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Cold turkey with a side of pills

Philip Quartier, a 64-year-old stockbroker from Mission Hill, had been smoking a pack of cigarettes a day for 45 years when he quit for the first time. After five clean years, an impulse led him to pick up another cigarette eight months ago, and the biking enthusiast, who has lung disease, was frustrated to be back to his old habit.

Determined to quit for good, he dug out the subliminal motivation tapes he'd used the first time around, went back on the nicotine patch, bought a self-help book, and joined a counseling group, but several months into the process, he was getting nowhere. So in November, he got a prescription for Chantix (varenicline), a six-month-old drug that is the first new quit-smoking treatment in a decade.

The pills don't work for everyone but quickly diminished Quartier's cravings. "By the eighth day I was absolutely ready" to give cigarettes up again, he said.

Though most smokers try to quit without help, nicotine-free treatments including Chantix and longtime staples like nicotine gum and patches are more effective than trying to quit "cold turkey," according to experts and research.

Using Chantix triples a smoker's odds of quitting for at least a year compared with a placebo, according to an analysis of six clinical trials published last month by the Cochrane Library. A second review by Cochrane, pooling the results of 53 trials, corroborated previous findings that the antidepressants Zyban (bupropion) and nortriptyline double the odds of quitting for at least six months. Other antidepressants, including SSRIs such as Prozac, have no proven effect.

Nicotine replacement therapies -- the gum, nasal sprays, and lozenges that gradually wean smokers off the chemical -- are about as effective as Zyban, while research into alternative therapies like hypnosis and acupuncture are inconclusive, Cochrane found.

No drug can be a cure-all for a chronic condition as behaviorally entangled as smoking addiction, said Kate Cahill of the Cochrane Tobacco Addiction Group.

Quitting is hard -- only about 5 percent of people who try to stop on their own are successful in that attempt. But doubling or tripling this rate can have a huge impact if you consider the tens of millions who try, said Robert Klesges, of the University of Tennessee Health Science Center.

The expanding array of quitting strategies gives motivated smokers a choice, catering to their individual tastes. And the more times smokers try to quit, the more likely they are to succeed.

As researchers learn more about the molecular processes involved in nicotine addiction, and how genetics influences addiction, they have been developing more "designer drugs" that specifically target these processes, said Dr. Nancy Rigotti, director of the Massachusetts General Hospital Tobacco Research and Treatment Center, who helped lead the Pfizer Chantix studies and receives funding from GlaxoSmithKline, Pfizer, and Sanofi-Aventis.

One Sanofi drug, Rimonabant -- approved in Europe for weight loss -- is being tested for smoking cessation and also prevents the weight gain associated with quitting. And several promising vaccines are being developed as one-shot methods to prevent nicotine from reaching the brain. Scientists recently identified a potential new target for therapy when they found that people who suffer injuries in a brain region associated with emotions suddenly lose the desire to smoke, according to a study in Science on Jan. 26 .

Drugs with "different mechanisms of action . . . increase the chances that any one smoker will be successful," Klesges said.

Chantix works by partially stimulating certain nicotine receptors in the brain, mimicking the pleasurable effects of the addictive agent while blocking nicotine from binding to the receptors, so the would-be quitter won't feel as satisfying a buzz.

Though this two-pronged treatment approach shows promising results, it's too early to confirm the efficacy and long-term safety of Chantix, cautioned Dr. Jonathan Samet, chairman of the Department of Epidemiology at the Johns Hopkins School of Public Health, and a consultant for Chantix's manufacturer, Pfizer.

Nicotine-free drugs like Chantix are "designed to reduce withdrawal symptoms and make it easier for people to tackle the behavioral aspects" of tobacco dependence, such as resisting daily cues that can trigger the urge to light up, said Dr. Corinne Husten of the US Centers for Disease Control and Prevention's Office of Smoking and Health.

Husten recommends that any drug therapy be accompanied by counseling, also shown to double quit rates, in the form of "practical advice about how to develop a quit plan [and] what to do when you have cravings" -- even if it is simply making a phone call to the free, government-funded hot line 1-800 QUIT-NOW.

Since July, MassHealth has covered counseling and all FDA-approved quit-smoking therapies .

Tobacco remains the number one preventable cause of death in the United States, with a CDC estimate of 440,000 deaths per year. Four of the nation's largest cigarette manufacturers have been increasing the nicotine content of their product over the last decade, according to a report released Jan. 18 by the Harvard School of Public Health, potentially making cigarettes more addictive.

But there are now more former than current smokers in the United States, and a majority of the 45.1 million who do smoke want to quit.

It's never too late to stop. "At any age 50, 60, 70, 80 people who stop smoking do better than people who keep smoking," reducing their odds of lung cancer and emphysema, said Dr. Steven Schroeder, director of the University of California, San Francisco's Smoking Cessation Leadership Center.

Quartier says he's quit forever this time. He'd rather be able to ride his bike up Mission Hill, he said, than puff another cigarette.