How the Successful Smoking Cessation Formula is Applied?

Source: http://www.medinet.hochiminhcity.gov.vn/ttyh/bshkhkt/CTCaiTL.htm (Master.Doctor. Le Khac Bao. HCM University of Medicine and Pharmacy)

Successful smoking cessation Formula was long known:

SUCCESS = KNOWLEDGE + SUPPORT DETERMINE

How the Successful smoking cessation Formula should be understood and applied in supporting smoking cessation?

I. Success:

1. Successful smoking cessation was defined as:

“Quitting smoking completely during at least one year”. Studies on the effectiveness of smoking cessation are based on this definition to determine the effectiveness of a particular method. With this definition, the rate of smoking cessation of support measures disappointed many people. Indeed, the rate of quitting respectively 5-10% for short consultancy [3]; 20-30% for actively consulting with providing solve solution skills [1]; 35% for positive advice combined nicotine replacement [2]; 30% for bupropion alone, 35% for bupropion combined nicotine replacement [4]. All of these ratios are lower than 50% – a figure far lower figure of 90% – 95% of the tested interventions such as antibiotics.

2. However, if you look at successful smoking cessation in a different angle, we – the people involved in the prevention of the harmful effects of tobacco will see much more secure. An intervention support to quit smoking may not help smokers quit in certain interventions but surely smokers have this support will have a shift in perception, attitude, behavior towards smoking. People say that smokers have moved a step during the mature determination in smoking cessation. Compared to smokers that donot receive the intervention, they were really closer to successfully quit smoking. So if conception quit smoking is a process consisting of several stages for a smokers from indifference stage – that is unaware of the harmful effects of tobacco to success – continuously quit over 1 year, then the transition to a higher stage of this process is a “successful” intervention of smoking cessation.

3. The mature stage smoking cessation determination illustrated by the diagram below:

Tips-Quit-Smoking-1

4. However, the above diagram is not a closed circle but a spiral. For example, a smoker can quit smoking – and relapsed several times but everything is different. In later times, people have experienced from the previous time, they know why they relapse, they know when they quit smoking what difficulty they meet, where the “temptation” make them smoke again. Based on that experience, they can have appropriate plan for current smoking cessation to prevent relapse like the last time. Thus, working in smoking cessation is no “failure” but only “not success” and temporary “failure” are necessary steps to obtain “permanent success” later.

II. Knowledge:

1. The harmful effects of tobacco on health are very serious so smokers should quit. This message has been mentioned in many books – newspapers, but many smokers, including medical personnel, though well aware of this message, continue to smoke. Why?

2. Tobacco has potentially strong addiction so you should be more thoroughly prepared in many ways to be successful tobacco cessation. Indeed tobacco capable easy to make smokers become addicted, the time becoming addicted entity is very short, easy to become severe addiction, and when you want to quit, this is hard addiction to quit.

A. Compare the level of the tobacco with other usual addiction:

level of addiction Heroin Cocain Wine marijuana Tobacco
NO 18% 14% 47% 49% 13%
slight 9% 10% 12% 18% 27%
medium 9% 19% 14% 13% 40%
severe 64% 57% 27% 20% 20%

Narcotics can cause severe addiction to about 60% for people exposed with, while potentially serious addiction of tobacco is only 20% of people exposed.

However, if we just review the percentage of people will not become addicted when exposed to Narcotics and cigarettes, we see these two rates are equal approximately 15%. As with Narcotics, very few people contact to tobacco that avoids become addicted.So, the best way to quit Narcotics is not exposing to the Narcotics even once. The best way to quit smoking remains the smokers never smokes a cigarette.

B. Level of heavy or light addiction concerned with smoking duration and intensity:

The following chart shows the changing level of alcohol exposure time:

Tips-Quit-Smoking-2

A new person exposure to alcohol a few times, the ability to become heavy drinkers is very low, over 90% are not addictive. However, if alcohol exposure as long, the number the more likely become more severe addiction, nearly 60% become severely addicted to long-term exposure to alcohol.

