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TOBACCO CESSATION

COMPETENCY CLASS

SECTION 4: WAYS TO
QUIT
WAYS TO QUIT
• There are several • COLD TURKEY
methods for • TAPERING
tobacco • SELF-HELP
cessation that do • AVERSIVE
not include SMOKING
medication • ACUPUNCTURE
• HYPNOSIS
COLD TURKEY

• Cold turkey is the abrupt cessation of all


forms of tobacco use

• It is the most popular method reported by 50


million former smokers from 1964-2000

Ferry, 1999
COLD TURKEY
• Cold turkey is also considered the most
successful method
• Some researchers believe this information is
biased, since it is reported by the surviving ex-
smokers and does not include the 12 million
smokers who have died from tobacco related
diseases between 1964-2000

Ferry, 1999
COLD TURKEY
• Smokers who choose to go cold turkey
are encouraged to pick a quit date and
then cease any form of tobacco use from
that day forward
• Cold turkey has shown to be most
successful for low-level nicotine
dependence

Lillington, et al., 2000


COLD TURKEY

• The 5 year abstinence rate for


going cold turkey is:
– 5 % for high risk smokers
– 10% for moderate smokers
– 20% low risk smokers

Ferry, 1999
COLD TURKEY
• Nicotine causes mood altering
neurotransmitter changes depending on
how it is administered
– Norepinephrine increases alertness
– Dopamine enhances pleasurability
– Serotonin enhances mood and reduces
stress
Ferry, 1999
COLD TURKEY
• Abrupt cessation of • ANXIETY
nicotine causes a • IRRITABILITY
decrease in these • DIFFICULTY
neurotransmitters CONCENTRATING
• This leads to • INCREASED
APPETITE
withdrawal
• WEIGHT GAIN
symptoms
• CRAVINGS
• DEPRESSION
Lillington, et al., 2000
COLD TURKEY
• Withdrawal symptoms are the leading
reason why people who try the cold
turkey method relapse

• The American Cancer Society


recommends going cold turkey as the best
method for smoking cessation
American Cancer Society, 1995
TAPERING

• Tapering (Controlled Smoking, Harm


Reduction) is the gradual cutting down
of the number cigarettes and the
amount of each cigarette smoked

American Cancer Society, 1995


TAPERING
• There are two methods for tapering:
– Counting the number of cigarettes smoked
and decreasing that number every day until
it reaches zero
– Postponing each cigarette until a
predetermined length of time has passed
between cigarettes

American Cancer Society, 1995


Tapering should only be considered
as a tool toward smoking cessation.
Decreasing the number of cigarettes
does not decrease the health risks.

American Cancer Society, 1995


CONTROLLED SMOKING
• Controlled Smoking is a – Change the regular
method of tapering brand of cigarettes
developed by Tom smoked to one with a
Ferguson MD lower level of tar and
• Principles of Controlled nicotine
Smoking:
– Reduce the number – Reduce the amount
of cigarettes smoked of each cigarette
by 1/2 to 2/3 smoked

Ferguson, 1987
TAPERING HAZARDS

• Smokers who taper cigarette use often


compensate for the decrease in nicotine
consumption by:
– Altering puffing depth
– Occluding the filter vents on the cigarettes
– Taking more frequent puffs
Ferguson, 1987
Another pitfall of tapering is
the ease at which a smoker can
return to his/her previous level
of tobacco use.

American Cancer Society, 1995


ANOTHER HAZARD
• Tobacco companies manufacture cigarettes
with varying levels of tar and nicotine.
These levels are determined by machines
with set puffing patterns
• In order to compensate for a decrease in
nicotine, a smoker can alter their puffing
patterns and extract as much nicotine from a
low nicotine level cigarette as they can from
a higher nicotineFerguson,
level1987cigarette
CLEARING A
MISCONCEPTION
• Labels that state “light” or “ultra-light” are
labels used by tobacco companies to
distinguish products. They do not indicate
a lower level of tar or nicotine (just a
different type of filter).
• These types of cigarettes offer NO health
benefits over regular cigarettes.
Centers for Disease Control and Prevention, 2000
SELF-HELP

• Self -Help is defined as using


resources other than clinical
interventions to aid in tobacco
cessation
• These resources can also be helpful
when used with other cessation
techniques
McMahon and Jason, 2000
SELF-HELP
• Self-Help materials
• Self-Help enable health care
materials include: professionals to reach
– Manuals a large number of
– Brochures smokers due to the
ease of distribution
– Videos
• The most effective
– Online Support
manuals include
exercises to track
smoking patterns
McMahon and Jason, 2000
SELF-HELP
• Material and online support are available from:
– American Cancer Society
• www.cancer.org

