Initially, the ill effects of tobacco smoking were unknown, as many physicians believed in traditional thought of tobacco having medicinal value. However, by the early 20th century, with smoking being widespread, there started to be investigations into the real health effects of tobacco smoking. In 1930, researchers in Cologne, Germany made a statistical correlation between smoking and cancer.
In 1988, nicotine was declared an addictive drug similar to heroin or cocaine in the Surgeon General’s Report on the Health Consequences of Smoking (Jorenby, 2001). Cigarette tobacco contains only a small amount of nicotine and most of this nicotine is destroyed by the heat of burning so that the actual concentration of nicotine in smoke is low. However, even a small amount of nicotine is sufficient to be addictive. Nicotine has various effects on the body. In small doses nicotine serves as a nerve stimulant, entering the bloodstream and promoting the flow of adrenaline, a stimulating hormone. It speeds up the heartbeat and may cause it to become irregular. It also raises the blood pressure and reduces the appetite, and it may cause nausea and vomiting. Because of its addictive nature, persons who attempt to discontinue the use of nicotine-containing tobacco experience an unpleasant withdrawal syndrome whose symptoms include depressed mood, disrupted sleep, irritability, frustration, anger, anxiety, difficulty concentrating, restlessness, decreased heart rate and increased appetite and weight gain (Jorenby, 2001). These symptoms may be experienced over a period of days or even within hours of smoking cessation.
There are, however, a myriad of cessation techniques which can be employed to quit smoking. The most commonly known methods are nicotine replacement methods including the gum, patch or nasal sprays. Nicotine patches are small, nicotine-containing adhesive disks that must be applied to the skin. The nicotine is slowly absorbed through the skin and enters the bloodstream. Over time, the nicotine dose is lessened and eventually the craving for nicotine is alleviated. Nicotine gum works in a similar manner, providing small doses of nicotine when chewed. Other nicotine replacement therapies include a nicotine nasal spray. This physician-prescribed spray relieves cravings for a cigarette by delivering nicotine to the nasal membranes. Also available by prescription, the nicotine inhaler looks like a cigarette; when puffed, the inhaler releases nicotine into the mouth. Nicotine substitutes treat the very difficult withdrawal symptoms and cravings that discourage most smokers from quitting. This method is most successful when used with another smoking cessation strategy.
There is also the use of medications to assist with reducing the severity of nicotine withdrawal, thereby facilitating cessation. One example is bupropion hydrochloride, which can be found in the prescription drugs Zyban and Wellbutrin. Both were approved by the Food and Drug Administration body (FDA) in 1998 to be used in smoking cessation. Bupropion hydrochloride is found to be most effective when used with other nicotine replacement therapies such as the gum or the patch. Recently, an approach combining three different smoking cessation therapies has gained favor. This new approach combines Zyban with nicotine replacement therapy and counseling. This approach to smoking cessation has shown remarkable results in the short term. While less than 25 percent of smokers who use nicotine replacement alone remain smoke-free for more than a year, 40 to 60 percent of smokers using the combination approach achieved this milestone. (Jorenby, 2001). However, like any drug, it has side effects, which include dry mouth, dizziness, insomnia, and rarely, seizures.
Acupuncture and related techniques, such as acupressure, laser therapy and electro stimulation have also been advertised to be effective measures of discouraging smoking. According to White, Rampes and Ernst (2002), they “failed to detect an effect of acupuncture on smoking cessation when compared to sham acupuncture at any time point.” They found that while it did have an effect on discouraging smoking in the early stages, there was no sustaining of that effect. White et al (2002) concluded that there is “no clear evidence that acupuncture, acupressure, laser therapy or electro stimulation are effective for smoking cessation.”
Hypnosis is another technique used to discourage smoking. A popular way of explaining hypnosis within the scientific community is that it is an “altered state characterized by increased relaxation, concentration and suggestibility” (Mutter & Coates 1990, p.70). Hypnosis as it applies to health is described as a “state of focused concentration in which the subject is more receptive to suggestions about changes that might improve his or her health” (Mutter & Coates 1990, p.70).
Hypnosis can exist either as self-hypnosis (or autohypnosis), in which the subject hypnotizes himself or herself, or as heterothypnosis, in which a clinician guides the subject into the hypnosis; in both cases, the subject is under control and can leave the hypnotic state if he or she wishes. Schwartz (1992) outlines five methods to hypnotic procedures: giving direct suggestions to the smoker to change, altering the smoker’s perceptions regarding addictive behavior, using hypnotherapy, which is hypnosis combined with verbal psychotherapy; using hypno-aversion, which is where hypnosis used to develop an aversion to smoking; and using self-hypnosis to supplement the treatment.
Research shows that under some circumstances, hypnotherapy is an effective method for smoking cessation. When the subject is susceptible to hypnosis, hypnotherapy can be a good method to aid in quitting the habit of smoking. Additionally, those who use hypnosis as an adjunct to other variables (social support, clinical support, or smokeless environment) find some success in the cessation of smoking. However, there is much evidence that hypnosis is only as effective as other accepted methods for treatment.
