TOBACCO CESSATION COMPETENCY CLASS SECTION 4: WAYS TO QUIT

WAYS TO QUIT
• There are several methods for tobacco cessation that do not include medication
• • • • COLD TURKEY TAPERING SELF-HELP AVERSIVE SMOKING • 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 exsmokers 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 nicotine causes a decrease in these neurotransmitters • This leads to withdrawal symptoms
• ANXIETY • IRRITABILITY • DIFFICULTY CONCENTRATING • INCREASED APPETITE • WEIGHT GAIN • 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 method of tapering developed by Tom Ferguson MD • Principles of Controlled Smoking: – Reduce the number of cigarettes smoked by 1/2 to 2/3
Ferguson, 1987

– Change the regular brand of cigarettes smoked to one with a lower level of tar and nicotine – Reduce the amount of each cigarette smoked

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, 1987 level cigarette

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 include:
– – – – Manuals Brochures Videos Online Support • Self-Help materials enable health care professionals to reach a large number of smokers due to the ease of distribution • The most effective 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 cautiously in patients who have suffered:
– Myocardial Infarction – Diabetes – CAD
Ferguson, 1987

• Contraindications for this technique include:
– Pregnancy – High blood pressure

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 action is thought to be neurochemical stimulation • When the needles are placed and stimulated the body produces: – endogenous opioids – serotonin – norepinephrine – 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 phases:*
– Absorption – Dissociation – Suggestibility

• The absorption phase uses deep breathing and fixation techniques to produce a trance

*Godoy, 1999; Margolis, 1997

• The dissociation phase is a period of deep relaxation which produces an altered state of consciousness • The suggestibility phase is the period when the patient is open to positive suggestions

HYPNOSIS
• During the suggestibility phase the patient experiences a change in mental function which can allow the practitioner to plant thoughts regarding:
Margolis, 1997

– Perceptions – Expectations – Conditioned responses – Self-talk – Self-control – Motivation

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

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