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Smoking cessation

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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 although the physical dependency is relatively minor compared to the psychological dependency. Although quitting smoking is commonly considered to be difficult, for some it is very easy once they have made the decision to stop. Psychological and pharmacological aids are available to help people quit smoking, although success rates vary considerably. Approximately 3% of smokers succeed using will power alone and it has been asserted that Nicotine Replacement Therapy (NRT) will double this rate to approximately 6%. However, much more successful are programs that address the psychological dependency, because it is the smoker's psychologically driven feeling of deprivation that is responsible for manifesting a wide range of other so-called "physical withdrawal symptoms". The physical withdrawal from nicotine is in fact very minor and consists of a slight feeling of insecurity, almost identical to the feeling of being hungry. It is this physical feeling which triggers the psychological feeling of needing or wanting a cigarette.

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. These campaigns certainly prompt smokers to attempt cessation but there is little evidence to suggest they actually help smokers to achieve permanent cessation. Tobacco use is one of the major causes of death worldwide, according to the World Health Organization.[1]

Outline

Smoking cessation services, which offer group or individual therapy can help people who want to quit. Some smoking cessation programs employ a combination of coaching, motivational interviewing, cognitive behavioral therapy, and pharmacological counseling. Some programmes in the UK are run by the NHS others are run by commercial organisations. However evaluation of the NHS programme has shown disappointing outcomes.

Trials have shown that an effective method for quitting smoking is cognitive behaviour therapy or CBT. For example, the QUIT FOR LIFE Programme (David Marks, 1993, 2005) has produced quit rates that are 5-6 times higher than quitting by willpower alone (Marks & Sykes, 2002). Another notable example is the Allen Carr method (combining CBT with hypnotherapy) which has shown a remarkable success rate of 53% at the one year stage (Hutter et al., 2006)

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 dependent smokers but those more heavily dependent on nicotine should seek out their local smoking cessation services, where they exist, or assistance from a knowledgeable health professional, where they do not. Some evidence suggests that better results are achieved when support and medication are used simultaneously. Quitting with a group of other people who want to quit is also a proven method of getting support, available through many organizations.

A serious commitment to arresting dependency upon nicotine is essential. 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.

However, critics have drawn attention recently to the risks associated with the administration of nicotine, a very powerful poison (used commercially as an insecticide), to pregnant women and adolescents (Ginzel et al., 2007).

Although some 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.

Some studies have concluded that those who do successfully quit smoking can 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.

Tobacco smoking has a laxative effect, smoking cessation may lead to constipation, however this is by no means inevitable and is easily treated. [2]

Women and smoking cessation

Major depression may influence smoking cessation in women. 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.[3]

Statistics

  • Seven percent 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 percent to ten percent at six months (see Table 11)
  • High intensity counseling of greater than 10 minutes can increase six month quitting rates to 22 percent 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 percent, regardless of quitting method (see Table 13)
  • Quitting programs involving 8 or more treatment sessions can increase six month quitting rates to 24.7 percent (see Table 14)
  • Bupropion (Zyban/Wellbutrin) use can generate quitting rates 13 percentage points above placebo rates at six 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.
  • Allen Carr method. Allen Carr clinics claim a 90 percent success rate based on their money-back guarantee, in helping smokers stop. An independent scientific study (referred to above) has shown that after twelve months 53 percent remain non-smokers after one year, achieving by far the highest success rate of any smoking cessation method.[4].

Methods

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

Modalities

A 21mg dose Nicoderm CQ patch applied to the right arm

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.
  • Smoking-cessation support and counselling, often offered over the internet, over the phone, or in person
  • 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, psychosis and diabetes) that also helps with withdrawal symptoms, cravings, and urges.
  • Nicotinic receptor antagonist varenicline (Chantix®) (Champix® in the UK)
  • "Five-Day Plan": quitting smoking through acceptance of addiction and realization of smoking's harmfulness
  • Smokeless tobacco Moist snuff is widely used in Sweden, and although it is much healthier than smoking, something which is reflected in the low cancer rates for Swedish men, there are still some concerns about its health impact. [1]
  • Herbal and aromatherapy "natural" program formulations.

Alternative techniques

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

  • Hypnosis Clinical trials studying hypnosis as a method for smoking cessation have been inconclusive. (The Cochrane Database of Systematic Reviews 2006, Issue 3.)
  • Herbal preparations such as Kava Kava and Chamomile
  • Acupuncture Clinical trials have shown that acupuncture's effect on smoking cessation is equal to that of sham/placebo acupuncture. (See Cochrane Review)
  • Attending a self-help group such as Nicotine Anonymous.[2]
  • Laser therapy based on acupuncture principles but without the needles.
  • Quit meters: Small computer programs that keep track of quit statistics such as amount of "quit-time", cigarettes not smoked, and money saved.
  • Self-help books (Allen Carr etc.) Some of these claim very high success rates but little externally verified evidence of this success exists.
  • Spirituality Spiritual beliefs and practices may help smokers quit.[3]

See also

References

  • Marks, D.F. & Sykes, C. M. (2002). Randomized controlled trial of cognitive behavioural therapy for smokers living in a deprived area of London: outcome at one-year follow-up

Psychology, Health & Medicine, 7, 17-24.

  • Hutter H.P. et al. (2006). Smoking Cessation at the Workplace:1 year success of short seminars. International Archives of Occupational & Environmental Health, Vol 79 pages 42-48.
  • Marks, D.F. (1993). "The QUIT FOR LIFE Programme:An Easier Way To Quit Smoking and Not Start Again". Leicester: British Psychological Society.
  • Marks, D.F. (2005), Overcoming Your Smoking Habit. London: Robinson.
  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.{{cite journal}}: CS1 maint: multiple names: authors list (link) 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.

Notes

  1. ^ World Health Organization, Tobacco Free Initiative
  2. ^ "Nicotine withdrawal symptoms:Constipation". helpwithsmoking.com. 2005. Retrieved 2007-06-29.
  3. ^ The impact of depression on smoking cessation in women.
  4. ^ An open letter to Tony Blair from Allen Carr 27/11/06
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