The following chart shows the changing level of marijuana over time:

Tips-Quit-Smoking-3

A new exposure to marijuana a few times, the ability to become heavy addiction are very low, similar to the case of wine, over 90% are not addictive. When exposed to marijuana long time, bulk, marijuana have ability heavy addtion but lower than the case of exposure to alcohol, about 40% become severely addicted.

The following chart illustrates the changing level of tobacco dependence over time:

Tips-Quit-Smoking-4

Thus, unlike in the situation that exposed with alcohol and marijuana, even when exposed with tobacco about time as well as quantity, capability serious addiction is also high about 20%, only 13% of non-addicts. Prolonged exposure, increase the amount of tobacco exposure, ability heavier addiction increased but not much, around 20%, however some people after long exposure time was not addicted to tobacco is very low just under 5%.

C. Similarly narcotics addiction – tobacco addiction is difficult to quit:

The diagram below shows a relationship between the proportions of drug addiction, alcohol, tobacco, marijuana succeeds rest over time.

Tips-Quit-Smoking-5

Thus, in four substance heroin, marijuana, alcohol and tobacco, the tobacco is hard to give up ranked in the second only after heroin with successful rate  to quit after 12 months was 25%, compared with heroin is 20%.

3. Cigarette Addiction is not simply an entity addiction to nicotine in cigarettes, but this is a process of coordination between addictions: entity addiction + psychological addiction + behavioral addiction.

A. An Entity addiction is present body of smokers are accustomed to high levels of ncotin in the blood When nicotine in the blood drops that make smokers have cravings intolerance then the symptoms of withdrawal syndrome: anger, irritability, loss of concentration, restlessness, insomnia etc. smokers must smoke back to avoid these unpleasant symptoms. Entity Addiction is the target effects of drug treatments like nicotine replacement, bupropion hydrochloride and vareniciline. These drugs can help to mitigate unpleasant symptoms of withdrawal syndrome.

B. psychological Addiction is a phenomenon smokers appear a point that tobacco will help them deal with the stressful situation. Whenever faced a difficult, anxiety, smokers will smoke to find peace of mind, look for a psychological prop.

C. behavioral Addiction is a phenomenon smokers formed a habit linked smoking events with other events in life as that of a classical conditioning. For example, smokers after drinking coffee, after dinner, when meeting friends etc.

If smoking cessation will affect the physical components, the counseling will impact on the psychological, behavior addiction. Because smokers are always a combination of three components addiction in various levels so the most appropriate measures of smoking cessation is combine between using drug and counseling in a appropriate proportion .

III. Determination:

1. It is the determination of smokers wants to give up this toxic substance. Determined obviously comes from a deep understanding of the harmful effects of tobacco on the health and the community. However a lot of people deeply understand the harmful effects of tobacco but the determination has not really high. Thus understanding the harmful effects of tobacco is only a necessary condition but not a sufficient condition to have a strong determination.

2. That determination was formed during long-term thinking and careful considerations between a “continuing smokers” and the other side is “stop smoking”.

A. “Continue smoking” will certainly be harmful to health but we also have to agree with those who are addicted to tobacco smoke also has some “advantages”. Smokers feel pleasure when smoking a cigarette. He can temporarily forget about the worries of life, he can focus more to solve matters etc. and many many other advantages that smokers can list. Thus, they know that tobacco is harmful to health, but they are not willing to quit them, because they consider the immediate benefits that tobacco brings “more” than the future health damage.

B. “Stop smoking” of course is beneficial to health, but we must agree with the smokers that quitting smoking with them is a loss. May include the loss here is “a partner” to share with them every minute sadness and joy; unhappiness and happiness, loss of “one means” help them more energetically, more excitement, more courageous and etc. That’s not to mention when they quit smoking, they feel uncomfortable like: cravings, feeling nervous etc. Thus, not because smokers do not know that smoking cessation brings them much health so they are not willing to quit smoking but because according to them the loss they would suffer immediate is “bigger” than the future health benefits.

C. Thus, a smoker want to have high determination will have to struggle so much between “the pros and cons”, between the “get and lost” continue smoking as well as stopping smoking. We should not only encourage smokers “determine” but we must help them to think more consideration for that determination.

