conclusion, they believe that alcohol programs may see significant improvements in their patients’/clients’ relapse-related outcomes if they offer access to non-medication-based therapy early in the treatment process.

Read How Do Recovering Alcoholics Respond To Baclofen?

Twelve-step programs are mutual self-help programs that use a combination of gradual goals (i.e., steps) and peer support to help recovering substance addicts establish and maintain a long-term commitment to avoiding further substance use. However, not all people who join these programs attend regularly or successfully abstain from substance intake. In a study published in May 2014 in the journal Addiction, researchers from the U.S. and Norway assessed the effectiveness of a technique called motivational intervention in helping 12-step participants increase their program involvement and their ability avoid substance relapses.

12-Step Approach

The 12-step approach was initiated in the 1930s with the formation of Alcoholics Anonymous. Participants in 12-step-based programs commit to a progressive series of actions designed to help them recover from active involvement in the use of alcohol or other substances of abuse. These actions including admitting a lack of self-control over addictive behaviors, making a call to a higher or greater power to assist in the recovery process, examining and atoning for damaging conduct while under the influence of drugs or alcohol, and eventually providing assistance to others not as far along the path of recovery. As a rule, 12-step programs rely heavily on peer sponsorship provided by longer-term members. The 12-step approach is widely used and has proven effective as an aid to the substance recovery efforts carried out in treatment centers that deal with problems such as alcohol addiction, cocaine addiction and opioid narcotic addiction.

Motivational Interventions

Many people who enter substance recovery programs do so with mixed feelings about the recovery process. In fact, significant numbers of program participants enter treatment only at the urging of others. People with ambivalent or hostile feelings toward substance recovery commonly fail to participate fully in their programs, meet the specific objectives that programs set for their clients/patients or successfully complete their program involvement. Motivational interventions are designed to help program participants uncover the mixed or negative feelings they may have about substance recovery, and also to help them change their minds and become more willing and proactive in their treatment. As a rule, practitioners of motivational interventions work cooperatively with clients/patients in an interactive process that strives to avoid a confrontational or antagonistic atmosphere. While a motivational intervention can help at almost any stage of treatment, it typically has its biggest impact in the initial stages of recovery.

Usefulness In 12-Step Programs

In the study published in Addiction, researchers from Stanford University, the Department of Veterans Affairs and Norway’s University of Oslo and Sorlandet Hospital used an examination of 140 Norwegians receiving treatment for alcoholism to assess the usefulness of motivational interventions in promoting involvement in 12-step programs. All of these study participants were in inpatient facilities for alcohol detoxification. Half of the participants received a motivational intervention called 12-step facilitation in two 30-minute sessions. This form of intervention is designed to increase clients’/patients’ level of comfort with 12-step involvement. The facilitation sessions provided during the study included detailed explanations of how substance addicts lose control over their behaviors, a DVD on the 12-step process created by Alcoholics Anonymous and immediately available resources for making direct contact with 12-step groups. The other half of the study participants received only basic advice on 12-step resources in a brief informational session.

Six months after the study participants concluded their involvement in inpatient detoxification, the researchers compared the level of 12-step involvement among the people who received motivational interventions to the level of involvement among the people who only received brief advice on 12-step resources. They concluded that the participants who received motivational interventions were significantly more likely to attend 12-step meetings than those who received only brief advice. They also concluded that the motivational intervention group used both alcohol and drugs on fewer total days than the brief advice group.

Despite the increased 12-step involvement and fewer days of substance use, the authors of the study published in Addiction concluded that the recovering alcoholics who received motivational interventions did not remain abstinent from substance use any more often than their counterparts who received brief advice on available 12-step resources. In addition, motivational intervention did not lead to a decrease in the severity of alcohol-related symptoms. Still, the authors note that, since motivational intervention recipients do attend 12-step meetings more often and use drugs and alcohol on fewer days, the technique may prove useful as part of the recovery process for alcoholics who go through alcohol detoxification.

In recent years, two federal laws have guaranteed fair and equal coverage for mental health and addiction treatment. Those working in the field of addiction care are not so sure that the intent of those laws is really playing out in reality. People struggling with substance use disorders may not be getting the insurance coverage they need in order to get well.

