Smoking cessation

Smoking cessation 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. According to the World Health Organization, tobacco use is one of the major causes of avoidable death worldwide.

Outline

Smoking has been associated with many negative health effects, and quitting smoking helps to reduce the risk of developing later health problems.

Psychological support, group therapy or cognitive behavioral therapy help people to quit. Medication, such as a nicotine replacement therapy product or Zyban/Wellbutrin, can also supplement these approaches. Medication without psychological support is generally discouraged, and some of the medical therapies themselves have proven addictive and potentially dangerous if misused.

Success rates are increased by a serious commitment to smoking cessation and regular follow-up. After successfully stopping tobacco smoking, quitters should consider ways they can change their lifestyle to improve their chances of not restarting, especially under stressful circumstances.

Although a significant proportion are successful, many fail several times. Many smokers find it impossible 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).

Statistics

No smoking cessation methods have consistently achieved better than a 25% quit rate after six months. About 1.5%–3% of smokers manage to quit each year without support from health services. Enrollment into the placebo arm of medical trial and receiving a minimum level of counselling increases this rate to about 5%–10% after one year, partly reflecting participants' motivation.

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

Effective techniques to increase smokers chances of successfully quitting are:

• "Five-Day Plan": quitting smoking through acceptance of addiction and realization of smoking's harmfulness
• Quitting "cold turkey": stopping smoking without external assistance
• Nicotine replacement therapy, NRT: pharmacological aids that (its makers claim) help with withdrawal symptoms, cravings, and urges (for example, transdermal nicotine patches, gum, lozenges, sprays, and inhalers)
• Smoking-cessation support and counselling
• Self-help books (Allen Carr etc.)
• Antidepressant bupropion (Zyban®, contraindicated in epilepsy and diabetes) that also helps with withdrawal symptoms, cravings, and urges

Alternative techniques

Alternative techniques which have been used for smoking cessation:

• Hypnosis
• Herbal preparations such as Kava Kava and Chamomile
• Nutritional nicotine detoxification
• Acupuncture
• Smokeless tobacco "...there is a substantial body of informed and independent opinion that sees the value of harm reduction strategies based on smokeless tobacco." [UK's Action on Smoking & Health (ASH)]

• Attending a self-help group such as Nicotine Anonymous
• 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.

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.

External links

• NHS UK website on giving up smoking
• www.whyquit.com - a site dedicated to cold turkey smoking cessation.
• Quit meters: SilkQuit, Quit Keeper