Treatment of Nicotine Dependence Is More Better?

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Abstract
The two studies assessing the safety and efficacy of high-dose nicotine patch therapy by Jorenby et al1and Dale et al2in this issue ofTHE JOURNALraise four questions: Should higher-dose nicotine patches be used? Should nicotine patch therapy be tailored to achieve 100% replacement? How effective is the nicotine patch when given with no physician advice, ie, in over-the-counter—like conditions, in comparison with its effectiveness with physician advice, in prescription-like conditions? How much is its efficacy increased by adding behavioral therapy? See also pp 1347 and 1353. Dale et al2found that 22-mg patches underdose the majority of smokers and that higher doses are safe, provide better withdrawal relief, and appear to increase efficacy. Their results are supported by other studies, which found that standard-dose patches (15 to 22 mg/d) provide less than 100% nicotine replacement3; greater nicotine replacement decreases withdrawal symptoms and increases