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Smoking cessation
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Smoking cessation is the action leading towards the discontinuation of the consumption of a smoked substance, keenly tobacco, however it may encompass cannabis and other substances as well.
first public smoking cessation movement was initiated by the Nazi Germany government in the 1930s.
niques which can increase smokers' chances of successfully quitting are:
Factors
Research in Western countries has found that approximately 3-5% of quit attempts succeed using willpower alone (Hughes et al, 2004).
Discussion
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Encyclopedia
Smoking cessation is the action leading towards the discontinuation of the consumption of a smoked substance, keenly tobacco, however it may encompass cannabis and other substances as well.
History
The first public smoking cessation movement was initiated by the Nazi Germany government in the 1930s.
Methods
Techniques which can 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 counseling is often offered over the internet, over the phone quitlines (e.g. 1-800-QUIT-NOW), or in person.
- Nicotine replacement therapy when used for less than eight weeks helped with withdrawal symptoms, cravings, and urges (for example, transdermal nicotine patches, gum, lozenges, sprays, and inhalers).
- The antidepressant bupropion, marketed under the brand name Zyban, helps with withdrawal symptoms, cravings, and urges. Bupropion is contraindicated in epilepsy, seizure disorder; anorexia/bulimia (eating disorders), patients use of psychosis drugs (MAO inhibitors) within 14 days, patients undergoing abrupt discontinuation of ethanol or sedatives (including benzodiazepines such as Valium)
- Nicotinic receptor agonist varenicline (Chantix) (Champix in the UK)
- Recently, an injection given multiple times over the course of several months, which primes the immune system to produce antibodies which attach to nicotine and prevent it from reaching the brain, has shown promise in helping smokers quit. However, this approach is still in the experimental stages.
- 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 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 and electronic self-help groups such as Stomp It Out
- 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.
- Spirituality Spiritual beliefs and practices may help some smokers quit.
- Smokeless tobacco: Snus 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.
- Herbal and aromatherapy "natural" program formulations.
- Vaporizer: heats to 410°F. or less, compared with 1500°F./860°C. in the tip of a cigarette when drawn upon; eliminates carbon monoxide and other combustion toxins.
- "FAUX Cigarette" or similar commercial products which can be used as alternative to smoking as well as cessation.
- Electronic cigarette: Shaped like a cigar or cigarette, this device contains a rechargeable battery and a heating element that vaporizes liquid nicotine (and other flavorings) from an insertable cartridge, at lower initial cost than a vaporizer but with the same advantages including significantly reducing tar and carbon monoxide. However in September 2008, the World Health Organization issued a release proclaiming that it does not consider the electronic cigarette to be a legitimate smoking cessation aid, stating that to its knowledge, "no rigorous, peer-reviewed studies have been conducted showing that the electronic cigarette is a safe and effective nicotine replacement therapy."
- Screened single-toke utensil (): smoking-reduction utensil substitutes 25-mg. single servings for the heavily advertised trap of each time lighting an entire 700-mg. commercial cigarette.
- Smoking herb substitutions (non-tobacco)
- Great American Smokeout is an annual event that invites smokers to quit for one day, hoping they will be able to extend this forever.
- Bubble wrap can be useful to distract and provide an alternate form of stress release, anxiety control and manual stimulation.
Factors
Research in Western countries has found that approximately 3-5% of quit attempts succeed using willpower alone (Hughes et al, 2004). The British Medical Journal and others have reviewed the evidence regarding which methods are most effective for smokers interested in breaking free of the smoking habit, and concluded that
Nicotine dependence is most effectively treated with a combination of drugs and specialist behavioural support…
An even better chance of success can be obtained by combining medication and psychological support (see below) (USDHHS, 2000). Medication or pharmacological quitting-aids that have shown evidence of effectiveness in clinical trials include medical nicotine replacement patches or gum, the tricyclic anti-depressant nortriptyline,bupropion (Zyban, or Quomem in some countries), and the nicotinic partial agonist, varenicline (Chantix in the U.S. and Champix elsewhere).
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.
Few smokers are successful with their very first attempt. Many smokers find it difficult to quit, even in the face of serious smoking-related disease in themselves or close family members or friends. A serious commitment to arresting dependency upon nicotine is essential. The typical effort of a person that finally succeeds is the seventh to fifteenth try. Each attempt is a learning experience that moves them that much closer to their goal of eventual permanent freedom from smoking.