Anxiolytics, which are drugs prescribed for anxiety and panic disorder, have also been credited with being aids in the cessation of smoking. There are two major reasons for this belief. Firstly, it is believed that anxiety may be a symptom of nicotine withdrawal and also that smoking is due to deficiencies of serotonin, dopamine and norepinephrine, all of which are increased by anxiolytics and anti-depressants (Hughes, Stead and Lancaster, 2002). The authors concluded that while there is no consistent evidence that they aid the cessation of smoking, the available evidence does not rule out the fact that anxiolytics may have a possible effect on breaking the habit of smoking.
Perhaps one of the most trusted cessation techniques is that of counseling. The most common counseling technique used is that of self-help materials. These include manuals, booklets, and other media. It was found by Lancaster and Stead (2005) that while self help materials had an effect, there was no added benefit from using them in conjunction with other cessation techniques. Individual and group counseling, in contrast, were found to be most successful in smoking cessation. Proactive telephone calls are a relatively new form of delivering counseling and are also found to be quite effective.
A problem-solving approach works well for many smokers. An example of this would be thinking about times of the day one is likely to smoke, for distract oneself when the urge strikes, such as leaving the situation or deep breathing. Social support, in the form of encouragement, caring, and concern, clearly increases the success rate of smoking cessation. Social support can come both from healthcare providers, which is known as intra-treatment social support and from family, friends, and other community members, known as extra-treatment social support.
An easy-to-implement, evidence-based clinical counseling approach, the “5 A’s,” has been recently developed and can double or even triple quit rates, particularly among pregnant smokers. This approach has been published by the U.S. Public Health Service in its Treating Tobacco Use and Dependence Clinical Practice Guideline, and by the American College of Obstetricians and Gynecologists. The approach is effective for most pregnant smokers, including low-income women, the group most likely to smoke during pregnancy. Studies show that a brief counseling intervention of 5-15 minutes, when delivered by a trained provider with the provision of pregnancy-specific self-help materials can increase cessation rates among pregnant smokers by 30-70%.
This process involves asking the patient about smoking status, providing clear, strong advice to quit with personalized messages about the impact of smoking on mother and fetus, assessing the willingness of the patient to make a quit attempt within the next 30 days, suggesting and encouraging the use of problem-solving methods and skills for cessation, and periodically assessing the patient’s smoking status and, if she is a continuing smoker, encourage cessation.
An important part of the cessation process is the maintenance of quitting. While many techniques have initial success, such as that experienced by users of hypnosis and hypnotherapy, to be a significantly successful quitter, the individual has to cease smoking for a period of at least one year. Individuals experience severe cravings for nicotine, and these ravings are usually preceded by triggers, such as places, another person smoking or stress. Individuals are encouraged to use diversions such as doodling or sugar-free gum to occupy themselves when they are craving cigarettes. They are also encouraged to find new hobbies and reward themselves for not smoking.
These techniques involve self-monitoring and self-rewarding and different health behaviour models can be deemed appropriate for the individual and utilized. These models which include the Transtheoretical, Health Action Process and the Health Belief models. All these require the full participation and cooperation of the person who wants to change, and if used consistently, can result in significant adjustments in not just smoking, but the individual’s opinions on and perceptions of smoking.
With the emergence of modern technology, there are also methods that employ such technology. For instance, there is a variety of websites which can be accessed to assist with smoking cessation. These websites provided resources, such as counseling, medical support, expert advice and a social support network for smokers who wish to quit. Websites such as http://co.quitnet.com, also allow members to track how much money they have saved since ceasing smoking, how many years they may have added to their lives and keep journals to help stay on track. This site in particular also provides a national directory of cessation programmes for the convenience of its members and games for diversion purposes. The important thing for many users is that all these services are provided to them at no cost.
In reference to the effectiveness of such websites, there has not yet been any research into how well they work. What is integral, however, is that they encourage users not to only rely on the website, but to seek help in their own areas, in the form of counseling or other cessation techniques deemed appropriate.
In closing, the different cessation techniques available provide the individual with immense choice. It must be acknowledged that not all persons will respond to the same method in a similar way. Through a combination of the less effective techniques, such as hypnosis or medication, with for instance, counseling, then the individual can guarantee himself a safety net, thereby increasing his or her chances to ceasing smoking. Practitioners must also consider the value of less traditional methods and are encouraged to tailor the method used to the client’s particular needs and personality.
References
Hughes JR, Stead LF, Lancaster T. Anxiolytics for smoking cessation. The Cochrane Database of Systematic Reviews 2000, Issue 4.
Jorenby, D.E. (2001). Smoking Cessation Strategies for the 21st Century. Retrieved on October 31, 2005 from circ.ahajournals.org/cgi/content/full/104/11/e51.
Mutter, C. B. & Coates, M. L. (1990). Hypnosis in Family Medicine. American Family Physician, 42(5Suppl), 70S-73S.
Schwartz, J. L. (1992). Methods of Smoking Cessation. Medical Clinics of North America, 76(2), 451-76
White AR, Rampes H, Ernst E. Acupuncture for smoking cessation. The Cochrane Database of Systematic Reviews 2002, Issue 2.
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