By treating smoking aggressively as a chronic, relapsing disease, clinicians can raise the odds for success, a pair of studies suggests. One gave patients a variety of cessation medications at the same time. The other investigated the effect of supplementary counseling.

Researchers divided 750 people who smoked at least half a pack a day into three groups. The controls were given either a nicotine patch or bupropion. “Moderately intense” intervention added one or two calls from addiction counselors. A “high-intensity” group got the patch or bupropion and as many as six counseling calls over the course of two years (Ann Intern Med. 2009;150:437-446).

Abstinence rates were assessed every six months. Overall analysis at 24 months showed patients in the high-intensity arm had higher quit rates than those in the moderate-intensity group. When the groups were combined, they showed higher rates than patients who received no counseling calls at all.

Meanwhile, another team recruited 127 smokers who had cancer, heart disease, or chronic obstructive pulmonary disease (Ann Intern Med. 2009;150:447-454). Participants were divided into two groups: One received nicotine patches for standard 10-week courses; the other was given nicotine patches, nicotine inhalers, and bupropion. After six months, 35% of the combination group had quit smoking compared with 19% of the patch-only arm. In addition, median time to relapse was significantly longer in the combination group (65 days vs. 23 days).

Attacking addiction via different mechanisms blends the passive, continuous patch with the shorter-term inhaler to respond to cravings. The combination group was also told to continue their medications for as long as they felt necessary. Consequently, they could customize their treatment and were more likely to succeed.