Nicotine Dependence

Treatment


Phillip W. Long, M.D.
1990

Contents


Medical Treatment

Basic Principles

Various treatment approaches have been applied to tobacco addiction. Yet, the vast majority (95%) of abstainers receive no formal intervention.

Other Drugs

Nicotine gum chewing is a pharmacological substitution approach in which smoking behavior is interrupted while maintaining blood levels of nicotine to minimize withdrawal. Three-month success rates of 76% and one-year success rates of 50% have been reported.

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Psychosocial Treatment

Basic Principles

The one-year post intervention effectiveness is between 25% to 40% in most intensive smoking cessation programs, which roughly parallels other substance abuse. Thus the majority of smokers revert to the original habit.

Poor treatment outcome is associated with: environmental stress; poor social support, including having family members who continue to smoke; lack of exposure to educational information; being female; poor overall adjustment; low self-confidence; poor motivation; and high pretreatment cotinine levels (a metabolite of nicotine) (Tunstall et al. 1985).

The best method is abrupt abstinence (going "cold turkey") when motivation is high.

Psychotherapy

The effective treatment of patients who attempt to stop using tobacco depends on accurate information, the avoidance of moralizing and judgmental stances, and the use of an understanding, supportive approach. Written contracts for the discontinuation of tobacco use may be helpful. The substitution of other activities during times when cigarettes are traditionally smoked may provide diversions. Some clinicians have suggested that persons who are trying to stop smoking should learn relaxation techniques and practice them daily. Smoking paraphernalia and all available sources of tobacco should be eliminated. Support from friends who have succeeded in quitting the habit should also be generated. Smokers attempting to quit have reported that positive reinforcement from treating clinicians is very influential. The doctor might also suggest that money previously used for tobacco be allocated for some narcissistic reinforcement, such as a desired vacation or the purchase of a luxury item.

Group Therapy

The best results are seen in programs that combine education with group therapy and support.

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