IV. Support:

1. What is Support for smoking cessation?

A. the moves made to help smokers quit. Of course the higher the level of support, the more professional, the more chance smokers quit smoking successfully.

B. Because of the support, so it can not substitute for smoking cessation determination of smokers. Some smokers believe that there is a drug, a miracle technique that can help them from a man yesterday is a heavy smoker, today become no longer addicted – even never smoke. It’s a completely false belief. And measures to support tobacco cessation whether it’s the best measures would never be a “miracle” at all.

C. However, if the support measures can not substitute for smoking cessation determination, it could make this determination strongger, maintain a high level of determination. But that support measures are no substitute for knowledge but may help understanding increasingly. Thus, the support measures have complementary roles in successful smoking cessation formula.

2. What measures of Support tobacco cessation under World Health organization (WHO)?

Non-drug measures:

Also known as advisory measures help regulate cognitive – behavioral change. This measure is considered as the basic measures in support smoking cessation. This process consists of many different phases depending on the understanding and determination of people quit smoking. The objective of this measure is to promote people quit smoking more mature in adult cycle of smoking cessation determination.

The first step, smokers are equipped with consulting through proper and full understanding of health damage when smoking, the benefits of stopping smoking. This knowledge helps the smokers in the “apathy” phase has the original intent of the need to quit smoking.

The second step, the “intended” person is adviced on drug mechanisms and methods to help them get rid of tobacco addiction, how to consider the benefits and loss when smoking or quitting smoking. On that basis, a smoking cessation determination is strengthened. Smokers in phase “intend” such has entered into the period of “preparation”.

Third, who quit smoking in the stage “preparation” is consulting the knowledge and skills to control addictions, coping cravings, avoid “temptation” relapse. Thus, smokers in “preparation” phase have transitioned to quit smoking.

The fourth step, advice on these situations can lead to relapse will be consulted, how to proceed in each particular situation is given, causes common relapse were also analyzed and planned to solve. The smoking cessation in consolidation phase will be supported as that.

The fifth step, when people quit smoking relapse, they will be consulted and analyzed relapse reason, they are encourage to quit again. And so on. Until a certain time smokers will quit smoking completely or go on successful stage.

That Consultant measures impact in all phases of maturation determination of smoking cessation, enhance understanding and determination is a key element in successful smoking cessation method.

B Use drugs:

Is the measure taking effect in reducing the discomfort eases appear during smoking cessation. And so these measures indicated in collaboration with advisory measures in the case of the smokers in tobacco cessation phase and consolidation phase. Here to emphasize a point that they are only coordinated measures to support and not a substitute for counseling measures.

Drug Measure is recommended by the world health organization include three measures: nicotine replacement (patches, chewable, inhaler); bupropion hydrochloride (pill), varenicilline. Currently in Vietnam has imported and official circulated bupropion hydrochloride drug form – NICOSTOP. Nicotine replacement patches form (NICORETTE), chewable (NICORETTE, NIQUITIN) can be bought on the market but not yet formally entered. Varenicilline is not coming in the Vietnam market.

The scientific basis of these medicines is to help the body reduce the discomfort caused by withdrawal symptoms when patients stop smoking. These measures have been shown to double success rate of quitting in current smokers have determination to quit smoking.

3. How to Use bupropion hydrochoride in supporting smoking cessation?

A. History:

Bupropion hydrochloride (Zyban, NICOSTOP) originally used for the purpose of anti-depressants. However, this is not the antidepressants were preferentially selected because of the low effective antidepressant.
However, they observed a high rate of depression + smokers may quit spontaneously when using bupropion hydrochloride as a treatment for depression for their depression.

It is conducting survey research in the role of bupropion hydrochloride therapy support smoking cessation showed that bupropion hydrochloride is capable of doubling the proportion of successful smoking cessation after 12 months compared with placebo, limited by side effects gain weight when quit smoking.

Along with nicotine replacement, bupropion hydrochloride is World Health Organization acknowledged that medications help support smoking cessation and recommended widely used for this work in the whole world.