The Federal Laws

In 2008, President Bush signed the Mental Health Parity and Addiction Equity Act. The law is supposed to ensure that health insurance plans are no more restrictive when it comes to mental health or addiction care than they are with other types of medical care. In other words, deductibles, co-pays and limits on treatment cannot be greater for mental health or addiction than anything else in the plan. The law does not require that plans cover these types of care at all.

President Obama’s Affordable Care Act added to the previous law by listing mental health and addiction treatment as essential benefits that must be covered by all health insurance plans, including those offered by small businesses and those for individuals. Prior to this law, most large company group plans included such coverage, but smaller plans often did not.

Equal Coverage Not So Equal

The two laws signed by Presidents Bush and Obama were intended to make sure that people needing care for mental health issues or for addiction would get the treatment they need. One of the biggest barriers to getting treatment has always been cost. If an insurance plan does not cover treatment, or if the restrictions on treatment are significant, someone who needs help may not get it. Those who are in the field of treatment for addiction are finding that the laws’ intentions are not always playing out as intended.

The National Association of Addiction Treatment Professionals conducts ongoing surveys and has reported that there are many denials of coverage for addiction care. Behind more than half of those denials is a debate over what is medically necessary. Unlike other medical conditions, like heart disease for instance, medical necessity for addiction is not always perfectly clear. The insurance plans need not cover care that is not deemed medically needed. Caregivers cite the changing laws as the reason insurers are getting tougher about what they will and will not cover.

One of the biggest battles over care for addicts is the number of days of coverage for residential stays. Many insurers want to cap the stay at a week or less, while addiction experts insist that patients need up to three months of treatment. Some insurers insist that treatment need not be inpatient care and that they will cover a few months of outpatient care. What is right for each patient, though, is highly individualized. Some may succeed with outpatient treatment, while others have nowhere safe to go and really need a long stay in a residential facility.

The changing laws regarding care for addiction and mental health represent an important societal shift in attitudes toward those struggling with these very real medical conditions. The shift is positive and the laws help, but there are still many bugs to work out. As insurers debate how to implement coverage that meets the requirements of the laws, addiction caregivers try to pick up the slack. It may take more time to ensure that everyone gets the help they need, but the changes so far are just not enough to reach everyone.

Like people addicted to a range of other substances, people addicted to cannabis (marijuana, hashish or hashish oil) can develop symptoms of withdrawal when their brains don’t receive the expected amount of the drug. The presence of significant withdrawal symptoms can potentially stop a habitual cannabis user from successfully discontinuing his or her drug intake. In a study published in March 2014 in the American Medical Association journal JAMA Psychiatry, researchers from several Australian institutions investigated the potential effectiveness of a multiple sclerosis medication, called nabiximols (Sativex), as a treatment for people going through cannabis withdrawal. Nabiximols is derived from certain types of cannabis plants.

I Thought Marijuana Wasn’t Addictive?

The American Psychiatric Association acknowledges cannabis withdrawal as a distinct and diagnosable mental health condition. People going through this form of drug withdrawal can develop symptoms that include a prominent urge to consume more cannabis, increased levels of anxiety, an unusually agitated or irritated mental state, a reduced ability to fall asleep or stay asleep and a reduced interest in food. As a rule, doctors consider officially diagnosing these symptoms when they substantially impair the day-to-day functionality of affected individuals or produce a notable decline in mental/emotional well-being. As of early 2014, there are no medications available in the U.S. designed to treat people affected by cannabis withdrawal.

Nabiximols

Nabiximols is an oral spray chemically extracted from flowers harvested from a cannabis species known as Cannabis sativa. Rather than using plants grown through usual methods (which can have highly varying amounts of THC and other active ingredients), manufacturers of the medication use plants cloned in tightly controlled conditions. Compared to the THC derived from smoking cannabis, the THC contained in nabiximols produces its drug effects more slowly and also reaches a lower overall peak inside the bloodstream. Still, the medication has a fairly rapid impact and typically triggers noticeable effects in 15 to 40 minutes. Together, these properties make nabiximols a potential option for treating people affected by the autoimmune nerve disorder multiple sclerosis. As of 2014, the medication is not available in America; however, Canada and several European countries have approved its use. Currently, pharmaceutical companies are seeking approval for use of the medication in the U.S. as a treatment for certain forms of cancer-related pain.

