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Quit smoking by cutting down by Ciaran J Newman FIITD
Giving up smoking by cutting down - a gradual reduction method.
GRM (Gradual Reduction Method) is an alternative to NRT (Nicotine Replacement
Therapy) and other drug-based smoking cessation methods. With NRT, the smoker
stops abruptly, using medication in the form of patches, gums, inhalers or tablets
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to continue the supply of nicotine for up to 3 months to help overcome nicotine
addiction. Another drug-based treatment, only available on prescription, is the
anti-depressant bupropion ('Zyban'); a low dose in the last two weeks before
quitting rises to full strength, taken for about 3 months after quitting. Research
shows that both NRT and bupropion create extra problems for smokers: they have
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their own side-effects and, for the majority of smokers, do not deliver the hoped-
for results.
The problem for most smokers, particularly those who have previously tried to
stop, is that they know that abruptly stopping is going to be a painful and difficult
experience, demanding significant willpower and resilience and would prefer to use
a gradual reduction method(1).
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Gradual reduction is an effective procedure(2). see
www.quitsmokinghowtoquit.com Moderate-to-heavy smokers who reduce their
consumption prior to their quit date are more likely to stop smoking; even those
who continue to smoke consume on average 11.4 fewer cigarettes per day(3).
Among relapsers, those who stop abruptly tend to return to their previous smoking
levels while the gradual reducers relapse to significantly below their original levels
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The GRM options available to date include:
Self-control - (i) Gradual reduction in the number of cigarettes daily ('cigarette
tapering'), using techniques such as reducing the number of cigarettes in their
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pack at the start of the day, increasing the time gaps between smoking, smoking
less and less of each cigarette. (ii) 'Nicotine fading' by switching to brands yielding
less nicotine. However, such brand switching leads to smoking more cigarettes and
taking larger and more frequent puffs(5). Most smoking cessation professionals do
not recommend self-control approaches as success rates are poor compared to
therapist-paced target-setting(6).
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Plastic filter systems - A nicotine fading method, using three or four different
filters to trap different amounts of tar and nicotine. However, the (unfashionable)
use of plastic cigarette holders, coupled to the need to dismantle and clean out the
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filter after every five cigarettes, makes them unattractive. Smokers using these
methods also tend to compensate for the reduced nicotine by smoking more
cigarettes or taking longer and deeper puffs(7).
Computer monitoring - Hand-held or wristwatch devices instructing smokers when
to smoke, gradually reducing consumption (cigarette tapering); these techniques
can improve a smoker's chance of giving up(8). Possible downsides are that
smokers can be required to smoke when they do not actually want to, and some
are uncomfortable handing control to a machine. They can be fairly expensive and
are not widely available.

Aerating devices - These introduce air into the smoke stream, either by punching
holes into the side of the cigarette or via plastic filters (nicotine fading). Smokers
tend to compensate for the diluted smoke by taking deeper puffs(9); this has been
shown to cause a particular type of lung cancer, also found in smokers who have
switched to 'low tar' or 'light' brands. Smokers also tend to cover up the ventilation
holes in order to 'taste' their cigarette.

http://www.goarticles.com/cgi-bin/showa.cgi?C=153557 The previous implementations of GRM have each had their particular problems, so
there has been hardly any GRM available via mainstream smoking cessation routes.
However, after ten years research and development, NicoBloc is now available,
heralding a new era in the provision of support for those who want to give up
cigarettes in a gradual and controlled manner.

NicoBloc - NicoBloc is a safe, natural product made from a food-grade composition
(FDA approved) and can be used by all smokers including those with medical
conditions or women in pregnancy. NicoBloc fluid soaks into the cigarette filter to
trap tar and nicotine; it is typically used over a six-week period, achieving gentle
weaning off nicotine addiction. www.quit2day.com

The smoker applies one drop of NicoBloc (which blocks up to 33% of tar and
nicotine) to each cigarette in week one, two drops in week two and, from week
three onwards, three drops, blocking up to 99% of tar and nicotine(10).

NicoBloc users do not compensate for reduced nicotine intake by smoking more
cigarettes(11), and NicoBloc use is not associated with increased craving or other
withdrawal symptoms, nor does it sufficiently affect the taste or smoking
experience to deter users(12).

