Fast Five Quiz: Helping Patients With New Year's Resolutions

George D. Harris, MD


December 12, 2018

Clinicians have a particularly important role as patient advocates in health promotion, discouraging smoking initiation, and encouraging and assisting smoking patients to quit. A critical component of treatment is educating patients about the benefits of smoking cessation and the cessation process. Offering guidance and support and being available to provide patients with assistance are very important in motivating cigarette smokers to quit.

Provide a description of the expected withdrawal syndrome. Continue with a discussion of the possible cessation methods, which include counseling, NRT, antidepressant medications, behavioral training, group therapy, hypnosis, and quitting "cold turkey." Successful cessation is confirmed by measuring cotinine or carbon monoxide levels. More than 90% of patients who attempt to quit smoking stop cold turkey. Professional group therapy or counseling achieves an initial cessation rate of 60%-100% and a 1-year cessation rate of approximately 20%. Hypnosis and acupuncture are popular programs that might encourage renewed attempts by people for whom other techniques have failed.

Nicotine patches deliver nicotine through the skin at a relatively steady rate. In general, they yield higher compliance rates than other NRT products do, but they may not adequately protect against craving provoked by smoking-related stimuli. For breakthrough cravings not adequately controlled by transdermal nicotine alone, acute therapies may be added.

The use of smokeless tobacco products constitutes a small but growing segment that requires special considerations in the design of treatment interventions. NRT does not increase smokeless tobacco quit rates; however, of the pharmacologic options, varenicline shows early positive results.

Bupropion acts by alleviating some of the symptoms of nicotine withdrawal, which include depression.  One clinical trial demonstrated that highly nicotine-dependent smokers who receive bupropion are more likely to experience a decrease in depressive symptoms during active treatment. Like NRT products, bupropion has been endorsed by the US Clinical Practice Guidelines as a first-line therapy. Compared with placebo, bupropion approximately doubles smoking cessation rates, and it is equally effective for men and women. It may yield higher cessation rates when combined with NRT than when used alone.

Read more on nicotine cessation.


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