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Smoking cessation

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This is an old revision of this page, as edited by Sampadakudu (talk | contribs) at 09:26, 9 October 2009 (→‎Suggested methods for quitting the habbit of tobaco consumption). The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.

Smoking cessation (or quitting smoking) is the action leading towards the discontinuation of the consumption of a smoked substance, mainly tobacco, but it may encompass cannabis and other substances as well.

Many people have the psycological obsession with tobaco addiction. They tend to relate it with their bowl movement and consequently becoming highly dependent on their tobaco addiction. Smoking certain substances can be either psychological or biological and many times both.

Tobaco is consumed by such addicts either through chewing directly or with Paan (beatle leaf) or through smoking. The nicotine is habit forming substance and induces certain metabolic activities initially when the habbit starts. There after the habbit becomes addiction. There very thin layer separating these two stages. Once addicted, the victim psychologically and biologically becomes totally dependent on the mode of tobaco consumption he/she chose. Stopping the tobacco consumption thus leads to nicotine induced constipation ranging from accute stage to a very cronic stage.

Traetment of such cases again depends on nicotine based therapies. Medicines/formulations based on buproprion and varenicline are known to have good effect. What may be necessary is psychological and behavioral therapy, to improve success rates of cessation an addiction.

Once the patient comes out and kicks the habbit, the bowl movement becomes normal and the nicotin induced constipation stops affecting him/her.

Suggested methods for quitting the habbit of tobaco consumption

Quitting the Smoking habbit:

A 21mg dose Nicoderm CQ patch applied to the left arm.

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[1] to 90%[2] 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)[3]
  • Nicotinic receptor agonist varenicline (Chantix) (Champix in the UK and Canada). Varenicline Tartrate is a prescription drug that can be used to alleviate some of the withdrawal symptoms. It can also be taken as a form of aversion therapy by smokers to make the act of smoking more repulsive.
  • 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. [1]
  • 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[2] and electronic self-help groups such as Stomp It Out[3]
  • Interactive web-based programs like DaretoQuit[4] specializes teaching you how to quit with lessons and strategies tailored to you and your habits
  • 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.[5]
  • Smokeless tobacco: Snus is widely used in Sweden, and although it is much less damaging to health than smoking, something which is reflected in the low cancer rates for Swedish men, there are still some concerns about its health impact. [6]
  • 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."[4]
  • Titration, slowly reducing over time, one's daily intake of nicotine, to levels below the "minimum daily amounts" required to maintain an addiction.
  • Screened single-toke utensil ([7])[5]: 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)[8]
  • Great American Smokeout is an annual event that invites smokers to quit for one day, hoping they will be able to extend this forever.
  • Herbal tobacco alternatives

Factors

Research in Western countries has found that approximately 3-5% of quit attempts succeed using willpower alone (Hughes et al., 2004)[6]. 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…[7]

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.[citation needed] Many smokers find it difficult to quit, even in the face of serious smoking-related disease in themselves or close family members or friends.[neutrality is disputed] 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.[citation needed] Each attempt is a learning experience that moves them that much closer to their goal of eventual permanent freedom from smoking.[neutrality is disputed]

There is an important social component to smoking. One study analyzing a densely interconnected network of over 12,000 individuals found that smoking cessation by any given individual reduced the chances of others around them lighting up by the following amounts: a spouse by 67%, a sibling by 25%, a friend by 36%, and a coworker by 34%.[8]

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. In 2009, it was found that smoking overexpresses the gene AZGP1 which stimulates lipolysis, which is the possible reason why smoking cessation leads to weight gain.[9]

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.[10]

Nicotine has an affinity for melanin-containing tissues and this has been suggested to underlie the increased nicotine dependence and lower smoking cessation rates in darker pigmented individuals.[11]

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.[12]

