Smoking cessation

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A 'No Smoking' sign
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A 'No Smoking' sign

Smoking cessation (commonly known as quitting, or kicking the habit) is the effort to stop smoking tobacco products. Nicotine is a psychologically and physically addictive substance, and quitting smoking is commonly considered to be difficult. Psychological and pharmacological aids are available to help people quit smoking, although success rates are relatively low. As part of the wider tobacco control movement, there have been numerous advertising campaigns, smoking restriction policies, tobacco taxes, and other strategies to encourage people to quit smoking. Tobacco use is a major cause of death worldwide, according to the World Health Organization.[1]

Contents

[edit] Outline

Smoking cessation services, which offer group or individual therapy can help people who want to quit. Most smoking cessation programs are a combination of coaching, motivational interviewing, cognitive behavioral therapy, and pharmacological counseling. Programmes in the UK are run under by the NHS, and use a clear and clinically tested protocol.

One effective way to assist smokers who want to quit is through a telephone quitline which is easily available to all. Professionally run quitlines may help less addicted smokers but those more severely addicted to cigarettes (ie anyone who smokes within half an hour of waking) should seek out their local smoking cessation services, where they exist, or assistance from a knowledgeable health professional, where they do not. The scientific evidence shows that best results are achieved when support and medication are used simultaneously. Quitting with a group of other people who want to quit is a great way of getting support.

A serious commitment to arresting a dependency upon smoking nicotine is essential no matter how you choose to go about quitting. Medication, such as a nicotine replacement therapy product or Wellbutrin (aka Zyban) have been clinically proven to double a quitter's chances of stopping successfully versus placebo. Interestingly, in real-world cessation surveys - outside clinical studies - those quitting without medications are generating quitting rates equal to or better than those relying upon pharmaceutical quitting aids (see Doran, CM et al 2006 and Pierce, John P et al 2002).

Although a significant proportion are successful, many people fail several times. Many smokers find it difficult to quit, even in the face of serious smoking-related disease in themselves or close family members or friends. The best predictor of smoking cessation success is past quit attempt(s).

Studies have concluded that those who do successfully quit smoking often gain weight. "Weight gain is not likely to negate the health benefits of smoking cessation, but its cosmetic effects may interfere with attempts to quit." (Williamson, Madans et al, 1991) Therefore, drug companies researching smoking-cessation medication often measure the weight of the participants in the study.

[edit] Women and Smoking Cessation

Major depression may influence smoking cessation in women because depression is twice as common among women as men, the history of depression and negative affect have been associated with smoking treatment failure, quitting smoking is especially difficult during certain phases of the reproductive cycle, phases that have also been associated with greater levels of dysphoria, and subgroups of women who have a high risk of continuing to smoke also have a high risk of developing depression. Since many women who are depressed may be less likely to seek formal cessation treatment, practitioners have a unique opportunity to persuade their patients to quit. [2]

[edit] Statistics

  • 7% of over-the-counter nicotine patch and gum quitters quit for at least six months
  • A physician's advice to quit can increase quitting odds by 30% to 10% at six months (see Table 11)
  • High intensity counseling of greater than 10 minutes can increase six month quitting rates to 22% when added to any quitting method, cold turkey or NRT (see Table 12)
  • Quitting programs involving 91 to 300 minutes of contact time can increase six month quitting rates to 28%, regardless of quitting method (see Table 13)
  • Quitting programs involving 8 or more treatment sessions can increase six month quitting rates to 24.7% (see Table 14)
  • Bupropion (Zyban/Wellbutrin) use can generate quitting rates 13 percentage points above placebo rates at 6 months (see Table 25). This fact is stated as such in that all bupropion studies to date have included counseling or support elements (having their own proven efficacy) and bupropion has not been tested in an over-the-counter type setting, as has NRT.

[edit] Methods

[edit] Screening

Health professionals may follow the "five A's" with every smoking patient they come in contact with:

  1. Ask about smoking
  2. Advise quitting
  3. Assess current willingness to quit
  4. Assist in the quit attempt
  5. Arrange timely follow-up

[edit] Modalities

Effective[citation needed] techniques to increase smokers chances of successfully quitting are:

  • Quitting "cold turkey": abrupt cessation of all nicotine use as opposed to tapering or gradual stepped-down nicotine weaning. It is the quitting method used by 80 to 90% of all long-term successful quitters and up to 10% of cold turkey quitters quit smoking for at least six months.
  • Smoking-cessation support and counselling
  • Nicotine replacement therapy, NRT: pharmacological aids that are clinically proven to help with withdrawal symptoms, cravings, and urges (for example, transdermal nicotine patches, gum, lozenges, sprays, and inhalers)
    • Antidepressant bupropion (Zyban®, contraindicated in epilepsy and diabetes) that also helps with withdrawal symptoms, cravings, and urges.
    • Nicotinic receptor agonist varenicline (Chantix®)(Champix® in the UK)
  • "Five-Day Plan": quitting smoking through acceptance of addiction and realization of smoking's harmfulness
  • Smokeless tobacco Snus has been widely used in Sweden.
  • Herbal and aromatherapy "natural" program formulations.

[edit] Alternative techniques

Some 'alternative' techniques which have been used for smoking cessation are:

There have been insufficient clinical trials to decide whether it might be helpful. The Cochrane Database of Systematic Reviews 2006 Issue 3

Nicotine has a half life of around two hours, so most smokers detox fairly effectively each night when they sleep. Hence the need to smoke so soon after waking that is seen in dependent smokers. Detoxification is probably an irrelevance in this field.

  • Acupuncture Placebo effect only. Clinical trials have shown that placebo acupuncture works equally well for smoking cessation as sticking the needles in the right place. (See Cochrane Review)
  • Attending a self-help group such as Nicotine Anonymous.
  • Laser therapy based on acupuncture principles but without the needles. No evidence of efficacy
  • Quit meters: Small computer programs that keep track of quit statistics such as amount of "quit-time", cigarettes not smoked, and money saved. These devices are aids essentially to cutting down. Experts generally agree that cutting down is, for most people, not an effective way to stop smoking.
  • Self-help books (Allen Carr etc.) Some of these claim very high success rates but little externally verified evidence of this success exists.
  • Fasting Many people claim that quitting smoking is easier during fasting. The Hypothalamus regulates hunger and thirst and is also heavily linked by conventional science to smoking. Perhaps quitting whilst fasting helps reset this craving mechanism.

[edit] See also

[edit] References

  1. World Health Organization, Tobacco Free Initiative
  2. Peters MJ, Morgan LC. The pharmacotherapy of smoking cessation. Med J Aust 2002;176:486-490. Fulltext. PMID 12065013.
  3. Williamson, DF, Madans, J, Anda, RF, Kleinman, JC, Giovino, GA, Byers, T Smoking cessation and severity of weight gain in a national cohort N Engl J Med 1991 324: 739-745
  4. Henningfield J, Fant R, Buchhalter A, Stitzer M. "Pharmacotherapy for nicotine dependence.". CA Cancer J Clin 55 (5): 281-99; quiz 322-3, 325. PMID 16166074. Full text
  5. Zhu S-H, Anderson CM, Tedeschi GJ, et al. Evidence of real-world effectiveness of a telephone quitline$for smokers. N Engl J Med 2002;347(14):1087-93.
  6. Helgason AR, Tomson T, Lund KE, Galanti R, Ahnve S, Gilljam H. Factors related to abstinence in a telephone helpline for smoking cessation. European J Public Health 2004: 14;306-310.

[edit] Notes

  1. ^ Tobacco Free Initiative
  2. ^ The impact of depression on smoking cessation in women.

[edit] External links

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