Potential Effectiveness

In the study published in JAMA Psychiatry, researchers from the University of Sydney, the University of New South Wales and several other Australian institutions used a monthlong project to assess the effectiveness of nabiximols as a treatment for the symptoms of cannabis withdrawal in people affected by cannabis dependence/addiction. Half of the 51 participants in this project received the medication for six days; the other half received a placebo that mimicked the appearance of nabiximols for the same amount of time. Four weeks later, the researchers conducted a follow-up examination of each participant in both the nabiximols group and the placebo group. This examination included a test (called the Cannabis Withdrawal Scale) designed to measure the intensity of withdrawal symptoms, as well as assessments of such things as length of stay in a treatment program, involvement in cannabis use after going through withdrawal and experiences with cannabis-related harm.

After comparing the two groups, the researchers concluded that use of nabiximols does contribute substantially to the general reduction of withdrawal symptoms in physically dependent cannabis users. Specifically, the medication helps lower the intensity of cannabis cravings and ease the impact of the mood alteration commonly associated with cannabis withdrawal. In addition, nabiximols use has a smaller but detectable impact on the severity of several other withdrawal symptoms. Compared to the study participants who did not receive nabiximols, the participants who received the medication also stayed in treatment longer during the project’s initial phase.

The authors of the study published in JAMA Psychiatry note that nabiximols apparently only helps extend participation in cannabis treatment during its active use. Once that use came to an end, the individuals who received the medication did not stay in treatment any longer than the individuals who received a placebo. All told, the study’s authors believe that their findings support the potential usefulness of the medication as a cannabis withdrawal treatment and point toward a need for additional research.

Significant numbers of the people who commit crimes in America are affected by clinically diagnosable symptoms of substance abuse or substance addiction. Current evidence indicates that successful treatment of these individuals’ substance-related issues substantially reduces the chances that they will commit additional crimes in the future. According to results reported by the National Institute on Drug Abuse, successful treatment of criminal offenders with substance-related issues also carries a lower financial burden for society than the reincarceration of those individuals who continue their involvement in illegal activity.

Drug Abuse And Jail Time

The close connection between substance problems and the chances of ending up in jail or prison is well documented. For example, figures compiled by the National Institute on Drug Abuse indicate that roughly 50 percent to 66 percent of the people incarcerated in a state jail or prison, or in a federal facility, have symptoms that could qualify them for an official diagnosis of alcohol use disorder (alcohol abuse or alcoholism). In addition, figures compiled for the year 2012 by the Substance Abuse and Mental Health Services Administration indicate that just over 25 percent of U.S. adults recently paroled from prison or under supervised prison release currently abuse either marijuana or some sort of prescription medication. Furthermore, well over a quarter (30.2 percent) of all U.S. adults who receive probation for criminal activity abuse marijuana or a prescription medication.

Medical Benefits Of Addiction Treatment

More than four out of five people in jail or prison with diagnosable substance problems don’t receive treatment for those problems while incarcerated. This means that the vast majority of affected individuals finish their sentences with their abuse or addiction issues intact. Statistically speaking, these individuals have an unusually high chance of committing more crimes, whether in direct support of their substance use or for other purposes. Current evidence strongly supports the usefulness of substance treatment for incarcerated men and women. Specific treatment approaches that produce positive results include both the use of substance-specific medications and the use of substance-specific counseling or behavioral therapy. Treatment settings that produce positive results include long-term residential communities called therapeutic communities (which work both inside and outside of a daily prison environment), the use of specialized courts that mandate both treatment participation and consequences for criminal activity, and the use of a specific form of case management called TASC (Treatment Accountability for Safer Communities).

Is Drug Treatment Cost-Effective?

The 2014 report from the National Institute on Drug Abuse details the results of a 2013 study published in the American Journal of Public Health by researchers from the University of California, Los Angeles. These researchers analyzed the financial impact of a California law, called the Substance Abuse and Crime Prevention Act of 2000, which mandated that people with little or no history of involvement with the criminal justice system receive parole for certain drug-related activities if they agreed to attend a suitable form of substance treatment.

