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Smoking Cessation Interventions; Pharmacological Aids |
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| Author Dr. Mohammed H. AL-Doghether ABFM, SBFM. Consultant family medicine Director of Center of Postgraduate studies in Family Medicine Ministry of Health P.O.Box 90945 Riyadh 11623 Saudi Arabia Tel number: 4961860 Fax number: 4970847 E-mail: doghether@hotmail.com Summary Tobacco dependence is a chronic condition that usually requires repeated intervention. Effective interventions exist that can produce long-term cessation at up to double the rate achieved by smokers without treatment. Because of the potential health benefits and availability of effective interventions every smoker should be offered intervention that at a stage involve pharmacotherapy. Because pharmacotherapies enhance the quit rates of most other cessation methods every smoker should be offered appropriate pharmacotherapy to support cessation attempts, unless contra-indicated. . A number of pharmacotherapies are effective and safe. Nicotine replacement therapy , Anti-depressants and other drugs are effective cessation aids. More intervention research is needed to evaluate the effectiveness of other cessation methods such as acupuncture and hypnotherapy. |
Tobacco dependence meets accepted criteria for a drug dependence disorder. In most users, tobacco produces tolerance, a well-characterised withdrawal syndrome, and an inability to control future use
(1).Thus tobacco dependence warrants medical treatment just as do other dependence disorders and other chronic diseases. Although many smokers succeed in quitting on their own, this is usually after several attempts. Over 90 per cent of unaided quit attempts are not successful(1,2). Use of appropriate pharmacotherapies could double or triple cessation rates. Types of pharmacotherapy A variety of pharmacological interventions for treating tobacco product dependence have been evaluated in recent years. These include: • Nicotine replacement therapies such as widely used gum and patches and less common aerosol inhalers, nasal sprays and lozenges (not all available in Saudi Arabia); • Anxiolytic medications which might reduce the anxiety symptoms associated with withdrawal; • Some classes of anti-depressants, including bupropion (Zyban), now available for use in Australia as well as the US and UK; and • A variety of other pharmaceutical therapies such as clonidine, nortriptyline, mecamylamine, naltrexone and silver acetate. Nicotine replacement therapy The aim of nicotine replacement therapy (NRT) is to replace some of the nicotine from cigarettes without the harmful constituents contained in tobacco smoke. NRT reduces withdrawal symptoms associated with smoking cessation and makes it easier to avoid smoking by replacing some, but not all, of the nicotine obtained from smoking (3). Nicotine replacement therapy (NRT) is considered a cornerstone of smoking cessation in the US,(4) and the UK (5). |
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