Quit Smoking in 2015




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Millions of smokers around the globe will resolve to quit this New Year, and despite an increasing number of evidence-based interventions with proven efficacy, more people fail than succeed, leaving smoking to prevail as the world’s leading cause of premature death and disability (WHO global report, 2012). This begs the crucial question. What’s the best way to quit smoking?

Self-help, exercise interventions, group therapy, text-support, alternative therapies, e-cigarettes, behavioral therapy, mindfulness, apps, web-based aids, aversion therapy, nicotine replacement and other pharmacotherapies; the list of potential tools goes on. In fact, there is an overwhelming boom of scientific research investigating smoking cessation, with thousands of papers published this year alone. So how do we make sense of it all and say no to tobacco for good?

Well, that’s easier said than done. It seems that certain combinations of interventions boost one’s success, while other combos are simply a waste of energy and can even lessen your chances of successfully calling it quits. A person’s ability to kick the habit will also vary depending on an unknown number of individual factors, from age to how a person handles failure.

A study published this year in Addictive Behaviors consolidated our understanding of the main predictors of relapse. It reinforced the view that the psychological aspects of smoking and stages of behavior change, also known as the transtheoretical model (TTM), are far more important to quitting than the physiological addiction to nicotine itself.

A Few Tips Based On the Results

  • If you are 18-24, get your battle gear ready as you are less likely to quit for good. If you want to quit successfully, use all the effective tools at your disposal.
  • If you have tried to quit once or twice before in the last 36–72 months, the statistics suggest that the third time really is a charm. However, those that have had 3-10 failed quit attempts should really roll up their sleeves if they don’t want to fall off the wagon again.
  • The number of cigarettes you smoke a day, or when you take that first drag in the morning isn’t the best indication as to how easy you’ll find it to quit. Currently, this is one of the main ways we assess addiction severity, prompting health professionals to alternatively rely on emotional and situational factors.
  • Positive social experiences associated with smoking, like popping out with workmates for a quick break, can make it all the more difficult to quit. Looking at strategies to minimize your social smoking risks will be essential to success.
  • Self-revaluation (realizing that the healthy behavior is an important part of who you want to be), helping relationships (finding those that are supportive of your changes) and stimulus control (using reminders and cues that encourage healthy behavior) are the key processes that are important to calling it quits and keeping it that way.

Enhancing Chances of Quitting Smoking by Combining Evidence-based Interventions

By wading through the sea of smoking cessation research, there are some useful and practical observations to be gleaned. To be truly effective, one thing is clear: different tools are needed at different stages of nicotine withdrawal and habit cessation. Here are some of the most effective evidence-based interventions and when they are particularly important:

1. Preparing To Take Action and Getting Started

Ultimately, a visit to your local clinic and seeking out seeking out behavioral therapy is a great way to start. However, there are many other effective and not-so effective related tools at your disposal:

The preparation stage is the only time when listing the pros and cons of smoking lists are useful, as it helps inspire change, but has no affect on maintaining abstinence for good.

A recent publication, coupled with many others, point to standard, as well as individually tailored, print-based self-help materials not providing any additional benefit when used alongside other interventions. Although, they are slightly better than no help at all. So while you may find your local stop smoking clinic’s brochures and other handouts informative, the majority of people won’t be able to quit with self-help alone.

If you want to get gravely serious about it, then booking an appointment for lung cancer screening could prove fruitful. Yet, as expected, it is sadly more effective for those that receive abnormal results. Nonetheless, multiple lines of research point to lung cancer screening providing a teachable moment, where health practitioners can more successfully introduce cessation interventions.

Although it might be a bit nerve-racking, a CT scan is a darn sight better than sticking those stomach churning warning labels of someone else’s smoke-riddled lungs on your office wall. These kind of warning labels have been recently considered in the October release of The American Journal of Public Health, to be modestly effective for behavior change at best.

Encouragingly, there is an increasing body of recent evidence indicating that some web-interventions and new quit smoking apps are proving promising and may be far more effective than email, text and telephone-based interventions. For example a study published in Translational Behavioral Medicine concluded that using the full version (but not the lite version) of the Smokefree.gov website led more people to a smokefree life than the reportedly ineffective quitline telephone counseling, brochures or email-messaging used in the study.

2. Kicking the Nicotine Addiction

Pharmacotherapy and e-cigarettes (not currently considered a therapy) aim to reduce the symptoms of nicotine withdrawal, thereby making it easier for a smoker to stop the use of cigarettes all together. However, pharmacotherapy alone will not be enough for the retraining of automatic behavioral tendencies and mental failsafes that lead to long-term abstinence after pharmacotherapy has run its course.

Nicotine replacement (e.g. patches and gum), and non-nicotine based drugs varenicline (Chantix®) and buprion (Zyban®), are the main medications used. Most importantly, combining smoking cessation drugs with behavioral therapy seems to be the best combination of interventions to date.

Beware however. Use of pharmacotherapy comes with a hefty warning. If you have any recent mental health conditions take great care and speak with a psychiatrist. In addition, those with heart problems should consult their doctor when considering pharmacotherapy. Multiple topical studies have warned about the severe and potentially fatal side-effects (depression, suicide, severe allergy, myocardial infarction and cardiac arrhythmia) with drugs like varenicline. Similarly, poor mental health has been linked with a higher risk of vaping becoming a new source of addiction rather than a stepping stone to getting clean.

