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Smoking Cessation in the Adolescent:

Smoking Cessation in the Adolescent:  A Guide For Parents & Teens

McKenzie Pediatrics 2012

A growing number of smoking cessation aids make it easier than ever for smokers to break their addiction to nicotine. This guide aims to help parents and teens to understand the wide range of available cessation aids, which can double or even triple the chances that a smoker will successfully quit.

But be warned, QUITTING IS NOT EASY. Smoking is a physical addiction, after all. Ninety percent of successful quitters will relapse at least once. And success must be considered even if there is just a significant reduction in daily cigarette use.

Nicotine Replacement Therapies

The idea is simple. To help smokers manage nicotine withdrawal, nicotine replacement therapies (NRT) deliver the potent drug in ways that are far healthier and safer than cigarettes. Ideally, ex-smokers can gradually reduce the amount of nicotine, or stop NRT all at once after theyíve broken the habit. Even when used for long periods of time, NRT is far safer than smoking. Quit rates range from 20 to 25%...they are NOT a guarantee of successful smoking cessation. They work as well in teens as in adults.

Gums, lozenges, and patches are available over the counter. Nasal sprays and inhalers require a prescription. Gums and lozenges are handy to use and offer something for smokers to put into their mouths instead of a cigarette. All of these forms are equally effective, and they can be used in combination. Evidence shows that combining patches with gum, lozenges, sprays or inhalers improves long-term quit rates. BUT YOU CANNOT CONTINUE TO SMOKE WHILE USING NRT.

The greatest risk of resuming smoking is stopping NRT too early. Plan on sticking with a NRT for a minimum of 2 to 3 months. Even once NRT is stopped, keep some gum or lozenges on hand just in case of a sudden craving.

Patches should be used daily for at least 8 weeks, starting at 14 or 21 milligrams a day for 6 weeks then tapering to 7 or 14 milligrams per day for 2 more weeks. There are a variety of brands available over-the-counter, and no single one is preferred, therefore itís okay to shop by price. Sale is restricted to persons at least 18 years of age, though patches may be prescribed by a doctor.

Nasal sprays are often not tolerated due to reports of burning, and the dislike of spraying a liquid into the nose. Inhalers have not been well-studied in children and teens.

Oral Medications

Approved in 1997, Zyban (Bupropion SR) acts on chemicals in the brain to ease nicotine withdrawal symptoms, making it easier for smokers to resist the craving to light up. The pills are usually taken twice a day for a period of 2 to 3 months, and started 2 weeks prior to the quit date. About 25% of smokers who use Zyban successfully quit. The drug is not recommended for people with seizure disorders, bulimia, anorexia, or patients using alcohol or certain other anti-depressants. The most common side effects are dry mouth and insomnia.

Welbutrin (Bupropion HCL) is also available to help smokers reduce their cravings. It works in a similar manner to Zyban, with similar side effects.

And, finally, there is Chantix (Varenicline), which is effective at blocking nicotine receptors in the brain. It is usually prescribed for a 12-week period, with the option of another 12-week maintenance course. About one-third of smokers who use the drug successfully quit. It CANNOT be used with NRT. Side effects potentially include nausea, vomiting, abnormal dreams, constipation, and flatulence. Serious neuropsychiatric events have been reported, including depression, suicidal thoughts, agitation, and hostility. Moods must be monitored closely on this drug.

It is important to note that none of these drugs are approved by the FDA for use in children under the age of 18, though they are sometimes prescribed for older teens.

Counseling

Counseling and support groups have been shown to improve a smokerís odds of successfully quitting. Counseling takes many forms, from a doctorís advice to a formal smoking cessation program. Counseling typically includes advice on how to recognize smoking triggers, strategies to resist cravings, how to prepare for your quit day, ongoing support during your first few weeks and months of quitting, and other assistance. Counseling is invaluable to the smoker motivated to quit, and we strongly encourage it.

Final Words

As you have read, there is no single sure-fire method to quitting smoking. NRT is the best first-step, but its short-term success rate is one in three AT BEST. If NRT fails after 2 to 3 months, it is wise to try an oral cessation aid next, possibly in combination with NRT. A smoking cessation program is ALWAYS a good idea, and should be continued for a period of time even after successful quitting.