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.
Major depression may challenge smoking cessation success 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.
A U.S Surgeon General's report includes tables setting forth success rates for various methods, some of which are listed below, ranked by success rate and identified by the Surgeon General's table number.
- Quitting programs combining counseling or support elements with a prescription for Bupropion SR (Zyban/Wellbutrin) found success rates were increased to , (Surgeon General's Table 25).
- Quitting programs involving 91 to 300 minutes of contact time increased six month success rates to , regardless of other quitting method included Table 13, page 59]
- Quitting programs involving 8 or more treatment sessions increased six month success rates to (Surgeon General's Table 14, page 60)
- High intensity counseling of greater than 10 minutes increased six month success rates to whether added to any other quitting method, nicotine replacement, or cold turkey Table 12, page 58]
- A physician's advice to quit can increase quitting odds by 30 percent to at six months Table 11, page 57]
- of those who used over-the-counter nicotine patch and gum products quit for at least six months
Prognosis
Many of tobacco's health effects can be minimized through smoking cessation. The British doctors study showed that those who stopped smoking before they reached 30 years of age lived almost as long as those who never smoked. It is also possible to reduce the risks by reducing the frequency of smoking and by proper diet and exercise. Some research has indicated that some of the damage caused by smoking tobacco can be moderated with the use of antioxidants.
Smokers wanting to quit or to temporarily abstain from smoking can use a variety of nicotine-containing tobacco substitutes, or nicotine replacement therapy (NRT) products to temporarily lessen the physical withdrawal symptoms, the most popular being nicotine gum and lozenges. Nicotine patches are also used for smoking cessation. Medications that do not contain nicotine can also be used, such as bupropion (Zyban or Wellbutrin) and varenicline (Chantix).
Upon smoking cessation, the body begins to rid itself of naturally foreign substances introduced to the body through smoking. These include substances in the blood such as nicotine and carbon monoxide, and also accumulated particulate matter and tar from the lungs. As a consequence, though the smoker may begin coughing more, cardiovascular efficiency increases.
Many of the effects of smoking cessation can be seen as landmarks, often cited by smoking cessation services, by which a smoker can encourage him or herself to keep going. Some are of a certain nature, such as those of nicotine clearing the bloodstream completely in 48 to 72 hours, and cotinine (a metabolite of nicotine) clearing the bloodstream within 10 to 14 days. Other effects, such as improved circulation, are more variable in nature, and as a result less definite timescales are often cited.
As with other addictions, apart from the dependence of the body on chemical substances, a smoking addiction is often related to everyday lifestyle events, which can include thinking deeply, eating, drinking tea, coffee or alcohol, or general socializing. As a result, smokers may miss the act of smoking particularly at these times, and this may increase the difficulty inherent in a cessation attempt. As a result of a lower dopamine response from nicotine receptors in the brain, a degree of depression may ensue, along with somatic responses where the smoker feels less able to perform the day to day tasks previously related to smoking without having the usual cigarette to accompany them.
High stress often results when heavily addicted individuals or long-time smokers attempt to quit, in part because their everyday lifestyle events have been altered and they may miss the social interaction normally associated with the habit.
Smoking cessation will almost always lead to a longer and healthier life. Stopping in early adulthood can add up to 10 years of healthy life and stopping in one's sixties can still add three years of healthy life (Doll et al, 2004). Stopping smoking is associated with better mental health and spending less of one's life with diseases of old age.
The immediate effects of smoking cessation include:
- Within 20 minutes blood pressure returns to its normal level
- After 8 hours oxygen levels return to normal
- After 24 hours carbon monoxide levels in the lungs return to those of a non-smoker and the mucus begins to clear
- After 48 hours nicotine leaves the body and tastebuds are improved
- After 72 hours breathing becomes easier
- After 2-12 weeks, circulation improves
- After 5 years, the risk of heart attack falls to about half that of a smoker
- After 10 years, the chance of lung cancer is almost the same as a non-smoker.
Public policy
There are many people and organizations touting what are claimed to be effective methods of helping smokers to stop. Such claims of success are rarely backed up by independent comparative clinical trials or correctly calculated success rates. A separate thorough review of the evidence for each of several methods and aids for stopping smoking is available via the Cochrane Library website, .
Several studies have found that smoking cessation advice is not always given in primary care in patients aged 65 and older, despite the significant health benefits which can ensue in the older population.
See also
External links
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