Smoking cessation
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Smoking cessation is the effort to stop smoking tobacco products. With nicotine an addictive substance, many people find it hard to stop smoking without help. Various approaches are available, both psychological and pharmacological, although success rates are relatively low.
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Outline
The prevalent view is that smoking is not safe for anybody, and that every smoker should be encouraged to stop. The cited benefits are decreased expenses, generally feeling better and a decreased risk of smoking-related diseases.
The main efficacy is to be expected from psychological support, group therapy or cognitive behavioral therapy. Pharmacological means (i.e. medication) is adjunctive to these approaches, and medication without psychological support is generally discouraged. Furthermore, some of the medical therapies are themselves addictive and potentially dangerous.
Predictive measures of success are a serious commitment to smoking cessation and regular follow-up. After succesfully stopping tobacco smoking, quitters are advised to consider ways they should change their lifestyle to improve their chances of not restarting, especially under stressful circumstances.
Although a significant proportion is successful, many fail several times. A small proportion is unable to quit, even in the face of serious smoking-related disease in themselves or close family members or friends. Nevertheless, incorrigible smokers are encouraged to keep on trying.
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" in every person they come in contact with:
- Ask about smoking
- Advise quitting
- Assess current willingness to quit
- Assist in the quit attempt
- Arrange timely follow-up
Modalities
Effective techniques to increase smokers chances of successfully quitting are:
- "Five-Day Plan": Oldest and most effective way of quitting smoking through acceptance of addiction and realization of smoking's harmfulness
- Going "Cold turkey": stopping by force of will
- Nicotine replacement therapy (includes transdermal patches, gum and inhalers)
- Specific support and counselling
- Self-help books (Allen Carr etc.)
- The antidepressant bupropion (contraindicated in epilepsy and diabetes)
Alternative techniques
Alternative techniques, from which many patients report benefit, include:
- Hypnosis
- Herbal preparations such as Kava Kava and Chamomile
- Nutritional nicotine detoxification
- Acupuncture
- Laser Therapy based on acupuncture principles but without the needles
References
- Peters MJ, Morgan LC. The pharmacotherapy of smoking cessation. Med J Aust 2002;176:486-490. Fulltext (http://www.mja.com.au/public/issues/176_10_200502/pet10850_fm.html). PMID 12065013.
External links
- Quitnet (http://www.quitnet.com), non-profit support network