The NicoBloc method also contains subtle behaviour modification. The action of
applying NicoBloc to each cigarette before it is smoked breaks the pack-to-mouth
routine. Also, as smokers are required to progressively undertake more 'work' in
order to receive less 'reward', they tend to opt not to smoke their least favourite or
the more inconvenient cigarettes, e.g. when driving.

When NicoBloc was used in the workplace 'Rosen Stop Smoking Programme' field
trials (800 smokers over a 2-year period in 88 different UK and Irish companies),
the results showed that 6 weeks was a comfortable period for gradual reduction
with 60% of participants completing the Programme and stopping smoking without
significant withdrawal symptoms. This Programme also generated the cigarette
tapering target-setting algorithms embodied in the printed NicoBloc materials and
within the interactive facility at www.nicobloc.com.

In a small study (which did not include NicoBloc), five different combinations of
various quitting strategies were tested; the most effective involved a combination
of nicotine fading and cigarette tapering; 12 months later, 57% were still non-
smokers(13).

NicoBloc combines, in one simple, user-friendly process, nicotine fading and
cigarette tapering together with target-setting and behaviour modification.

The NicoBloc retail pack contains an illustrated instruction booklet with a free CD
or video and website support. Also included is a voucher for a nicotine test kit that
can show, with a simple urine test, the presence or absence of nicotine in the
smoker's body. This is usually used at the end of the programme to provide
confirmation to the smoker that they are clear of nicotine.

NicoBloc is readily available over the counter in pharmacies or on the web
(www.quit smokinghowtoquit.com)and comes in a convenient sized pack that
provides a typical 20-a-day smoker with 2 weeks' supply.

References 1. Hazelden Foundation (1998). Heading off a nation of teenage
smokers. New York Times, 17/11/98.

2. Flaxman, J. (1978) Quitting smoking now or later: Gradual, abrupt, immediate
and delayed quitting. Behavior Therapy, 9, 260-270.

3. Farkas, A.J. (1999) When does cigarette fading increase the likelihood of future
cessation? Annals of Behavioral Medicine, 21, 71-76.

4. Gunther, V., Gritsch, S. & Meise, U. (1992) Smoking cessation - gradual or
sudden stopping? Drug and Alcohol Dependence, 29, 231-236.

5. Zacny, J.P. & Stitzer, M.L. (1998) Cigarette brand-switching: Effects on smoke
exposure and smoking behavior. Journal of Pharmacology & Experimental

http://www.goarticles.com/cgi-bin/showa.cgi?C=153557 Therapeutics, 246, 619-627.
6. Hill, A.A. (1982) Target-setting self-control for smoking. Psychological Reports,
50, 68-70.

7. Henningfield, J.E, & Griffiths, R.R. (1980) Effects of ventilated cigarette holders
on cigarette smoking by humans. Psychopharmacology (Berlin) 68, 115-119.

8. Cinciripini, P.M., Lapitsky, L., Seay, S., Wallfisch, A., Kitchens, K. & Van Vunakis,
H. (1995) The effects of smoking schedules on cessation outcome: Can we improve
on common methods of gradual and abrupt nicotine withdrawal. J. Consult. Clin.
Psychol., 63, 388-399.

9. Stitzer, M.L., Brigham, J. & Felch, L.J. (1992) Phase-out filter perforation: Effects
on human tobacco smoke exposure. Pharmacology, Biochemistry and Behavior, 41,
749-754.

10. Stillwell & Gladding Testing Laboratories. (April 19, 1993) Cigarette smoking
tests using Accudrop (=NicoBloc) filter solution.

11. Pickworth, W.B., Fant, R.V., Nelson, R.A. & Henningfield, J.E. (1998) Effects of
cigarette smoking through a partially occluded filter. Pharmacology, Biochemistry
and Behavior, 60, 817-821.

12. Gariti, P. & Alterman, A. (1997) Testing a smoking cessation aid. College on
Problems of Drug Dependence. 59th Annual Meeting. Nashville TN June 1997. In:
L.S. Harris (ed), Problems of Drug Dependence. NIDA Research monograph 178.
p.158.

13. Becona, E. & Garcia, M.P. (1993) Nicotine fading and smokeholding methods to
smoking cessation. Psychological Reports, 73, 779-786.

About the Author
Ciaran J Newman is a past Chairperson and Fellow of the Irish Institute of Training
& Development. He has lectured extensively on the subject of Goal Setting and
Behaviour Modification. www.arkomax.com

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