The researchers gathered financial data from 42,000 active cases between the middle of 2001 and the middle of 2002 and compared that information with financial data from 47,000 active cases between the middle of 1997 and the middle of 1998. All of the people in the first group qualified for treatment under the Substance Abuse and Crime Prevention Act; all of the people in the second group would have qualified for treatment under that law had it existed at the time. After calculating all of the costs involved, the researchers concluded that treatment of offenders dealing with serious substance-related issues saved California an average of $2,300 per person. This equated to a total savings of roughly $100 million in a single year. Most of the savings came from reduced costs to the California prison system stemming from the need to house fewer individuals.

Despite the savings produced by treating first- and second-time offenders affected by substance issues, California stopped providing funding for enforcement of the Substance Abuse and Crime Prevention Act after 10 years. The authors of the study published in the American Journal of Public Health note that financial costs for dealing with the community-wide effects of substance-using criminal offenders are steadily trending upward. They also note the usefulness of programs such as the one employed in California throughout the first decade of the 2000s. This usefulness includes both economic savings and the achievement of substance treatment results for criminal offenders that match up well with the results gained by people not involved with the criminal justice system.

Read Why Drug Rehab In Lieu Of Jail Does Not Always Work

Millions of cigarette smokers across the U.S. are addicted to nicotine, a natural ingredient in tobacco capable of producing harmful, long-term changes in brain chemistry just like a range of other legal and illegal substances of abuse. In most cases, people who attempt to quit smoking do so without the help of an addiction specialist or any other health professional prepared to deal with nicotine addiction. In a study published in March 2014 in the journal Addiction, a team of British and Dutch researchers assessed the likelihood that smokers addicted to nicotine will successfully quit using cigarettes without professional help.

The Basics Of Nicotine Addiction

Nicotine addiction is related to a nicotine-induced chemical imbalance in the area of the brain responsible for producing pleasurable responses to various activities. This imbalance activates the pleasure center and gives a smoker an incentive to introduce nicotine into the brain again and again over time. This incentive is heightened by the fact that any single episode of nicotine exposure only briefly produces its pleasurable effects. Over 40 million American adults smoke cigarettes; since most habitual smokers are nicotine addicts, nicotine addiction constitutes the most widespread form of substance addiction in the U.S. More than two-thirds of the people who smoke cigarettes want to quit, according to figures compiled by the federal Centers for Disease Control and Prevention.

Smoking Cessation Techniques

The main smoking cessation technique available to a cigarette user who does not seek professional assistance is non-prescription nicotine replacement therapy. This approach relies on the use of over-the-counter nicotine-containing gum, lozenges or patches to gradually reduce an individual’s dependence on nicotine and help him or her avoid the unpleasant symptoms of nicotine withdrawal (which commonly act as a strong deterrent to smoking cessation efforts). Techniques used under the guidance of an addiction specialist or some other form of health professional include prescription nicotine replacement therapy (nasal sprays, inhalers or patches) and prescription nicotine-free medications such as varenicline (Chantix) or buproprion (Zyban), as well as forms of counseling that include short training and motivational sessions called brief interventions, longer group or individualized counseling sessions, remote counseling sessions that rely on phone or Internet technology and a form of in-person practical training called behavioral therapy. As a rule, a combination of professionally administered medication and counseling produces results that are superior to an all-medication or an all-counseling approach.

Chances Of Quitting Success

In the study published in Addiction, researchers from University College London and the Maastricht University Medical Centre used information gathered from a large-scale survey project called the Smoking Toolkit Study to compare the chances of smoking cessation success among people who make their own efforts to the chances of success among people who seek professional help. All told, data was collected from 10,335 smoking adults in England who had tried to stop using cigarettes one time or more in the year prior to the survey. The researchers broke these individuals down into four groups: people who received both professionally administered counseling and medication while trying to quit, people who only received professionally administered medication while trying to quit, people who tried to quit on their own with non-prescription nicotine replacement products and people who tried to quit on their own without using non-prescription nicotine replacement.

The researchers concluded that, compared to smokers who try to quit on their own without nicotine replacement products, smokers who try to quit while receiving professionally administered counseling and medication successfully stop smoking more than three times as often. Smokers who try to quit while only receiving prescription medication successfully stop smoking over 1.5 times more often than smokers who quit on their own without nicotine replacement products. Smokers who quit while only using non-prescription nicotine replacement successfully stop smoking about 0.96 times more often than those individuals who try to stop without any form of non-prescription medication or professional help.

