Another approach is to encourage and instruct unwilling smokers to substantially and persistently reduce their daily smoking (“as much as possible”25), while using NRT (Table 3)25–27. A meta-analysis of 7 placebo controlled trials (Total N = 2767) examined the effects of patients using NRT (nicotine gum, inhaler, or patch) for 6 months or more while trying to reduce their smoking27. This, “Smoking Reduction+NRT” treatment almost doubled patients’ abstinence rates vs. placebo (10 vs. 5%) in patients previously unwilling to quit. A similarly strong finding was obtained in a recent study28 of 1,154 “unwilling” smokers who used either nicotine gum or patches for only 2 months; at 6-month follow-up 17% were abstinent in the NRT group, but only 10% in the control group. About a quarter or so of non-quitters reduce their smoking by 50% or more in such treatments25,27. Importantly, patients using NRT while smoking report about the same level of adverse events as patients using placebo27.