That being said, there is a second warning if using e-cigarettes. There has been a lot of ranting and raving about them and research is beginning to catch-up with the hype. The evidence for e-cigarettes being a bona fide quitting tool is very limited, and may be better suited to managing nicotine withdrawal as opposed to long-term abstinence, with research suggesting a similar effectiveness to other established nicotine replacement therapies like patches and gum.

Nicotine replacement therapy in the form of gum and patches is the safest bet, although they may not be as effective as cessation drugs, or as novel and attractive as e-cigarettes.

3. Kicking the Habit

Research is strongly pointing to behavioral therapy being the trump card when it comes to being guided through all the stages of changing your smoking habits, as ritual (e.g a smoke with your morning beverage) and social behaviors are at the core of smoking addiction. Meeting with a behavioral therapist, or attending group behavioral therapy focuses on learning new coping skills and breaking those habits. Combined with pharmacotherapy, multiple reviews indicate this intervention cocktail markedly increases smoking cessation success compared with other interventions.

4. Long-Term Prevention of Relapse

Effective stress management has been suggested to be the cream on the cake when it comes to your long-term ability to quit, as surmised in multiple 2014 publications. Especially seeing as intense nicotine cravings cause and exasperate both physical and psychological stress, and that stressful events cropping up in life can transport you back to square one. It’s not surprising that such urges are the most commonly cited cause of relapse in smokers.

How well you can stick to the straight and narrow to prevent minor hiccups snowballing into full-blown relapse is essentially down to stress management. This may be why mindfulness training for smokers, which is routinely used as a meditation therapy for stress-reduction, significantly reduced smoking urge ratings compared with the American Lung Association Freedom From Smoking program. Similarly, exercising more, also known to relieve stress, may boost the effectiveness of other interventions, although more research is needed to provide a definitive answer.

In Summary

If you are one of the many millions that want to quit smoking, a specific focus on personalizing your treatment to suit your personal needs throughout the quitting process is advised. This should preferably include the combination of one-on-one or group behavioral therapy and pharmacotherapy to raise your chances of quitting. If pharmacotherapy is not an option, stick with behavioral therapy. And don’t forget integrating healthy, stress-reducing lifestyle changes into your day, like mindfulness and exercise sessions, and making use of engaging web-based tools for a smoother journey towards long-term smoke free living. However, its important to bear in mind that a recent cohort study concluded that use of nicotine replacement therapy bought over the counter, like patches and gum, lowered odds of abstinence by more than 20% when compared with no help at all.

References

Davis JM, Manley AR, Goldberg SB, Smith SS, & Jorenby DE (2014). Randomized trial comparing mindfulness training for smokers to a matched control. Journal of substance abuse treatment, 47 (3), 213-21 PMID: 24957302

Gökbayrak NS, Paiva AL, Blissmer BJ, & Prochaska JO (2014). Predictors of relapse among smokers: Transtheoretical effort variables, demographics, and smoking severity. Addictive behaviors, 42C, 176-179 PMID: 25481450

Gomez MM, & LoBiondo-Wood G (2013). Lung Cancer Screening With Low-Dose CT: Its Effect on Smoking Behavior. Journal of the advanced practitioner in oncology, 4 (6), 405-14 PMID: 25032020

Harrell PT, Simmons VN, Correa JB, Padhya TA, & Brandon TH (2014). Electronic nicotine delivery systems (“e-cigarettes”): review of safety and smoking cessation efficacy. Otolaryngology–head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 151 (3), 381-93 PMID: 24898072

Hartmann-Boyce J, Lancaster T, & Stead LF (2014). Print-based self-help interventions for smoking cessation. The Cochrane database of systematic reviews, 6 PMID: 24888233

Heffner JL, Vilardaga R, Mercer LD, Kientz JA, & Bricker JB (2015). Feature-level analysis of a novel smartphone application for smoking cessation. The American journal of drug and alcohol abuse, 41 (1), 68-73 PMID: 25397860

Kotz D, Brown J, & West R (2014). Prospective cohort study of the effectiveness of smoking cessation treatments used in the “real world”. Mayo Clinic proceedings, 89 (10), 1360-7 PMID: 25282429

Monárrez-Espino J, Liu B, Greiner F, Bremberg S, & Galanti R (2014). Systematic review of the effect of pictorial warnings on cigarette packages in smoking behavior. American journal of public health, 104 (10) PMID: 25122019

Oostveen R, van der Galiën OP, Smeets HM, Hollinga AP, & Bosmans JE (2014). Effectiveness of pharmacotherapy in behavioural therapeutic smoking cessation programmes. European journal of public health PMID: 25477132

Orr KK, & Asal NJ (2014). Efficacy of electronic cigarettes for smoking cessation. The Annals of pharmacotherapy, 48 (11), 1502-6 PMID: 25136064

Stead LF, & Lancaster T (2012). Combined pharmacotherapy and behavioural interventions for smoking cessation. The Cochrane database of systematic reviews, 10 PMID: 23076944

Image via Andrey Popov / Shutterstock.

Carla Clark, PhD

Carla Clark, PhD, is BrainBlogger's Psychology and Psychiatry Section Editor and a scientific consultant, writer and researcher in fields including psychology and neuropsychology, as well as biotechnology, molecular biology and biophysical chemistry. She is also our newly appointed Digital and Social Media Manager. Follow her on Facebook or Twitter @GeekReports
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