Chemical formula:

Tips-Quit-Smoking-6

B Mechanism of effect of drugs:
The mechanism of action of bupropion hydrochloride is not really clear, it is known that bupropion hydrochloride help to quit smoking not due to the effect of antidepressant and only bupropion hydrochloride can support smoking cessation but other antidepressants is not.

The current regime is accepted as the effect of bupropion hydrochloride:

Dopamine receptors:
Inhibition arresting part of dopamin.
Increased concentrations of extracellular dopamine.

Noradrenaline receptors:
Inhibition strongly arrested.
Increase the level of concentration.
Reducing the severity of withdrawal symptoms.
Nicotine receptors: Competitive with nicotine

C. Indications – contraindications:
Indications:
– Smokers, entity smokers – nicotine dependence.
– Having determined the high smoking cessation.

Contraindications:
– Hypersensitivity to any components of the drug.
– Have a history of seizures or epilepsy.
– Brain tumors.
– Being treated alcohol or sleeping pills.
– Psychosis eats more, drink more. Manic mental disorders – depression.
– Is taking psychotropic MAO group.
– Severe hepatic dysfunction.

D. The dosage and duration of treatment:

The total duration of treatment is 7-9 weeks. In the first week, patients taking bupropion hydrochloride content of 1 tablet of 150 mg. In this week if the patient wants to smoke, they can smoke again. From the second week of 2-9, patient use 2 tablet per day separated by 8 hours, and the second was taken before 18 pm.

Do not exceed 300 mg / day, dose reduction to 150 mg / day in the case:
Use enclosed reliever epileptic threshold.
Alcoholism.
A history of head injury.
Showing pill treatment hypoglycemia, insulin.
Taking drugs manic or appetite suppressants.

E. Side effects: dry mouth, insomnia, headache, allergic reactions.

F. The process of treatment:

Patient selection:
Patients are entity addiction and have high determination to quit smoking.
There are no contraindications for the use of bupropion hydrochloride.
Schedule follow-up while taking: 1 week, 3 weeks, 6 weeks, 10 weeks.
Follow after discontinuation:
Patients will be discontinued after 9 weeks.
Subscribe continue every 1-3 months to 1 year.
In this process of treatment cognitive – behavioral change always comes.

How support smoking cessation conducted in Ho Chi Minh City?

A. Many hospitals have counseling organizations to integrate smoking cessation counseling with disease (Cancer Hospital) etc. However, organizing a consultation room are not many establishments.

B. HCM Hospital Medical University City has held intensive counseling rooms from 15.01.2005. In prime time, mainly consult – treating cognitive behavioral change, subsequent treatment with adjunctive bupropion hydrochloride and nicotine replacement. Preliminary result in Medical University informed the rate success lasted more than 12 months was 20% if used purely advisory, 33% if the combination of bupropion hydrochloride, 29% if the combination of nicotine replacement [5].

C. Currently has Bupropion hydrochloride drug also had officially entered into the Vietnam market with the brand name NICOSTOP, perhaps in the near future the support for smoking cessation will be replicated in other locations besides the hospital. HCM University of Medicine and Pharmacy..

References:
1. Anthonisen NR, Skeans MA, Wise RA, MANFREDA J, Kanner RE, Connett JE, et al. The effects of smoking cessation intervention on 14.5 year mortality: a randomized clinical trial. Ann Intern Med 2005; 142 (4): 233-9.
2. Parrott S, Godfrey C, Raw M, West R, McNeil A. Guidance for commissioners on the cost effectiveness of smoking cessation Interventions. Educational Health Authority. Thorax 1998; 53 Suppl 5 Pt 2: S1-38.
3. Wilson DH, Wakefield MA, Steven ID, Rohrsheim RA, Esterman AJ Graham NM. “Sick of Smoking”: evaluation of a smoking cessation intervention minimal print tagerted general practice. Med J Aust 1990; 152 (10): 518-21.
4. Jorenby DE, Leischow SJ, Nides MA, Rennard SI, Johnston JA, Hughes AR, et al. A controlled trial of sustained-release bupropion, a nicotine patch, or smoking cessation cả for. N Engl J Med 1999; 340 (9): 685-91.
5. Le Khac Bao. Effective tobacco cessation counseling in hospital HCMC Medical University.