WebMD Medical News
Louise Chang, MD
Nov. 28, 2011 -- If you had high blood pressure, you wouldn't expect your doctor to give you some pills, pat you on the back, and say good luck, would you?
Of course not, you would expect long-term treatment. What if the same principle was applied to smoking?
Well, treating smoking like a chronic disease could help people who want to give up cigarettes be more successful, results from a new study show.
Researchers enrolled smokers who wanted to quit and then randomly put them into two groups. The first had eight weeks of counseling and nicotine replacement, and the second had the same followed by 48 more weeks of counseling and treatment when needed.
Quitting was the long-term goal for both groups. But setbacks were considered part of the process for the smokers followed for at least a year, and counselors worked with these patients to set short-term goals to help get them back on track.
"Instead of treating a smoking relapse as a failure, it was seen as a step in the process," says study researcher Anne M. Joseph, MD, of the University of Minnesota. "Cutting back to five or ten cigarettes a day might be considered progress toward the goal for someone who was previously a pack-a-day smoker."
The study is published in the Nov. 28 issue of the Archives of Internal Medicine.
Surveys consistently show that more than 3 out of 4 smokers would like to quit. While about a third try to quit each year, only about 10% are successful.
The best smoking-cessation programs combine behavioral counseling with nicotine replacement, but most last only two or three months, Joseph tells WebMD.
Many people who quit smoking during treatment end up relapsing after the programs end.
While U.S. health officials consider tobacco dependence a chronic disease like high blood pressure, high cholesterol, and diabetes, the current strategies for promoting smoking cessation do not reflect this, Joseph says.
In an effort to assess the impact of a treatment strategy that looks at smoking as a chronic disease, Joseph and colleagues recruited 443 smokers for their study.
Half of the participants received free nicotine-replacement therapy along with behavioral therapy that consisted of at least five telephone counseling calls, including an initial call to choose a quit date and a nicotine-replacement therapy (gum, patch, or lozenge).
The other half received the same treatment along with additional telephone counseling and nicotine replacement treatments, if needed, for an additional 48 weeks.
At 18 months, 30% of the participants in the long-term group reported at least six months prolonged abstinence from cigarettes compared to 23% of those in the short-term group.
People in the long-term group also tried to quit more often over the course of the year and even among those who didn't successfully quit, they did smoke less.
The researchers concluded that incorporating failures, setting short-term goals, and continuing care was roughly 75% more effective than less intensive treatment for helping smokers become nonsmokers.
Smoking-cessation specialist Patricia Folan, RN, says treating tobacco addiction like a chronic disease makes sense.
Folan directs the Center for Tobacco Control for the North Shore LIJ Health System in Great Neck, N.Y.
"We would never think of stopping treatment in a patient with high blood pressure or diabetes when they don't reach treatment goals right away," she tells WebMD. "Medical management of these chronic conditions is an ongoing process."
Even among smokers who don't want to quit, a similar, although shorter plan like the one above may at least help get smokers headed in the right direction.
A separate study published in the same issue of the journal found that smokers who aren't particularly motivated to quit may find the motivation they need when offered nicotine-replacement therapy along with counseling about how to stop smoking.
Nicotine-replacement gums, lozenges, and patches along with counseling are effective for helping smokers who want to quit kick the habit. But their usefulness for helping smokers who report little desire to quit is not well known.
For the study researchers from the Medical University of South Carolina at Charleston recruited close to 850 smokers who expressed no motivation to quit. They were asked to try to quit, but without the pressure of committing to quit.
Over six weeks, half the participants were given free samples of nicotine lozenges, while half were not. Both groups received counseling designed to increase their motivation and confidence in quitting.
Up to six months later, 49% of the participants who used the nicotine-replacement lozenges made at least one attempt to quit smoking compared to 40% of those who didn't receive the nicotine-therapy samples.
"We wanted to see what would happen if we gave a small supply of medication to smokers who expressed no desire to quit, and the outcome suggests that this intervention may have motivated the unmotivated to at least think about quitting," study researcher Matthew J. Carpenter, PhD, tells WebMD.
SOURCES:Joseph, A.M. Archives of Internal Medicine, Nov. 28, 2011.Anne M. Joseph, MD, MPH, department of medicine, University of Minnesota, Minneapolis.Matthew J. Carpenter, PhD, Medical University of South Carolina, Charleston.Patricia Folan, RN, director, Center for Tobacco Control, North Shore-LIJ Health System, Great Neck.News release, JAMA Media.
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