The authors of the study published in Addiction note that, while there is some difference in the rates of smoking cessation success for people who only use over-the-counter nicotine replacement and people who use no assistance at all, the results in these two groups are close enough to qualify as “similar.” In contrast, people who receive a combination of counseling and prescription medication or just prescription medication clearly have improved odds of successfully quitting smoking.

Find Out If Nicotine Patches Work If You Are Pregnant

Buprenorphine is an opioid medication approved in the early 2000s as a treatment for people addicted to both legal and illegal opioid substances. This medication has a proven record of effectiveness, but current evidence indicates that doctors don’t often prescribe it to their opioid-affected patients. In a study published in March 2014 in the journal Substance Abuse, researchers from five U.S. institutions sought to determine how many people that use/abuse an IV (intravenous) opioid drug are aware of buprenorphine as a treatment option. These researchers also assessed IV opioid users’ willingness to participate in buprenorphine-based treatment.

What Is Buprenorphine?

It might seem strange that a doctor would prescribe an opioid medication to help a person affected by opioid addiction; however, buprenorphine does not produce its effects as rapidly as heroin or other commonly abused opioids (or the opioid medication methadone); in addition, the medication has a relatively low maximum level of effect, and people who keep using it after reaching this level will not get any more “high.” In combination, these qualities make buprenorphine suitable as either a short-term or long-term option for people addicted to stronger opioids that enter treatment. Essentially, use of the medication makes it possible for recovering addicts to avoid uncontrolled substance intake while simultaneously avoiding the highly distressing symptoms of complete opioid withdrawal. One commonly used prescription product, called Subutex, contains only buprenorphine. Another commonly used product, called Suboxone, contains both buprenorphine and a second medication (naloxone) that effectively decreases the risks for buprenorphine abuse.

Effectiveness And Access Of Buprenorphine

Numerous studies have verified the effectiveness of buprenorphine and buprenorphine/naloxone as treatments for opioid addiction and opioid dependence (a state of physical reliance that does not include the dysfunctional symptoms of addiction). In addition, unlike methadone, which can only be administered to patients in a fairly small number of sanctioned clinics, any doctor who obtains a mandated ID number from the U.S. Drug Enforcement Agency can prescribe buprenorphine and buprenorphine/naloxone. This means that, theoretically, people affected by opioid addiction can get buprenorphine-based treatment in a far greater number of locations than they can gain access to methadone. Thousands of doctors across the U.S. have gone through the training needed to properly prescribe buprenorphine and buprenorphine/naloxone and have also registered with the DEA.

Awareness Among IV Opioid Users

In the study published in Substance Abuse, researchers from Johns Hopkins University, the City University of New York, the Albert Einstein College of Medicine, the Montefiore Medical Center and New York Harm Reduction Educators used an examination of 158 IV opioid users in New York City to assess how many such users know about buprenorphine as a treatment option for opioid addiction. All of these users were participants in a syringe exchange program. In addition to gauging basic awareness among these individuals, the researchers used interviews to determine how many people had received some form of buprenorphine and how many people displayed a willingness to try the medication or learn more about it. The researchers also looked for any connection between established familiarity with buprenorphine and the willingness to use the medication.

All told, the researchers found that most of the study participants (70 percent) had heard about buprenorphine as a possible treatment option. Roughly one-third of the participants (32 percent) had first-hand knowledge of someone who took buprenorphine, while another third (31 percent) had second-hand knowledge of someone who took the medication. Only 12 percent of all the individuals enrolled in the study had received buprenorphine themselves. When the researchers asked the 138 participants with no personal history of buprenorphine use if they were curious about using the medication, more than half of these individuals (57 percent) replied in the affirmative. Upon further investigation, the researchers concluded that curiosity about buprenorphine use was basically limited to those participants with second-hand knowledge of the medication.

