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Thursday, October 21, 2010

Stop Smoking Aids

This is part 2 of a series by Tim Frymyer from over at To view part 1 in this series, click here. To view part 2 in the series click here.

Today I thought I would talk about the world of stop smoking aids. You know, it still amazes me that smoking retains such widespread popularity in the United States despite all the Surgeon Generals warnings and tobacco company lawsuits. Roughly a quarter of all Americans are still smoking. As we all know, in many parts of the United States, smoking is as part of the mainstream culture as baseball and apple pie.

Currently, there are many stop smoking aids, methods or products on the market. Everything from electric cigarettes to lasers. But when you get past the hype and look at the science of smoking cessation, you are left with a very stark reality, low success rates. Let's look at the most popular methods for smoking cessation.

The first category can be called non-pharmacologic means. This includes quitting cold turkey, behavior modification, and support groups/counseling. Quitting cold turkey, although the preferred method of quitting by most smokers, offers the lowest success rate at around 3-5%. People seem to quit smoking cold turkey everyday. There is something in our DNA that takes pride in the idea of quitting without any help. Quitting cold turkey also gives the person a chance to "test the waters" of cessation without anyone else knowing about it. So if they fail or relapse, then their ego doesn't have to take a hit.

In contrast though, group counseling and behavior modification has the highest success rate, right around 20%. However, there is often a stigma associated with counseling in our society and so very few smokers will choose this option, despite the relatively high quit rates. This route to becoming smoke-free is wrought with lots of exposure and many don't want to admit they need help or are simply not that serious about quitting yet. So as a result, if I may borrow a poker term, they don't go "all-in".

The second category would then be pharmacological interventions. Here is where you see nicotine replacement therapy (NRT), like nicotine gum, the patch, the nasal spray, etc. You'll also find Zyban and Chantix in this category.

The success rate found with nicotine replacement is about equal to what is found with Zyban, which is basically double that of quitting cold turkey, right around 7-10%. NRT comes in a variety of forms, some expensive and some cheap. Some require a physician script, while others are OTC. I had one smoker tell me that he thought NRT was horrible because it didn't cure him of his smoking habit. After further questioning, he explained that he just wanted to "try" something different from cold turkey which had also failed him. So I believe smokers have this perception that you first try cold turkey, then NRT, then the next method and so on and so forth until you eventually quit.

Zyban is an anti-depressant which not only shows some smoking cessation properties, but also can help to treat some of the underlying depression associated with smoking. If smoking were a disease, which many feel it is, depression would be a primary co-morbidity. For many, Zyban is a good option because of the psych treatment component.

Chantix is a pill which boasts a success rate above 20%. However, Chantix has been required by the FDA to place a warning label on each box dispensed. The label warns the consumer that some who take Chantix, have experienced erratic and bazaar behavior. Many who want to quit smoking may not be willing to take that chance, in spite of the potential upside in success. But Chantix also utilizes a "program" for smoking cessation. They don't look at it as simple a “magic bullet“, but rather a piece in a complex support system to help smokers quit. There are some who believe that it is the support and not the pill that provides the high success rate seen with Chantix. Remember, counseling has a very high success rate by itself. So regardless of the method used, the addition of a counselor or behavior program will greatly increase the likelihood of cessation.

There is one more pharma category that many people like to use and that is what I call the placebo method - this group wouldn't be classified as front line though. This is where someone takes a legitimate medication with a very real medical use but offers it up as a stop smoking aid in an "off-label" manner. In other words, they may take some benign medication used to dry up secretions, and market it as a stop smoking shot. The consumer then receives this medication thinking they are getting some new smoking cure. This idea is so powerful, it creates a very real placebo effect in their mind. You’ll also find the “natural smoking remedies” in this category too. Various herbs mixed together to form a cessation cocktail of sorts. Again, it’s not so much the product that counts, but the advertising. The buyer needs to really believe the product will work. The success rates for placebo is thought to be about equal to that of quitting cold turkey, as you would expect.

The final category is what I label as alternative methods. This sort of catch-all group is where you find hypnosis and acupuncture (both traditional and laser). These methods might have a basis in non-traditional science and certainly have helped people to stop smoking. But there is sometimes no rhyme or reason as to whether it will or will not work; which, I suppose, doesn't make them much different than any other method. Like placebo meds, there are no studied success rates with these methods and there are no clinical studies to quote statistics from. But most agree, the success is equal to that of quitting cold turkey.

After looking at these success rates, it becomes easy to see why smoking is still so prevalent. Too often people buy into a product or method because it offers them the magic bullet. But in the end, they're just not mentally prepared for the grind. So how do we improve our results then? Many researchers and experts agree that education and information is what smokers need. Only then can they connect the dots between behavior, treatment and commitment.

As therapists, we need to help our patients set realistic expectation and help them select the best stop smoking aid that suits their personality and addiction. Simply put, knowledge has to be the driving force. The better informed someone becomes, the more sound their expectations will be and the more success they'll have.

This is one reason why I created a literature-based stop smoking website. I wanted it to be a resource for RTs and other healthcare professionals so they could talk intelligently about smoking cessation with their patients. I have a
stop smoking aids page on my site that is a great resource for anyone who wants more information on the subject.

Thanks again to Rick for allowing me to share this information.

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