Nicotine and related disorders Health Article

Behavioral treatments

Behavioral treatments are used to help smokers learn to recognize and avoid specific situations that trigger desire for a cigarette. They also help the smoker learn to substitute other activities for smoking. Behavioral treatments are almost always combined with smoker education, and usually involve forming a support network of other smokers who are trying to quit.

Behavioral treatments often take place in support groupseither in person or online. They are most effective when combined with nicotine reduction therapy. Other supportive techniques include the use of rewards for achieving certain goals and contracts to clarify and reinforce the goals. Aversive techniques include asking the smoker to inhale the tobacco smoke deeply and repeatedly to the point of nausea, so that smoking is no longer associated with pleasurable sensations. Overall, quit rates are highest (about 30%) when behavior modificationis combined with nicotine replacement therapy and tapering.

Alternative treatments

Many alternative therapies have been tried to help smokers withdraw from nicotine. Hypnosis has proved helpful in some cases, but has not been tested in controlled clinical trials. Acupuncture, relaxation techniques, restricted environmental stimulation therapy (REST, a combination of relaxation and hypnosis techniques), special diets, and herbal supplements have all been used to help people stop smoking. Of these alternative techniques, clinical studies of REST showed substantial promise in helping people stop smoking permanently.

Prognosis

Smoking is a major health risk associated with nicotine dependence. About half of all smokers die of a smoking-related illness, often cancer. About 90% of lung cancers are linked to smoking. Smoking also causes such other lung problems as chronic bronchitis and emphysema, as well as worsening the symptoms of asthma. Other cancers associated with smoking include cancers of the mouth, esophagus, stomach, kidney, and bladder. Smoking accounts for 20% of cardiovascular deaths. It significantly increases the risk of heart disease, heart attack, stroke, and aneurysm. Women who smoke during pregnancy have more miscarriages, premature babies, and low-birth-weight babies. In addition, secondhand smoke endangers the health of nonsmokers in the smoker's family or workplace. Although most of these effects are not caused directly by nicotine, it is dependence on nicotine that keeps people smoking.

Even though it is difficult for smokers to break their chemical and psychological dependence on nicotine, they should remember that most of the negative health effects of smoking are reduced or reversed after quitting. Therefore, it is worth trying to quit smoking at any age, regardless of the length of time a person has had the habit.

Prevention

The best way to avoid nicotine dependence and withdrawal is to avoid the use of tobacco products.

See also Stress; Substance abuse and related disorders

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders.4th edition, text revised. Washington DC: American Psychiatric Association, 2000.

Brigham, Janet. Dying to Quit: Why we Smoke and How we Stop.Washington DC: John Henry Press, 1998.

Galanter, Marc and Herbert D. Kleber, eds. Textbook of Substance Abuse Treatment.2nd ed. Washington DC: American Psychiatric Press, Inc., 1999.

O'Brien, Charles P. "Drug Addiction and Drug Abuse." Chapter 24. In Goodman & Gilman's The Pharmacological Basis of Therapeutics,edited by J. G. Hardman and L. E. Limbird. 9th edition. New York and St. Louis, MO: McGraw-Hill, 1996.

Sadock, Benjamin J. and Virginia A. Sadock, eds. Comprehensive Textbook of Psychiatry.7th ed. Vol. 1. Philadelphia: Lippincott Williams & Wilkins, 2000.

PERIODICALS

Mathias, Robert. "Daughters of Mothers Who Smoked During Pregnancy Are More Likely to Smoke, Study Says." NIDA Notes10, no. 5 (September/October 1995).

National Institute on Drug Abuse. "Nicotine Addiction." National Institute on drug Abuse Research Report Series 21 (February 2001).

United States Department of Health and Human Services. "2001 Monitoring the Future Survey Released" HHS News10 December 2001.

ORGANIZATIONS

American Cancer Society. National Headquarters, 1599 Clifton Road NE, Atlanta, GA 30329. (800) (ACS)-2345. <http://www.cancer.org>.

American Lung Association. 1740 Broadway, New York, NY 10019. (212) 315-8700. <http://www.lungusa.org>.

Cancer Information Service.National Cancer Institute, Building 31, Room 10A19, 9000 Rockville Pike, Bethesda, MD 20892. (800) 4-CANCER. <http://www.nci.nih.gov/cancerinfo/index.html>.

OTHER

Campaign for Tobacco-Free Kids. "Public Health Groups File Petition Urging FDA to Regulate New 'Reduced Risk' Products Being Marketed to Smokers as Healthier Alternatives." <http://tobaccofreekids.org/Script/DisplayPressRelease.php3?Display=429>.

Tish Davidson, A.M.