– American Heart Association


• www.amhrt.org
– Centers for Disease Control and Prevention Office
on Smoking and Health
• www.cdc.gov/nccdphp/osh/tobacco.htm
SELF-HELP
• Materials and online support continued:
– National Cancer Institute
• www.nci.nih.gov
– American Lung Association
• www.lungusa.org
– Agency for Health Care Policy and
Research
• www.ahcpr.gov/clinic
SELF-HELP
• Self-help techniques offer a higher
success rate when combined with a
cessation program that offers social
support
• However, there are few studies available
to document the effectiveness of self-help
techniques for tobacco cessation

McMahon and Jason, 2000


AVERSIVE SMOKING

• Aversive smoking is a cessation


technique that involves smoking a
high number of cigarettes in a short
time frame in order to produce
discomfort

Fiore, et al., 2000


AVERSIVE SMOKING

• Aversive Smoking is also called Rapid


Smoking, Rapid Puffing, Focused Smoking,
Satiation Smoking
• Cigarettes are smoked rapidly until the
patient experiences:
– Nausea
– Malaise
– Vomiting
Fiore, et al., 2000
AVERSIVE SMOKING
• Technique for Aversive Smoking:

– The patient should take as large a puff as


possible from a cigarette every 6 seconds
– This should be continued for up to 30
minutes or until the patient experiences
nausea and vomiting

Ferguson, 1987
AVERSIVE SMOKING

• Aversive Smoking aids in cessation by


applying a negative association with
smoking
• This technique should only be used under
medical supervision
• This should be used only after other
techniques have been unsuccessful
Ferguson, 1987
AVERSIVE SMOKING
• This technique
should be used • Contraindications
cautiously in for this technique
patients who have include:
suffered: – Pregnancy
– Myocardial – High blood pressure
Infarction
– Diabetes
– CAD
Ferguson, 1987
ACUPUNCTURE

• Acupuncture is a treatment method that


originated in the Far East
• During treatment a specially trained
acupuncturist places long thin needles
through specific points on the body. The
needles are then manipulated or supplied
with weak electrical current
White, et al., 2000
ACUPUNCTURE
• Acupuncture has been recognized by the
American medical and veterinary
communities as an alternative treatment
method for substance abuse, pain relief, and
anesthesia
• It is also considered an acceptable
treatment for many other ailments
according to the World Health Organization
Bernstein, 2000
ACUPUNCTURE
• The principle mode of – endogenous opioids
action is thought to be
neurochemical – serotonin
stimulation
• When the needles are – norepinephrine
placed and stimulated
the body produces:
– cholecystokinin

White, et al., 2000


ACUPUNCTURE

• Acupuncture for smoking cessation


commonly uses points on the ear and
face
• Other points on the body may be
needled simultaneously

White, et al., 2000


ACUPUNCTURE
• Once the needles are placed, a mild
electrical current may be applied
• This procedure can take from 10-20 minutes
• After these needles are removed a second
needle is placed in the ear and covered with
an adhesive dressing

White, et al., 2000


ACUPUNCTURE

• This indwelling needle is left in the ear for


1 to 2 weeks
• The patient is instructed to press on the
needle when cravings occur
• During a follow up visit the needle is
removed by the practitioner

White, et al., 2000


ACUPUNCTURE

• Few research studies have been done to


assess the effectiveness of acupuncture for
smoking cessation
• The success of this technique is thought to
be connected with the patient’s positive
expectations about the procedure

Fiore, et al., 2000


HYPNOSIS

• Hypnosis is an altered state of


consciousness accompanied by an abnormal
sensibility to suggestions
• Hypnosis has its origins in ancient Greece
• The technique gained medical recognition
in the 18th century when it was popularized
by Franz Anton Mesmer
Margolis, 1997
HYPNOSIS
• Hypnosis has three • The dissociation phase
phases:* is a period of deep
– Absorption relaxation which
– Dissociation produces an altered
– Suggestibility state of consciousness
• The absorption phase • The suggestibility
uses deep breathing phase is the period
and fixation when the patient is
techniques to produce open to positive
a trance suggestions
*Godoy, 1999; Margolis, 1997
HYPNOSIS

• During the – Perceptions


suggestibility phase – Expectations
the patient
experiences a – Conditioned
change in mental responses
function which can – Self-talk
allow the – Self-control
practitioner to plant
thoughts regarding: – Motivation
Margolis, 1997
HYPNOSIS
• Hypnosis has been used in a variety of
treatments:
– Pain
– Psychosomatic symptoms
– Stress management
– Habit control

Margolis, 1997
HYPNOSIS

• Hypnosis for tobacco cessation has no


standardized procedure
• The technique may take from 1 to 10
sessions depending on the practitioner
• Hypnosis appears to be most successful for
low risk smokers

Margolis, 1997
There are very few scientific
studies which have been
conclusive in supporting
hypnosis as a smoking
cessation technique

Fiore, et al., 2000


IN CONCLUSION

• A variety of methods are popular


for tobacco cessation. However,
pharmacological interventions
combined with clinical counseling
are the only accurately documented
methods for tobacco cessation.
Fiore, et al., 2000