Only drug-based interventions are effective at getting smokers to stop smoking permanently - Essay Example

?Only drug-based interventions are effective at getting smokers to stop smoking permanently Introduction Although research and publicized law suits against tobacco companies have combined to heighten public awareness of the ill-effects of smoking, smoking continues to be a serious public and personal health issue (Mallin, 2002). Researchers have conducted a number of studies indicating that a variety of factors contribute to effective strategies for smoking cessation and preventing relapses. Essentially the literature is undecided in terms of whether only drug-based interventions are effective for achieving permanent cessation of smoking. Some studies suggest that behaviour modification and drug-related therapy are more effective than one or the other. Other studies suggest that behaviour modification and drug-related therapy alone can achieve permanent smoking cessation. This paper examines the literature and concludes that the permanent cessation of smoking is a personal choice. Smoking cessation programs can get the individual to quit smoking, however, it is up to the individual to permanently remain smoke-free. Research: Smoking Cessation Ockene, et. al., (1994) examined the smoking cessation patterns of 1,261 patients in primary care with doctors who conducted smoking intervention programs. The smoking intervention programmes included advice only, counselling and counselling combined with nicotine chewing gum. Follow-ups were conducted at 6 and 12 month intervals. Within the first week there was a 15.2% cessation rate among patients receiving advice only. Patients receiving counselling demonstrated a 12.9% cessation rate within one week, and those receiving both drugs (nicotine chewing gum) and counselling demonstrated a 16.7% rate of cessation in one week (Ockene, et. al., 1994). The results of the study indicated however, that as intervention intensified, cessation rates increased with respect to cessation at the 6 and 12 month intervals. However, at the 6 and 12 month intervals, patients in the drug and counselling program had a much higher rate of cessation than patients in the other two categories. The study therefore concluded that drug based programs combined with counselling can have a long-term impact on cessation of smoking (Ockene, et. al., 1994). Ockene, et. al.’s (1994) study does not claim that drugs alone or that drugs in combination with counselling can facilitate the permanent cessation of smoking. This study only states that the combined intervention strategy can have a long term impact on smoking cessation. It can be assumed however, that if an individual can quit smoking for 6 months or a year, the individual has broken the habit and any relapse will be a personal choice as opposed to the success of an anti-smoking program. The program achieved its goal in getting smokers to quit smoking and the follow-up study indicates that the smoking intervention strategy in which drug-related therapy was combined with counselling was more effective in the long term than programs that did not use drug-related therapy. Clark, Hogan, Kviz and Prohaska (1999) conducted a study indicating that in order to achieve the goal of permanent cessation of smoking, it is necessary to expose the factors linked to “readiness to quit smoking” (p. 1). The study involved an analysis of the role that symptoms among a population of adults in managed care played in the decision to quit smoking among three different age groups: 18-34, 35-54, and over 55. Readiness to quit smoking was measured in terms of change phases and intention to quit smoking (Clark, et. al., 1999). The study used an ordinal logistic regression and findings indicated that smokers in the age groups 35-54 and over 55 years of with at least three symptoms linked to the ill effects of smoking were more committed to quit smoking. Even so, all participants in all age groups who experienced symptoms linked to smoking were “motivated” to quit smoking and those who connected symptoms with aging were not committed to quit smoking (Clark, et. al., 1999, p. 1). Clark, et. al. (1999) therefore suggests that focusing on the symptoms of smoking is likely to achieve the permanent cessation of smoking. Clark, et. al. (1999) did not investigate the effectiveness of an anti-smoking program. Instead, Clark, et.al. (1999) observed the role that symptoms had on the decision to quit smoking. Thus all indications are that individuals can be motivated to quit smoking. It is therefore argued that since individuals can be motivated to quit smoking, they can likewise be motivated to permanently quit smoking without drug-based interventions. Marlatt and Witkiewitz (2005) argue that the technique for achieving the permanent cessation of smoking is effective relapse prevention therapy. Relapse prevention therapy addresses the relapse problem and uses “techniques for preventing or managing its occurrence” (Marlatt & Witkiewitz, 2005, p. 1). Relapse prevention therapy is founded on a “cognitive-behavioural framework” and: ...seeks to identify high-risk situations in which an individual is vulnerable to relapse and to use both cognitive and behavioural coping strategies to prevent future relapses in similar situations (Marlatt & Witkiewitz, 2005, p. 1). It would therefore appear that drugs are not often associated with preventing a relapse or with the permanent cessation of smoking. Instead, drugs may be an effective strategy for getting the smoker to quit. However, in terms of achieving the permanent cessation of smoking, behavioural modification therapy appears to be the most effective strategy since it focuses on client specific coping strategies and behavioural modification tools. A study conducted by Wilson, Wakefiled, Steven, Rohrsheim, Estemann and Graham (1990) indicates that long-term cessation of smoking can be achieved without the use of drugs or relapse prevention therapy. The study was conducted among 1238 smokers located in South Australia. The participants were placed into two groups: intervention and non-intervention. Participants in the intervention group were subjected to mere physician advice to quit smoking. The results of the study revealed that 7.5% of the participants in the intervention group quit smoking and remained smoke free at the 6 