Health: Nothing's a patch on will power

TOMORROW is No Smoking Day. Many of Britain's 12 million smokers will pause when they see the "Ready, Steady, Stop" posters, and for one melancholy moment think about how they really ought to stop. Eleven million of them will snap out of it, shrugging the thought off with a reassuring, "I'll do it next week/month/year." But one million of them, the ones who have really had enough, will go for it.

Most of them will depend on will power, but about a quarter will use some form of nicotine replacement therapy (NRT) - gum, patches, nasal sprays or the "fashionable" new inhalators, which look like plastic cigarette- holders - some of the guests at last month's Brit Awards were spotted having a drag on hand-painted inhalators.

Whether they got through the night without succumbing to the real thing is another question. The depressing truth is that although these products do increase your chances of giving up, the success rate is low. Pharmacia & Upjohn, the makers of the market leader Nicorette, say using NRT "typically doubles or triples the success rates when compared to those smokers who quit using will power alone". What the trials show is that people using will power have a success rate of 1-3 per cent for every quit attempt, while those using NRT have a 5-10 per cent chance of stopping.

The more positive evidence is that people who join specialist smoking clinics, as well as using NRT, have a much higher chance of stopping - up to 20-25 per cent in some trials. This is compared to a 10-12 per cent success rate for people attending clinics without using NRT. The trouble is there are very few clinics. As there is no funding available, they depend on the enthusiasm of the medical staff who run them.

But most people using NRT are buying it over the counter, getting only minimal advice from the pharmacist. Apart from the nasal spray, NRT is not available on prescription and, given the 90 per cent failure rate for using it without support, seems expensive. The NRT market is worth about pounds 32.4m a year in the UK. Nicorette's gum costs about pounds 15 for a week's worth and pounds 180 for the recommended three months. The inhalator starter pack is pounds 5.95, with cartridge refills costing pounds 19.95 a week.

"NRT is the only method proven to work," says Gillian Riley, an addiction counsellor and NRT sceptic. "But only drug companies can afford to do trials. There is no research into other techniques." Her main objection to NRT is the implication that physical withdrawal from nicotine is a significant part of giving up, and that the solution is to maintain nicotine levels in the bloodstream. "Stopping smoking is primarily a mental process," she says. "Nicotine leaves the body less than 24 hours after the last cigarette. Unless you deal with the psychological side, the conflict between wanting a cigarette and wanting to give up, it's always going to be difficult."

Smokers, certainly, seem to perceive NRT as being useful. This may be because of the pounds 6.5m Pharmacia & Upjohn spend on advertising every year, or because of their own experience of trying to stop. A survey of smokers, published yesterday by the organisers of National No Smoking Day, found that 44 per cent wanted cheaper, subsidised NRT. Second on their wish list, was more smoking clinics.

But Dr Andrew Sherwood, who runs a clinic at his Kings Lynn practice, says persuading people to get help is incredibly difficult. Even though two-thirds of smokers say they want to stop, most of them are in a "pre- contemplative" stage. "That means they want to stop, just not now," he says.

Although doubtful about NRT's worth, he would like to be able to prescribe it. "It would at least provide an opening gambit to talk about smoking, which on the whole people are reluctant to do. But what we need is better techniques for dealing with the psychological side," he says. "What I tell people is that it will help them stop, but it won't help them stay stopped - that it will get them about 10 to 15 yards in an 100-yard race."

Days daze, page 17

'Patches didn't take away the urge'

"I'M A REALLY dedicated smoker. I just love it. I've only had two serious attempts at giving up - once using patches, once after seeing Alan Carr's stop smoking video," says Emma Messenger, 27, who smokes 20 a day and has no intention of trying to give up again soon. "The patches were OK. You can feel it seeping in, but it didn't take away the urge in those moments when you catch sight of a box of Marlboro, or you're getting ready to go out."

She lasted two weeks, before having a puff at a party and finding herself back as a full-time smoker before she knew it. "I'd already cheated a few times, smoking when I had the patch on, a bit like Patsy in Absolutely Fabulous."

Watching Alan Carr, she says, was a "near religious experience" and she stuck it out for six weeks. She recently had a go on a friend's inhalator. "Disgusting. I've never coughed so much in all my life. Next time I do it, I'll watch Alan Carr again and then go cold turkey.

"I reckon it's all about tricking your mind."

'It's a psychological battle, not physical'

"I HAVE to stand still and shout at myself," says Brian Harvey, who gave up smoking seven weeks ago. "I fight and argue, telling myself I don't want to smoke." Now 53, he had his first cigarette at 16 and had been smoking 60 a day, costing him pounds 70 a week. Having just retired from teaching, he decided it was time to stop, and contacted Quit who told him about a clinic at St George's Hospital in south London. He did a group course there for six weeks which advised using some sort of nicotine replacement.

"I've found the gum is pretty helpful, although the moral support is just as important. I'd tried gum before but thought it was a complete waste of time, probably because I didn't know how to use it properly ... I also thought it was a substitute for smoking, which it's not.

"You've got to go off and do something else, some painting or use the computer. That urge is gradually going away but when it comes, now about every two or three days, I it feels like more of a psychological battle than physical one."