How to tell if a smoking cessation aid works.

In previous posts I’ve discussed some of the behavioral steps you can take to increase your chances of successfully quitting. It is sensible to also consider using a product designed to help people quit smoking. But there are hundreds on the market, so how do you tell which ones are likely to be helpful?

It can certainly be confusing, particularly because many products have similar sounding names (e.g. there are over 20 beginning with the letters, “nic….”). I can’t pretend to have looked at all the available products. That would be a full-time job in itself, but there are some fairly simple guidelines to help you avoid wasting money on a product that’s at best useless and at worst, dangerous.

The most basic piece of advice for a drug or medicines is to only use a smoking cessation medicine that has been approved by the US Food and Drug Administration (FDA) as an aid to smoking cessation. Currently, only a relatively small number of medicines fall into this category. These are:

• Nicotine replacement products available over-the-counter (without a prescription):
• Nicotine gum (brand name: Nicorette, plus generic versions)
• Nicotine patch (brand names: Nicoderm and Nicotrol, plus generics)
• Nicotine lozenge (brand name: Commit)
• Prescription-only nicotine replacement products:
• Nicotine inhaler (brand name Nicotrol)
• Nicotine nasal spray (brand name Nicotrol)
• Prescription-only, non-nicotine pills:
• Bupropion (brand names Zyban or Welbutrin)
• Varenicline (brand name Chantix)

The FDA has approved all of the medicines mentioned above, and their product labeling, as safe and effective for smoking cessation.

Two medicines not approved by the FDA for smoking cessation have good evidence that they help smokers quit (nortriptyline and clonidine). These prescription-only medicines typically have more serious side effects than the medicines mentioned above, and so should only be used on the advice of a medical doctor with appropriate experience in tobacco treatment.

Currently the medicines mentioned above are the only ones that are likely to help you to quit smoking. They each have very solid evidence showing that they work. This means that your chances of successfully quitting are roughly doubled if you use one of these medicines, as compared with not using one. There is enough choice from these 7 medicines such that most smokers should be able to find one that suits them, without needing to resort to using a product without solid evidence on its safety and efficacy. Many others are currently being studied in clinical trials but are not yet approved. Similarly, there are numerous herbal products, fake cigarettes, and other gadgets that are being offered to desperate smokers. Smokers should generally save their money for something more likely to be helpful.

There is an excellent website that describes most of the available smoking cessation aids, shows photographs of them, and lists the specific claims made on the labeling or advertising. The address is: https://secure.tobaccofreekids.org/cessation/ . When you visit this site, clicking on “FDA Approved Product List” will provide a description of each medicines approved by the FDA for smoking cessation. Each of these medicines has been shown to be safe and effective for smoking cessation.

Clicking on “Other Cessation Product List” will provide access to descriptions of a long list of unapproved products. I don’t recommend the use of any of these products. None of them have adequate evidence that they help people to stop smoking.

Labels: quit smoking aids

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Can Smoking Cessation Internet Sites Help You Quit?

Many smokers use the internet to seek help in stopping smoking. Thousands of websites (including this one) provide basic information and advice on stopping smoking, and over 30 focus on providing direct smoking cessation assistance (e.g. a tailored quit plan) rather than just information and advice. So do these smoking cessation websites actually help smokers to quit?

When one considers some of the advantages of the internet (easy access, anonymity, lack of face-to-face contact etc), one can immediately also see some of the challenges in evaluating smoking cessation websites. For example, how do you follow-up on people who visited a website anonymously, in order to find out if they quit smoking? Research on this topic has only recently started, but there are already some promising studies suggesting that some smoking cessation websites boost the smokers’ chances of quitting. A recent study by Dr Lynn Swartz at the Oregon Center for Applied Science compared one particular internet site with no intervention. They found that smokers given access to the smoking cessation internet site were roughly twice as likely to have quit smoking three months later. Another recent study by Dr Joanne Pike at University of Texas Health Science Center compared utilization and quit rates at 5 interactive websites and one static website, all of which aimed to help smokers quit. They found that some of the interactive websites had much higher participation rates than others, and that this was associated with the amount of interactivity available on the site. Sites containing a lot of interactive functions also tended to have more participants succeed in quitting smoking.

Many of the websites offer the chance to view some of the basic information pages immediately but require visitors to complete an online registration process (and possibly pay a fee) before being given full access to the more useful interactive features on the site. One of the top smoking cessation websites can be found at: www.quitnet.com . This site offers a range of interactive features including “chat rooms”, and “ask-the-expert” functions, as well as online “wizards” that automatically calculate how much money you have saved since you quit smoking. This site is widely used around the world, so that at any given moment there will be hundreds or thousands of people visiting the site for help to quit.

