What is GRM?

GRM (Gradual Reduction Method) is an alternative to NRT (Nicotine Replacement Therapy) and other drug-based smoking cessation methods.

With NRT, the smoker stops abruptly, using medication in the form of patches, gums, inhalers or tablets to continue the supply of nicotine for up to 3 months to help overcome nicotine addiction.  Another drug-based treatment, only available on prescription, is the anti-depressant bupropion (‘Zyban’); a low dose in the last two weeks before quitting rises to full strength, taken for about 3 months after quitting.  Research shows that both NRT and bupropion create extra problems for smokers: they have their own side-effects and, for the majority of smokers, do not deliver the hoped-for results.

The problem for most smokers, particularly those who have previously tried to stop, is that they know that abruptly stopping is going to be a painful and difficult experience, demanding significant willpower and resilience and would prefer to use a gradual reduction method⁽¹⁾.

Gradual reduction is an effective procedure⁽²⁾.  Moderate-to-heavy smokers who reduce their consumption prior to their quit date are more likely to stop smoking; even those who continue to smoke consume on average 11.4 fewer cigarettes per day⁽³⁾.  Among relapsers, those who stop abruptly tend to return to their previous smoking levels while the gradual reducers relapse to significantly below their original levels⁽⁴⁾.

The GRM options available to date include:

Self-control – (i) Gradual reduction in the number of cigarettes daily (‘cigarette tapering’), using techniques such as reducing the number of cigarettes in their pack at the start of the day, increasing the time gaps between smoking, smoking less and less of each cigarette.  (ii) ‘Nicotine fading’ by switching to brands yielding less nicotine.  However, such brand switching leads to smoking more cigarettes and taking larger and more frequent puffs⁽⁵⁾.  Most smoking cessation professionals do not recommend self-control approaches as success rates are poor compared to therapist-paced target-setting⁽⁶⁾.

Plastic filter systems – A nicotine fading method, using three or four different filters to trap different amounts of tar and nicotine.  However, the (unfashionable) use of plastic cigarette holders, coupled to the need to dismantle and clean out the filter after every five cigarettes, makes them unattractive.  Smokers using these methods also tend to compensate for the reduced nicotine by smoking more cigarettes or taking longer and deeper puffs⁽⁷⁾.

Computer monitoring – Hand-held or wristwatch devices instructing smokers when to smoke, gradually reducing consumption (cigarette tapering); these techniques can improve a smoker’s chance of giving up⁽⁸⁾.  Possible downsides are that smokers can be required to smoke when they do not actually want to, and some are uncomfortable handing control to a machine.  They can be fairly expensive and are not widely available.

Aerating devices – These introduce air into the smoke stream, either by punching holes into the side of the cigarette or via plastic filters (nicotine fading).  Smokers tend to compensate for the diluted smoke by taking deeper puffs⁽⁹⁾; this has been shown to cause a particular type of lung cancer, also found in smokers who have switched to ‘low tar’ or ‘light’ brands.  Smokers also tend to cover up the ventilation holes in order to ‘taste’ their cigarette.

The previous implementations of GRM have each had their particular problems, so there has been hardly any GRM available via mainstream smoking cessation routes.  However, after ten years research and development, NicoBloc is now available, heralding a new era in the provision of support for those who want to give up cigarettes in a gradual and controlled manner.

NicoBloc - NicoBloc is a safe, natural product made from a food-grade composition (FDA approved) and can be used by all smokers including those with medical conditions or women in pregnancy.  NicoBloc fluid soaks into the cigarette filter to trap tar and nicotine; it is typically used over a six-week period, achieving gentle weaning off nicotine addiction.

The smoker applies one drop of NicoBloc (which blocks up to 33% of tar and nicotine) to each cigarette in week one, two drops in week two and, from week three onwards, three drops, blocking up to 99% of tar and nicotine⁽¹⁰⁾.

 NicoBloc users do not compensate for reduced nicotine intake by smoking more cigarettes⁽¹¹⁾, and NicoBloc use is not associated with increased craving or other withdrawal symptoms, nor does it sufficiently affect the taste or smoking experience to deter users⁽¹²⁾.

