Smoking Cessation Interventions

Smoking Cessation Interventions; Behavioural interventions

Smoking rates and trends in smoking in Saudi Arabia Tobacco use is surprisingly prevalent, given the public's awareness of those dangers. Smokers represent 21 per cent of the male population over 15 years of age. The highest rate of smoking is amongst 21 to 40 year olds (67%). The majority of smokers (59 per cent) smoke more than 20 cigarettes per day, and 25 per cent smoke 10 to 19 cigarettes per day. Twenty one per cent of smokers had smoked for 20 years or more ⁽⁶⁾. The proportion of regular smokers declined in most western countries with the introduction of guidelines for health clinicians and patient-centered activities ⁽⁷⁾. Nicotine dependence Nicotine is the primary substance found in tobacco that causes dependence on cigarette smoking ⁽⁸⁾. Nicotine reaches the brain very quickly and rapidly accumulates there once absorbed. It works by stimulating release of dopamine, the chemical responsible for positive mood. The acute effects of nicotine dissipate quickly, causing decreased positive mood. As nicotine deprivation occurs, cravings occur causing the smoker to want another cigarette to maintain the pleasurable effects and to prevent withdrawal symptoms such as insomnia, anxiety, anger, restlessness and increased appetite. Withdrawal symptoms commonly occur within 12 hours of cessation, peak at three to four days, but may persist for several weeks ⁽⁹⁾. The process of smoking cessation Tobacco dependence is a chronic condition that for the majority of smokers requires repeated and persistent effort to overcome. Theoretical analysis of smoking cessation suggests that it is a process, not a single event ⁽¹⁰⁾.		Stage of change theory (Figure 1) suggests that smokers move from being content to smoke, thinking about quitting, planning to quit, attempting to quit, maintaining cessation or relapsing to smoking. Smokers may cycle through some or all of the stages many times before they achieve long-term cessation. North American surveys suggest that two thirds of smokers are interested in quitting but only 20 per cent are planning to quit in the next month⁽¹¹⁾ . Overall, almost 50 per cent of smokers try to quit each year ⁽¹²⁾ but 75 to 80 per cent of smokers that try to quit relapse within six months and 90 per cent within 12 months ⁽¹³⁾. Those who quit for longer may relapse at any time, even after years ⁽¹⁴⁾ . Despite the difficulty of quitting, three to five per cent of smokers quit each year for a year or longer. Self-reported data from the US in 1997 suggest that 50 per cent of people who ever smoked successfully quit smoking ⁽⁹⁾. In the past, up to 90 per cent of smokers who successfully quit smoking did so 'on their own'. Current estimates are that 20 to 35 per cent of quit attempts in the United States are associated with medication use or other forms of assistance ^(15,16). The success rate of those who use some form of assistance is double (20% vs. 8%) that of those who try to quit 'on their own' ⁽¹⁶⁾. these forms of assistance are Behavioural interventions, Pharmacological aids or some other forms of interventions. We will discuss each of these interventions separately. In this review we will concentrate on the behavioural interventions. Behavioural interventions They consist of: self-help intervention, minimal clinical intervention and intensive clinical intervention..