prevent addiction and should be used in
conjunction with other therapeutic
approaches.^178
A cocaine vaccine also has been developed and
was found in a preliminary study to reduce
cocaine use.^179 Researchers also are exploring a
vaccine or antibody administrations for other
addictive stimulants including
methamphetamine^180 and phencyclidine (PCP)^181
and have found promising results in animal
samples.
Maintenance Medications/Medication
Assisted Therapies. Certain medications used
to treat addiction function by delivering a less
dangerous or less addicting version of the
addictive substance during the acute care phase
of addiction treatment.* These medications may
function by reducing cravings or withdrawal
symptoms and/or by reducing the rewards
associated with the addictive substance.
Maintenance medications have proven to be
highly effective in treating a variety of
manifestations of addiction and in disease
management.
Nicotine Replacement Therapy (NRT). NRT,
when used as directed, provides lower doses of
nicotine at a slower rate than smoking,^182
thereby easing nicotine withdrawal symptoms.^183
For many smokers, it works best as an aid to
managing nicotine-related cravings when used in
conjunction with psychosocial therapies. In
most cases of acute care treatment, a therapeutic
level of nicotine is reached and then use is
reduced in order to eliminate the medication
entirely or reach a maintenance level.^184
Because most patients who use NRT control
their treatment regimen on their own, there is a
risk that the nicotine intake from NRT products
may be higher than intended for those who do
not use them as directed or who use them while
continuing to smoke.^185
Nicotine gum, lozenges and inhalers and nasal
sprays deposit nicotine in the bloodstream
through the lining of the mouth or nose, whereas
- These medications also may be used for an
extended period of time for disease management.
the nicotine patch delivers the nicotine through
the skin.^186 Nicotine gum and lozenges both are
over-the-counter medications; inhalers and
sprays require prescriptions. The nicotine patch
is available both over-the-counter and by
prescription.^187A meta-analysis† of 13 studies found that use of
nicotine gum can increase significantly smokers’
chances of quitting for at least six months.^188
The use of nicotine lozenges nearly doubles the
chance of achieving continuous abstinence over
at least a six-month period.^189 Side effects of
nicotine gum and lozenges include sore throat,
heartburn, jaw pain and nausea.^190Nicotine inhalers come in cartridges which
release nicotine vapor when puffed that is
absorbed through the lining of the mouth and
through the back of the throat.^191 Two meta-
analyses found that inhaler use can nearly
double patients’ abstinence rate over at least a
six-month period, relative to those who received
a placebo.^192 The primary side effect is local
irritation.^193 Nicotine nasal spray is aerosolized
nicotine that comes in a spray pump. The
nicotine is sprayed into the nostrils and absorbed
rapidly by the nasal membranes.^194 Meta-
analyses indicate that patients almost double
their chances of achieving and maintaining
abstinence at six months with the use of a nasal
spray versus a placebo.^195 The primary side
effect of the medication is local irritation.^196
This form of NRT has the highest potential for
misuse: 15 to 20 percent of patients report using
the spray for longer than the recommended
period and five percent report using a higher
dose than recommended.^197The nicotine patch is available in both single and
step-down dosages. An eight-week course of† The review included only those studies that had
been published in peer-reviewed journals; however,
some studies were supported by the pharmaceutical
industry. Most of the studies included in the analysis
drew participants from self-selecting populations of
smokers and, in general, the studies’ participants
received counseling regardless of whether they were
randomly assigned to receive medication or placebos.
(This is true of all meta-analyses of tobacco cessation
interventions reported here.)