The advantages of these interactive smoking cessation websites are that they are available 24/7, from the comfort of your own home, are generally free or low cost, and can put you in touch with a whole community of people going through the same process. Website assistance can also be used in addition to other methods (e.g. counseling and/or medication). Generally the more help and support you can get, the more likely you are to succeed in quitting. If you found any websites particularly helpful (or unhelpful), let me know, so I can pass it on to others. Best of luck.

Labels: cessation, online, Smoking, website

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Telephone Quitlines: Do They Help Smokers To Quit?

It may not always be easy to find someone who seriously wants to stop smoking at the same time as you and who is prepared to do it together with you. What other kinds of support are available? Perhaps the most accessible form of support available in the United States is that provided by telephone quitlines. Many states have their own dedicated service but there is also a single national number that will route the call to your local service. The number for the national quitline is: 1-800-QUITNOW (1-800-784-8669). Quitlines often have an initial screening service which identifies whether you just want simple information which can be mailed to you, or whether you would like to speak to a trained person who may be able to provide expert advice and support over the phone. Quitline counselors have been trained in how to help people who want to stop smoking. Many offer a call-back service in which they will call you back to continue counseling and monitor progress at pre-arranged times (at no cost to you). Some also provide free nicotine patches by mail. These pro-active telephone counseling programs have been shown to increase quit rates compared with just a single call and information.

When you call, you may have to select from a range of options, and wait a little while as the options are read to you. In most services you should get through to a live counselor fairly quickly. Once the counselor has established that you are seeking help to quit smoking, they may initiate an assessment in order to help them provide the best advice. This may involve answering some simple questions about how much you smoke, previous quit attempts etc. The counselor may then try to help you select a “quit day” and to start preparing for it. They may arrange to call you back at an agreed time around your quit date, and at other times shortly after you have quit. The counselor will be knowledgeable about quit smoking methods and able to answer any questions you may have. Most smokers find these quitlines to be helpful, and research has demonstrated that they can increase your chances of quitting. As most quitlines are free, there’s nothing to lose by giving them a try. If you do, let me know how you get on and what you thought of the service.
The national number is: 1-800 QUITNOW (1-800-784-8669).
Best of luck.

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What About Quitting Smoking With Someone Else?

Sometimes natural opportunities present themselves to quit with someone else. It could be that your workplace, home or whole state is going smoke-free and this has prompted a number of people to try to quit. Is it a good idea to do it with others?

The evidence is pretty clear that getting social support with your quit attempt will increase your chances of success. There area few things to be wary of. If you and your spouse or close work colleague are thinking of quitting together then just be clear that you will both be under the stress of nicotine withdrawal at the same time. Its worth checking that your “buddy” is as serious about it as you are and is really willing to be supportive. One kind of social support that is often suggested is that of “buddying up” with someone else who is planning to stop smoking at the same time and the two people supporting each other with encouraging phone-calls, plans to spend the money saved on doing fun things together etc. Some studies encouraged people to do this and have found smokers who paired up with a buddy were up to three times more likely to quit. In one study, smokers were encouraged to see the nurse at their family practice for help to stop smoking. Half were seen on their own, and half were paired with another person, and encouraged to swap phone-numbers and support each other in quitting. A month later the people in the “buddy” treatment were more than twice as likely to have succeeded in stopping smoking. The evidence clearly suggests that quitting with someone else, even someone you don’t initially know very well, increases your chances of success.

Here are some tips on quitting with a buddy.
1. Try to find a friend, workmate or family member who will quit with you.
2. Agree on a quit date.
3. Agree together on something you’ll do with the money saved by not smoking.
4. Have a bet with your “buddy”, with the deal being that if either of you smokes in the next week, you both donate the money to some obnoxious cause (e.g. a political party neither of you likes).
5. Make sure you encourage each other every day, even if it is just on the telephone or by e-mail.

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Chantix: How Does This New Quit Smoking Medicine Work?

Chantix is the brand name of the latest quit smoking drug, varenicline. Chantix is a new type of prescription-only medicine that is typically taken as a pill, twice a day. Chantix appears to target the nicotine receptors in the brain that are involved in producing the rewarding effects from smoking. Chantix is believed to work via two mechanisms:

1. Chantix binds to nicotine receptors and blocks them so that nicotine can no longer activate those receptors (an effect that pharmacologists sometimes call an “antagonist” effect). This means that when someone is trying to quit and they lapse and smoke a cigarette, they probably won’t get much satisfaction from smoking it, and will be less likely to smoke another.