The NicoBloc method also contains subtle behaviour modification.  The action of applying NicoBloc to each cigarette before it is smoked breaks the pack-to-mouth routine.  Also, as smokers are required to progressively undertake more ‘work’ in order to receive less ‘reward’, they tend to opt not to smoke their least favourite or the more inconvenient cigarettes, e.g. when driving.

When NicoBloc was used in the workplace 'Rosen Stop Smoking Programme' field trials (800 smokers over a 2-year period in 88 different UK and Irish companies), the results showed that 6 weeks was a comfortable period for gradual reduction with 60% of participants completing the Programme and stopping smoking without significant withdrawal symptoms.   This Programme also generated the cigarette tapering target-setting algorithms embodied in the printed NicoBloc materials and within the interactive facility at www.nicobloc.com.

In a small study (which did not include NicoBloc), five different combinations of various quitting strategies were tested; the most effective involved a combination of nicotine fading and cigarette tapering; 12 months later, 57% were still non-smokers⁽¹³⁾. 

NicoBloc combines, in one simple, user-friendly process, nicotine fading and cigarette tapering together with target-setting and behaviour modification.

The NicoBloc retail pack contains an illustrated instruction booklet with a free CD or video and website support.  Also included is a voucher for a nicotine test kit that can show, with a simple urine test, the presence or absence of nicotine in the smoker’s body.   This is usually used at the end of the programme to provide confirmation to the smoker that they are clear of nicotine.

NicoBloc is readily available over the counter in pharmacies and comes in a convenient sized pack that provides a typical 20-a-day smoker with 2 weeks’ supply.

Thanks to Alex Milne, author of Smoking - the Inside Story, for helpful comments on the text.

 References

 1. Hazelden Foundation (1998). Heading off a nation of teenage smokers. New York Times, 17/11/98.

 2. Flaxman, J. (1978) Quitting smoking now or later: Gradual, abrupt, immediate and delayed quitting. Behavior Therapy, 9, 260–270.

 3. Farkas, A.J. (1999) When does cigarette fading increase the likelihood of future cessation? Annals of Behavioral Medicine, 21, 71–76.

 4. Gunther, V., Gritsch, S. & Meise, U. (1992) Smoking cessation – gradual or sudden stopping? Drug and Alcohol Dependence, 29, 231–236.

 5. Zacny, J.P. & Stitzer, M.L. (1998) Cigarette brand-switching: Effects on smoke exposure and smoking behavior. Journal of Pharmacology & Experimental Therapeutics, 246, 619–627.

 6. Hill, A.A. (1982) Target-setting self-control for smoking. Psychological Reports, 50, 68-70.

 7. Henningfield, J.E, & Griffiths, R.R. (1980) Effects of ventilated cigarette holders on cigarette smoking by humans. Psychopharmacology (Berlin) 68, 115–119.

 8. Cinciripini, P.M., Lapitsky, L., Seay, S., Wallfisch, A., Kitchens, K. & Van Vunakis, H. (1995) The effects of smoking schedules on cessation outcome: Can we improve on common methods of gradual and abrupt nicotine withdrawal. J. Consult. Clin. Psychol., 63, 388–399.

 9. Stitzer, M.L., Brigham, J. & Felch, L.J. (1992) Phase-out filter perforation: Effects on human tobacco smoke exposure. Pharmacology, Biochemistry and Behavior, 41, 749–754.

 10. Stillwell & Gladding Testing Laboratories. (April 19, 1993) Cigarette smoking tests using Accudrop (=NicoBloc) filter solution.

 11. Pickworth, W.B., Fant, R.V., Nelson, R.A. & Henningfield, J.E. (1998) Effects of cigarette smoking through a partially occluded filter. Pharmacology, Biochemistry and Behavior, 60, 817–821.

 12. Gariti, P. & Alterman, A. (1997) Testing a smoking cessation aid. College on Problems of Drug Dependence. 59^th Annual Meeting. Nashville TN June 1997. In: L.S. Harris (ed), Problems of Drug Dependence. NIDA Research monograph 178 . p.158 .

 13. Becona, E. & Garcia, M.P. (1993) Nicotine fading and smokeholding methods to smoking cessation. Psychological Reports, 73, 779–786.