  • Quitting programs combining counseling or support elements with a prescription for Bupropion SR (Zyban/Wellbutrin) found success rates were increased to 30.5 percent, (Surgeon General's Table 25).
  • Quitting programs involving 91 to 300 minutes of contact time increased six month success rates to 28 percent, regardless of other quitting method included Surgeon General's Report Table 13, page 59]
  • Quitting programs involving 8 or more treatment sessions increased six month success rates to 24.7 percent (Surgeon General's Table 14, page 60)
  • High intensity counseling of greater than 10 minutes increased six month success rates to 22 percent whether added to any other quitting method, nicotine replacement, or cold turkey Surgeon General's Report Table 12, page 58]
  • A physician's advice to quit can increase quitting odds by 30 percent to ten percent at six months Surgeon General's Report Table 11, page 57]
  • Seven percent 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[13] 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.[14]

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 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.

Programs

United States Navy and smoking effects

According to the National Defense Authorization Act of 2009, the Navy now has an authorized tobacco cessation benefit. Prior to this time, the military healthcare system (known as TRICARE) was prohibited from funding a tobacco cessation benefit. At Great Lakes Naval Healthcare Clinic there are numerous opportunities for free tobacco cessation support to include walk-up cessation help available at the pharmacy window, cessation care via medical visits, and cessation support during dental visits as well.[15] By instruction, the recruits that train at the Navy's only boot camp, cannot use any tobacco products. The clinic has instituted an education program for all recruits which advises them to remain tobacco free after they leave their 8-week training program.[16]

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, Cochrane Library.[17]

Several studies have found that smoking cessation advice is not always given in primary care in patients aged 65 and older,[18][19] despite the significant health benefits which can ensue in the older population.[20]

See also

Notes

  1. ^ Doran CM, Valenti L, Robinson M, Britt H, Mattick RP. Smoking status of Australian general practice patients and their attempts to quit. Addict Behav. 2006 May;31(5):758-66. PMID 16137834
  2. ^ American Cancer Society. "Cancer Facts & Figures 2003" (PDF).
  3. ^ Charles F. Lacy et al., LEXI-COMP'S Drug Information Handbook 12th edition. Ohio, USA,2004
  4. ^ "Marketers of electronic cigarettes should halt unproved therapy claims". World Health Organization. 2008-09-19. Retrieved 2008-10-01.
  5. ^ Hughes; et al. ""Smoking reduction may lead to unexpected quitting"". Retrieved 2007-12-27. {{cite web}}: Explicit use of et al. in: |author= (help)
  6. ^ Shape of the relapse curve and long-term abstinence among untreated smokers Hughes, John R.; Keely, Josue; Naud, Shelly; Addiction. 99(1):29-38, January 2004 (pdf)
  7. ^ Managing smoking cessation | Paul Aveyard, National Institute of Health research career scientist, Robert West, professor of health psychology and director of tobacco studies | Clinical Review | BMJ 2007; 335:37-41 (7 July) | doi:10.1136/bmj.39252.591806.47 | http://bmj.bmjjournals.com/cgi/content/full/335/7609/37?fmr
  8. ^ Fratiglioni L, Wang HX (2008). "The collective dynamics of smoking in a large social network". N Engl J Med. 358 (21): 2249–58. doi:10.1056/NEJMsa0706154. PMID 18499567. {{cite journal}}: Unknown parameter |month= ignored (help)
  9. ^ "Cigarette Smoking Induces Overexpression of a Fat-Depleting Gene AZGP1 in the Human". Chest. 2009. pp. 1197–208. PMID 19188554. {{cite web}}: Missing or empty |url= (help)
  10. ^ The impact of depression on smoking cessation in women.
  11. ^ King G, Yerger VB, Whembolua GL, Bendel RB, Kittles R, Moolchan ET. Link between facultative melanin and tobacco use among African Americans.(2009). Pharmacol Biochem Behav. 92(4):589-96. doi:10.1016/j.pbb.2009.02.011 PMID 19268687
  12. ^ Clinical Practice Guideline, Treating Tobacco Use and Dependence, U.S. Department of Health and Human Services, Public Health Service, June 2000, 28 percent
  13. ^ Doll R, Peto R, Boreham J, Sutherland I (2004). "Mortality in relation to smoking: 50 years' observations on male British doctors". BMJ. 328 (7455): 1519. doi:10.1136/bmj.38142.554479.AE. PMC 437139. PMID 15213107. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  14. ^ Panda K, Chattopadhyay R, Chattopadhyay DJ, Chatterjee IB (2000). "Vitamin C prevents cigarette smoke-induced oxidative damage in vivo". Free Radic. Biol. Med. 29 (2): 115–24. doi:10.1016/S0891-5849(00)00297-5. PMID 10980400. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  15. ^ Williams LN , “Tobacco Cessation: An Access to Care Issue”, Navy Medicine, 2002
  16. ^ Williams LN , “Oral Health is Within REACH”, Navy Medicine, Mar-Apr 2001
  17. ^ Cochrane Topic Review Group: Tobacco Addiction
  18. ^ Maguire CP, Ryan J, Kelly A, O'Neill D, Coakley D, Walsh JB. Do patient age and medical condition influence medical advice to stop smoking? Age Ageing. 2000 May;29(3):264-6. PMID 10855911
  19. ^ Ossip-Klein DJ, McIntosh S, Utman C, Burton K, Spada J, Guido J. Smokers ages 50+: who gets physician advice to quit? Prev Med. 2000 Oct;31(4):364-9. PMID 11006061
  20. ^ Ferguson J, Bauld L, Chesterman J, Judge K. The English smoking treatment services: one-year outcomes. Addiction. 2005 Apr;100 Suppl 2:59-69. PMID 15755262

