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.
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. 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 proven method of getting support, available
through many organizations.
A serious commitment to arresting a dependency upon smoking 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.
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).[citation
needed]
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.
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]
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.
Allen Carr method - Easyway - up to 55% succes rate for at least one year
Methods
Screening
Health professionals may follow the "five A's" with every smoking patient 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[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, 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 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.
Alternative techniques
Some 'alternative' techniques which have been used for smoking cessation are:
Hypnosis
There have been insufficient clinical trials to decide whether it might be
helpful. The Cochrane Database of Systematic Reviews 2006 Issue 3.
Herbal preparations such as Kava Kava and Chamomile
Nutritional nicotine detoxificationNicotine has a fast half life, around 90
minutes, detoxification therefore happens quite naturally. In any case the doses
of nicotine found in cigarettes and NRT medications are not thought to be
damaging to health
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.
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