The authors of the study published in Substance Abuse note that the opioid users enrolled in their project were among those that may be overlooked by programs offering treatment for opioid addiction. Even still, most of these individuals knew about the medication and many showed a willingness to learn more about it or possibly use it as a treatment option. The study’s authors believe that public health officials should explore the interest shown by those IV opioid users with second-hand knowledge of buprenorphine as a potential inroad for eventually making active treatment with the medication more widespread.

Read More About Successful Buprenorphine/Naloxone Treatment For Opioid Addiction

Cigarette use during pregnancy is associated with a range of health problems that can lead to serious or severe complications before or after childbirth. For this reason, public health guidelines strongly urge women not to smoke while pregnant. In a study published in March 2014 in the journal BMJ (formerly known as the British Medical Journal), researchers from several French institutions sought to determine if nicotine replacement patches, one of the common options for smoking cessation treatment, produce any real-world benefit for pregnant smokers. These researchers concluded that nicotine patches don’t appear to work any better for pregnant women than placebo treatments.

Smoking During Pregnancy

Statistics compiled by the Centers for Disease Control and Prevention indicate that slightly over half (54 percent) of all women smokers suspend their cigarette use while pregnant. Still, significant numbers of women continue to smoke during the early, middle or late stages of pregnancy or throughout all stages of pregnancy. Known harms of fetal exposure to the chemicals in cigarette smoke include heightened risks for a pregnancy-ending miscarriage, heightened risks for delivering a baby prematurely, heightened risks for delivering a baby lacking in sufficient body weight, heightened risks for delivering a baby affected by one of several specific birth defects and heightened risks for delivering a child who will eventually die from sudden infant death syndrome (SIDS). In addition to the problems associated with direct exposure to cigarette smoke, developing children also have increased chances of being born underweight when exposed to secondhand smoke.

Nicotine Patches And Pregnancy

Like other nicotine replacement therapy products (such as gum, nasal sprays, inhalers and lozenges), nicotine patches produce their benefits by delivering preset, relatively small amounts of nicotine into the bloodstreams of people affected by nicotine addiction. These nicotine doses allow a person to curb his or her cigarette intake while avoiding the onset of the withdrawal symptoms that commonly afflict individuals trying to quit smoking and interfere with successful smoking cessation. Some smokers try to quit with the help of low-strength, non-prescription nicotine patches that are available at all sorts of commercial outlets throughout the U.S. Others rely on stronger nicotine patches that require a doctor’s prescription. In some cases, nicotine replacement therapy forms the entirety of a smoking cessation strategy. In other cases, nicotine replacement forms part of a larger approach that also includes some form of counseling, brief training or behavioral therapy training.

Effectiveness Of Nicotine Patches For Pregnant Women

In the study published in BMJ, the French research team used information gathered from 402 pregnant women to assess the effectiveness of nicotine patches as a deterrent to cigarette use. These women, all of whom were over the age of 18 and in the second trimester of pregnancy, came from 23 French hospitals and had a daily nicotine intake of five or more cigarettes. Half (203) of the study participants received nicotine patches, while the other half received placebo patches that mimicked the appearance of nicotine patches. Both groups continued to use their respective patches until they delivered their babies at the end of pregnancy.

The researchers used several criteria to compare the effectiveness of the nicotine patches to the placebo patches. The main criteria for each woman were successful abstention from cigarette use and the delivery of a child with normal birth weight. Secondary criteria included the overall number of women in each group who remained cigarette-free and the time it took for any given woman to relapse back into cigarette use.

Only 11 women in the nicotine patch group remained abstinent from cigarette use over the course of the study; a nearly identical number of women (10) in the placebo group also remained entirely cigarette-free. In both groups, the average woman relapsed back into cigarette use after a period of 15 days. In addition, when compared to the babies born to the women who used a placebo medication, the babies born to the women who received nicotine patches were, on average, only heavier at birth by about 1.8 ounces.

During part of the study published in BMJ, the researchers increased the nicotine patch doses until these doses reached or exceeded the amount of nicotine the women normally consumed while smoking. Even this increase in medically supplied nicotine did not improve smoking abstinence or delay the average time to smoking relapse. The study’s authors concluded that nicotine patches, in particular, do not appear to provide any benefit as a smoking deterrent to women during pregnancy. Pregnant smokers should discuss all possible treatment options with their doctors.

Read “Pregnant And Addicted – What Now?”