SOURCE: Corbis Corporation.

versus placebo medication. As indicated in Table 4.2, recent research has examined the combination of nicotine replacement therapies. Combinations of NRT reflect recognition of the utility of augmenting steady levels of nicotine replacement obtained with the nicotine patch, with more flexible forms of dosing (e.g., nicotine gum) to cope with transient urges. A recent study also evaluated the efficacy of combining the nicotine patch with bupropion SR. In this study, the combined drugs did not significantly out-perform either therapy alone. Still unanswered is whether combining bupropion SR with NRT that has a more flexible dosing regimen (e.g., gum, nasal spray, or inhaler) would enhance cessation.

The 1988 Surgeon General’s report on smoking as nicotine addiction (US DHHS, 1988) concluded that nicotine replacement is best viewed as an adjunct to counseling or other smoking cessation programs and efforts. The 1996 Agency for Health Care Policy and Research (AHCPR) Guidelines were unable to reach a clear conclusion as to whether nicotine replacement without any behavioral counseling was no better than placebo (AHCPR, 1996). Other reviews found little evidence for nicotine replacement in isolation. For example, a meta-analysis found an odds ratio of 1.91 for continued smoking cessation for those who receive nicotine gum plus a brief intervention versus those who receive only nicotine gum (Baillie et al., 1994). The 2000 PHS Guidelines emphasized the importance of at least brief counseling for all smokers interested in quitting and concluded that, except in special circumstances, all individuals interested in quitting smok-



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