2. When Chantix binds to nicotine receptors it also triggers some of the same effects that nicotine has (an effect pharmacologists call an “agonist” effect). This includes a small release of dopamine, the reward neurotransmitter in the brain. In this way Chantix dampens down nicotine withdrawal symptoms and cravings.

The results of clinical trials of Chantix have been very encouraging. In all the trials published to date, smokers treated with Chantix had a significantly higher quit rate than smokers treated with a placebo pill. (Note these were “double blind” trials in which no-one knew who got the real drug and who received the “dummy” pills until the end). In some of the trials Chantix was compared to bupropion (the drug marketed as Zyban for smoking cessation or Welbutrin for depression). In those trials more people quit with bupropion than placebo pills, but Chantix produced higher quit rates than bupropion. The other interesting finding has been that the longer people use Chantix the more likely they are to stay quit. The standard treatment consists of one week before the “Quit Date” (in which the dose is gradually increased while the person gets used to the drug) and then 12 weeks after the quit date at the full dose (two 1mg pills per day, one with breakfast and the other with dinner). But people who took it for an extra 12 weeks were less likely to relapse. Just this week a new trial was published. It reported that among smokers who took Chantix for a year, 37% remained smoke-free, compared with 8% among those receiving placebo pills.

Importantly, Chantix appears to have a good side-effect profile. Mild to moderate nausea is the most frequent symptom but it only infrequently leads to discontinuation. Sleep disturbance and abnormal dreams were the next most common side-effects but again these were typically mild.

Although this medicine appears to be very promising, it is important that people don’t expect a magic bullet that makes it easy to stop smoking. While Chantix appears to reduce cravings and withdrawal symptoms and to triple quit rates, people using it still have to put up with some continued urges to smoke. They should use all the usual helpful strategies (preparation, counseling, online support, get rid of tobacco etc) to quit smoking as well as the medicine.

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Nicotine Addiction: How It Can Trick You Into “Absent-Minded” Smoking.

When we think of the challenges of beating nicotine addiction we usually think of strong cravings and struggling with severe irritability and restlessness. However, sometimes the addiction works in much more subtle ways. Sometimes the addicted mind can play tricks that are (sometimes subconscious) attempts to sabotage the quit attempt. These are thoughts, decisions or actions that at first are not recognized as leading to smoking, but are really attempts to get you closer to having a smoke. Here are ten "apparently irrelevant" things people do when trying to stop smoking, which are really designed to bring them closer to smoking:

Keeping a pack of cigarettes in the house
Buying cheap cigarettes while on vacation
Lighting or holding other people's cigarettes
Drinking so much alcohol you'll forget you are trying to stop smoking
Sitting in the smoking area at work "just to be sociable"
Thinking "it doesn't count if its (a) in a joint (b) an ultra-light cigarette (c) someone else's cigarette (d) on vacation (e) no-one else sees it "
Offering to "look after" someone else's cigarettes
Thinking "there's so much smoke in this bar I might as well smoke myself"
When craving for tobacco, popping round to your nearest smoker friend's house for a chat.
Picking an argument with your smoker friend/partner knowing that in the end they'll tell you to shut up and have a cigarette (and will be in a position to give it)

Many people who are trying to stop smoking describe it as being a bit like living with a little devil sitting on your shoulder who tries to get you to have a smoke. Every now and again he shouts little messages: "A smoke would help calm you down now,... one won't do any harm......go on..etc etc.." However, at other times he is more subtle than this, and actually provides the smoker with disguised misinformation designed to manoeuvre them into a situation where they'll be more susceptible to direct cravings (e.g. "Don't throw away your cigarettes, that will make the craving worse). In reality that little devil is the addiction itself. The thing to keep in mind is that it can be beaten and that the chances are greater if you can recognize the misinformation and not be fooled by it. This means that whenever you find yourself making an apparently irrelevant decision that makes it easier for you to have smoke (by bringing you closer to tobacco in some way) the warning lights should flash and you should challenge that thought (e.g. "Am I buying a bottle of vodka so I'll have an excuse for smoking?...am I lingering in the smoking room in the hope that someone will offer me one? etc. ). If by doing this you are able to avoid one of these "absent-minded" slips than your chances of remaining smoke-free in the long term should be greater.

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