Nov. 26, 2007 Scientists at the Centre for Addiction and Mental Health (CAMH) are defining the most effective ways to treat tobacco dependence. They highlight the surprisingly significant role that the health practitioner can play in helping people quit smoking. Many people's attempts to quit are unsuccessful, so effective interventions are critical for the 4.5 million smokers in Canada alone.
"Advising patients to quit, even just once, helps to double quit rates," write CAMH researchers Dr. Bernard Le Foll and Dr. Tony George. Their article Treatment of tobacco dependence: integrating recent progress into practice is a comprehensive summary of tobacco use, causes of nicotine dependence, and advances in treatment and intervention."To initiate as many cessation attempts as possible, practitioners should advise all of their patients who smoke to quit."
Research shows that since an estimated 70% of smokers visit a physician each year, family doctors have a substantial opportunity to influence smoking behaviour. "Even a short intervention (three minutes or less) can increase a person's motivation to quit and can significantly increase abstinence rates," the authors write. They provide an algorithm topped by the simple question "Are you smoking?" to help physicians integrate a patient's smoking status and his or her readiness to quit, taking a comprehensive approach that combines assessment, behavioural interventions and pharmacologic treatment of tobacco dependence.
The article also showed that smokers with moderate to severe tobacco dependence have been found to respond best to three types of pharmacotherapy -- nicotine replacement therapy, bupropion and varenicline -- but there is no clear threshold that can help clinicians decide whether a particular patient will benefit from a particular pharmacotherapy, and there is no consensus on which one should be used first. The authors' provide physicians with a clear comparative table of these three first-line pharmacologic treatments, as well as advice on whether to combine these pharmotherapies, or to consider nortriptyline and clonidine as second-line medications.
Epidemiologic studies have indicated that the majority of successful attempts to quit smoking occur without direct medical assistance or without pharmacotherapy. "The use of nonpharmacologic methods (such as counseling) should be encouraged, especially for people for whom medication use is problematic," say the authors. "The goal is to motivate the patient to try to quit smoking." Moreover, pharmacological interventions are clearly effective and allow doctors to double or triple the odds of success.
This research article is published in the November issue of the Canadian Medical Association Journal.
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