Start with Step 2 in nicotine replacement therapy for patients who smoke fewer than 10 cigarettes per day. Which step is recommended?

• A. Step 1
• B. Step 2
• C. Step 3
• D. Step 4

Answer: (B)

The main idea is matching nicotine replacement therapy to how dependent a smoker is, as reflected by daily cigarette use. When someone smokes fewer than 10 cigarettes a day, their nicotine dependence tends to be lower, so starting with a moderate-dose option provides enough nicotine to prevent withdrawal and control cravings without giving more nicotine than needed. This balance reduces the risk of side effects and makes it easier to progress toward stopping. Starting at a lower or higher step isn’t as efficient: the lowest step may not relieve withdrawal for light smokers, while the higher steps deliver more nicotine than necessary. After an initial period, therapy can be adjusted based on cravings and withdrawal success.