and 12 months intervals as revealed by follow-up inquiries. Only 3.2% of the members of the non-intervention group had quit smoking and remained smoke free (Wilson, et. al., 1990). Wilson, et. al.’s (1990) study indicates that drugs-related therapy is not always used in smoking cessation programs and is nonetheless successful. Assuming that the strategies used for getting a smoker to quit smoking are the same techniques and strategies that will determine the extent to which the smoker will abstain permanently, if a smoke quits with the use of a drug free strategy, the smoker will likely remain smoke free if he or she wants to remain smoke free permanently. A study was conducted by Hall, et. al. (1998) indicating that while drugs-related therapy was necessary for long-term smoking cessation among patients with major depressive disorder (MDD), it was only effective when combined with cognitive-behavioural therapy. The study involved 199 smokers divided into several groups: treatment with nortriptyline, treatment with placebo, cognitive-behavioural therapy, history of MDD and no history of MDD. The participants were tested by biological methods to determine smoking cessation at intervals of 12, 24, 38 and 64 week intervals. Withdrawal, modds and depression were measured at 3, 5, and 8 day intervals following the cessation of smoking (Hall, et. al., 1998). The results of the study indicated that nortriptyline was more successful in terms of cessation rates than placebo regardless of the participant’s history of depression. However, cognitive-behavioural therapy was more successful in achieving smoking cessation among participants with a “history of depression” (Hall, et. al., 1998, p. 683). Moreover, nortriptyline relieved the symptoms associated with withdrawal. The study also found that smokers with no history of depression who suffered greater withdrawal symptoms were less likely to smoke again. The study also found that women with no history of MDD were less likely to abstain than women with a history of MDD (Hall, et. al., 1998). Hall, et. al., (1998) therefore concluded that: Nortriptyline is a promising adjunct for smoking cessation. Smokers with a history of depression are aided by more intensive psychosocial treatments. Mood and diagnosis interact to predict relapse. Increases in negative affect after quitting smoking are attenuated by nortriptyline (p. 683). Although Hall, et. al.’s (1998) indicated that the use of drug therapy was successful in an smoking cessation program, it was not the only therapy used. Moreover, the drug was used in combination with cognitive-behavioural therapy which was more effective in achieving long-term smoking cessation. It appears that the drugs were only used to counter the physical aspect of addiction and not as a method for achieving long-term smoking cessation. Long-term smoking cessation was achieved via the use of counselling and this was intended to modify behaviour and coping mechanisms to avoid the temptation to smoke again. Stead, Perera, Bullen, Mant and Lancaster (2008) conducted a study of trials recorded by the Cochrane Addiction Group in which nicotine replacement therapy (NRT), no treatment or placebo was used. A meta-analysis utilizing a Mantel-Haenszel Fixed-Effect model was used to test the cessation rates at the six month mark and beyond. Altogether 132 trials with at least 111 containing 40,000 participants were identified (Stead, et. al., 2008). The results of the study indicated that: All of the commercially available forms of NRT (gum, transdermal patch, nasal spray, inhaler and sublingual tables/lozenges) can help people who make a quit attempt to increase their chances of successfully stopping smoking. NRTs increase the rate of quitting by 50-70%, regardless of setting (Stead, et. al., 2008, p. 4). The results of Stead, et. al.’s (2008) study do not claim that nicotine replacement therapy (NRT) prevents relapses and therefore facilitates the permanent cessation of smoking. The study merely shows that NRT increases the likelihood of quitting. Conclusion There is not empirical evidence that only drugs-related therapy facilitates smoking cessation permanently. All indications are that drugs alone can increase the likelihood of quitting. Studies have also shown that drugs can be useful in the initial stages of intervention for relieving the symptoms associated with withdrawal. However, long-term or permanent cessation of smoking appears for the most part to be a personal choice best dealt with by the use of behavioural therapy. This is particularly so with respect to smokers with MDD. However, studies show that patients with particularly vulnerable personality traits such as MDD are more likely to permanently or at least in the long-term, abstain if they are subjected to cognitive-behavioural therapy. Works Cited Clark, M. A.; Hogan, J. W.; Kviz, F. J. and Prohaska, T. R. (January-February 1999). “Age and Role of Symptomatology in Readiness to Quit Smoking.” Addictive Behaviors, Vol. 24(1): 1-16. Hall, S. M.; Reus, V. I.; Munoz, R. F.; Sees, K. L.; Humfleet, G.; Hartz, D. T.; Frederick, S. and Triffleman, E. (August 1998). “Nortriptyline and Cognitive-Behavioral Therapy in the Treatment of Cigarette Smoking.” Arch Gen Psychiatry, Vol. 55(8): 683-690. Mallin, R. (March 2002). “Smoking Cessation: Integration of Behavioral and Drug Therapies.” American Family Physician, 1107-1115. Marlatt, G. A. and Witkiewitz, K. (2005). “Relapse Prevention for Alcohol and Drug Problems.” In Marlatt, G. A. and Donovan, D. M. (Eds.), Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors. New York, NY: The Guilford Press. Ockene, J. K.; Kristeller, J.; Pbert, L.; Herbert, J. R.; Luippold, R.; Glodberg, R. J.; Landon, J. and Kalan, K. (May 1994). “The Physician-Delivered Smoking Intervention Project: Can Stort-Term Interventions Produce Long-Term Effects for a General Outpatient Population?” Health Psychology, Vol. 13(3): 278-281. Stead, L. F.; Perera, R.; Bullen, C.; Mant, D. and Lancaster, T. (July 2008). “Nicotine Replacement Therapy for Smoking Cessation.” The Cochrane Library, Issue 3: 1-125. Wilson, D. H.; Wakefield, M. A.; Steven, I. D.; Rohrsheim, R. A.; Esterman, A. and Graham, J. (1990). “Sick of Smoking: Evaluation of a Targeted Minimal Smoking Cessation Intervention in General Practice.” Medical Journal of Australia, Vol. 152(1): 518-521. Read More