References

  • Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years' observations on male British doctors. Bmj 2004;328(7455):1519.
  • 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.
  • Henningfield J, Fant R, Buchhalter A, Stitzer M (2005). "Pharmacotherapy for nicotine dependence". CA Cancer J Clin. 55 (5): 281–99, quiz 322–3, 325. doi:10.3322/canjclin.55.5.281. PMID 16166074.{{cite journal}}: CS1 maint: multiple names: authors list (link) Full text
  • Hughes JR, Keely J, Naud S. Shape of the relapse curve and long-term abstinence among untreated smokers. Addiction 2004;99(1):29-38.
  • Hutter H.P. et al. Smoking Cessation at the Workplace:1 year success of short seminars. International Archives of Occupational & Environmental Health. 2006;79:42-48.
  • Marks, D.F. The QUIT FOR LIFE Programme:An Easier Way To Quit Smoking and Not Start Again. Leicester: British Psychological Society. 1993.
  • Marks, D.F. & Sykes, C. M. 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. 2005;7:17-24.

  • Marks, D.F. Overcoming Your Smoking Habit. London: Robinson.2005.
  • Peters MJ, Morgan LC. The pharmacotherapy of smoking cessation. Med J Aust 2002;176:486-490. Fulltext. PMID 12065013.
  • Silagy C, Lancaster T, Stead L, Mant D, Fowler G. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev 2004(3):CD000146.
  • USDHHS. Treating Tobacco Use and Dependence. Rockville, MD: Agency for Healthcare Research Quality; 2000.
  • West R. Tobacco control: present and future. Br Med Bull 2006;77-78:123-36.
  • 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
  • World Health Organization, Tobacco Free Initiative
  • Zhu S-H, Anderson CM, Tedeschi GJ, et al. Evidene of real-world effectiveness of a telephone quitline$for smokers. N Engl J Med 2002;347(14):1087-93.
  • Williams LN , “Oral Health is Within REACH”, Navy Medicine, Mar-Apr 2001
  • Williams LN , “Tobacco Cessation: An Access to Care Issue”, Navy Medicine, 2002
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