Self-help - Nicotine Dependence

Self-help

Many smokers have successfully quit smoking without participat-ing in formal treatment and the success rate improves with mul-tiple attempts and probable self-learning through trial and error and learning from others. Eventually about 50% of smokers are able to quit and more than 90% of successful quitters have been able to do so without the assistance of professionals or formal programs. These numbers reflect multiple factors including the limitations on access to treatment (nonexistent health insurance coverage and limited number of providers with expertise to help), the cumulative process of multiple attempts and learning from others and from self-help materials, and the severity of the nico-tine dependence. The advantage of quitting without professional intervention is the decreased expense and time commitment; however, professional treatment may be necessary for higher se-verity cases that are often complicated by other behavioral health problems. The primary unassisted method of detoxification from nicotine dependence is precipitous cessation (cold turkey), which is used by more than 80% of smokers. This is followed by spon-taneous strategies to handle cravings and triggers. Some smokers attempt to limit intake, taper the number of cigarettes smoked, or switch to a reduced tar or nicotine brand. Special filters and holders are also available to decrease the amount of smoke that is available from a cigarette. These methods are usually less suc-cessful because smokers have been shown to alter smoking be-havior by increasing the frequency, volume, or duration of the inhalation to ensure maintenance of blood levels of nicotine ad-equate to prevent withdrawal symptoms. Some smokers use non-prescription pills that are analogues of nicotine, such as lobeline, to help manage or prevent withdrawal symptoms. These agents have not been shown to be effective in controlled studies.

Some geographical areas have Nicotine Anonymous groups that are structured similarly to Alcoholics Anonymous or Narcotics Anonymous groups. These groups are based on the 12-Step approach to recovery from addictions. Nicotine Anonymous is a relatively new organization (founded in 1985). and does not have the extensive network that other 12-Step pro-grams like Alcoholics Anonymous or Narcotics Anonymous have developed. No formal controlled studies of the benefits of this intervention have been carried out. In addition, self-help written materials can play an important role in educating patients about the negative health effects of nicotine, the benefits of quit-ting and the nature of the addiction. Self-help literature, internet resources and Nicotine Anonymous can be effectively integrated into formal treatments of brief interventions, individual and group treatments. Even smokers with major health conditions, such as chronic obstructive pulmonary disease or cardiovascu-lar disease, often have a difficult time attaining and maintaining abstinence. Numerous psychological and pharmacological treat-ments have been developed to assist with smoking cessation.

Even a brief face-to-face intervention by a physician or other medical staff can increase the likelihood of cessation two- to tenfold (Klesges et al., 1990). The impact of physician’s brief advice to quit has received the most study relative to other disciplines such as nursing; however, clearly all disciplines have an opportunity to make an impact. Physicians can inquire about a patient’s smoking status, urge the patient to stop smoking, and spend a brief time counseling the patient about cessation strate-gies. Multiple follow-up interventions, even telephone contacts by other medical staff, can further improve the cessation rate. Resources are available to assist physicians in providing effec-tive antismoking interventions, which can even be used by those not highly skilled in counseling. Physicians’ advice appears to be most successful with patients with a serious medical problem or specific medical reason for quitting (e.g., pregnancy or con-gestive heart disease). In addition, because an estimated 70% of smokers in the USA visit their physicians at least once a year, an important opportunity exists for providing this type of smoking cessation intervention.