You've decided that you really do want to stop smoking. Should you use "the Patch," special chewing gum, a nasal spray, an inhaler, antidepressant drugs or some combination? Any of these methods, used in conjunction with structured behavioral and psychological support, will greatly increase your chances of success. Let's sort it all out.

"The Patch," a nicotine transdermal system, delivers a steady measured dose of nicotine to the body. In a graduated program, special patches are placed on the skin, which over time administer varying dosages of nicotine. Nicotrol® TD, Nicoderm CQ®, and ProStep® are available without a prescription. Habitrol® is available only by prescription. There are few side effects and the patches need to be applied only once a day, although the nicotine is delivered more slowly than in some other methods. Skin irritation can occur at the patch sites.

Nicotine gum is marketed over-the-counter as Nicorette® and comes in doses of 2 milligram (for smokers of 24 or fewer cigarettes a day) and 4 milligram (for smokers of 25 or more cigarettes a day). Chewing the gum requires a bit of re-training, since you must chew it in a certain way to make it work. It is chewed slowly until a "peppery" taste comes out. Then, the gum is "parked" between the cheek and the gum. The nicotine from the gum is absorbed through the lining of the mouth. Nicorette is convenient, but you may want to avoid it if you have dental or jaw problems. For those who dislike the taste of the gum, the FDA recently approved Nicorette Mint for over-the-counter sale.

Can you really pop a pill and stop smoking? Not quite. Bupropion is an antidepressant medication available by prescription, under the brand name of Zyban®. It has been proven to be effective in treating nicotine addiction by stimulating the release of dopamine and norepinephrine, two amino acids in the brain that help smokers deal with the anxiety that comes with quitting. Zyban® comes in a sustained release formula. Zyban® causes few side effects, but there is a small risk of seizures, as with any antidepressant. If you are currently taking any other medications, be sure to remind your doctor of them before he or she writes you a prescription for Zyban®.

Nicotrol® nasal spray, available by prescription, provides a quick nicotine delivery system. The usual dose of 1 milligram (1 spray) into each nostril can be used up to 40 times per day. The rapid absorption through nasal membranes makes it a desirable cessation aid, although it is sometimes irritating to the nose, especially during the initial treatment.

Nicotrol® Inhaler is a plastic cylinder almost the size of a cigarette. A cartridge containing nicotine is inside the cylinder. When you "puff" on the device, nicotine vapors are absorbed through the lining of the mouth. It takes about 80 "puffs" to equal the amount of nicotine in one cigarette. The Nicotrol Inhaler is flexible to schedule through the day, although it may have to be used frequently. Nicotrol mimics the physical habits of holding and puffing on a cigarette, which some smokers find helpful in quitting. Mouth and throat irritation are the most common complaints.

Studies show that smokers who use a combination of cessation aids greatly increase their chances of remaining smoke-free. Smokers who used a combination of a nicotine patch and nasal spray doubled their chances of remaining smoke-free for six years, compared to those who used the patch alone.

It is believed that the combination helps smokers quit because it teams the patch's slow and steady release of nicotine with the quick administration of the nasal spray whenever the smoker has a craving.

Researchers have not yet tested whether a patch-and-gum combination is as effective as a patch and a nasal spray. Studies have shown the effectiveness of Bupropion may be even stronger when it is used along with nicotine replacements. In a recent study published in The New England Journal of Medicine, researchers compared the effects of treating about 900 smoking cessation patients with Bupropion alone, the patch alone, both Bupropion and the patch, or a placebo. The group with the highest rate of success over a 12-month period were those who used Bupropion and the patch. It wasn't in this particular study, but there is also a good deal of evidence that nicotine replacement therapy, in combination with behavioral or psychological support (such as one might find in counseling, or with a structured support group), is more successful than pharmacological therapy alone.

Most insurance companies do not cover smoking cessation therapy of any kind. Some plans cover prescription aids but not over-the-counter patches and gum. Studies have shown that a higher percentage of smokers participated in smoking cessation programs when they had full insurance coverage, but there is a higher rate of success among those smokers who had to pay for a portion of their treatment.

The makers of Zyban® estimate the average cost of their product at $76 per month. Patches and gum cost between $150 and $250 for a seven week supply. Each 10 milligram nasal spray container is approximately $45. Of course you are saving money by not smoking. A pack of cigarettes now costs about three dollars. Over a year, you would spend $1,095 on your habit if you smoked one pack a day.

Clonidine is an anti-hypertensive drug used to lower high blood pressure, that appears also to reduce symptoms of withdrawal associated with nicotine. This drug has been tested both as a tablet and a skin patch. Its potential use in smoking cessation is being studied further.

Most products already have some type of support program. These programs keep evolving and becoming more and more useful. Some pharmaceutical companies are also utilizing informational web sites.

Some experts now believe that smokers need to use cessation aids for longer than three months, the average length of cessation programs. Even in the long term, nicotine replacement and antidepressants are preferred over the cardiovascular-damaging and carcinogenic properties of tobacco.