The Role of Supportive Therapy in Smoking Cessation

Why do so many smokers try to quit and repeatedly fail? The answers are complicated, but it is clear that treatment for smoking must do more than replace nicotine.

Cigarette smoking remains the single most preventable cause of death in the United States. Smoking is most prevalent among people between the ages of 20 and 40 and is higher among males than among females. Twenty-four percent of Americans older than the age of 18 smoke. In the 1950s the first reports of the health effects of cigarette smoking appeared, and increases in tobacco consumption decreased due to a number of reports linking smoking to disease. Since then the number of smokers has dropped from 51 percent to 24 percent in 1998.

In spite of this reduction, nicotine remains the most widely used and abused drug in the world. There are approximately 1 billion cigarette smokers in the world today and approximately 3 million people die each year from smoking-related illnesses.

The awful truth about quitting

Most tobacco-dependent persons never achieve lasting abstinence, and half die prematurely of tobacco-related disease. In the United States, less than 10 percent of the nearly 20 million people who quit smoking for a day remain abstinent one year later. With only 2 percent to 3 percent of smokers succeeding in smoking cessation, tobacco is considered among the most addictive drugs with one-third of occasional cigarette smokers graduating to physical dependence.

Supportive therapy

Because smoking is so addictive, abstinent smokers need little reason to relapse. Conversely, they require persistent, compelling reasons to remain abstinent. As a result, motivation to attempt to quit and sustain abstinence is essential to the smoking cessation process.

Understanding why one wants to quit can provide valuable insight into treatment strategies for the process. Those who are most successful in quitting discover that their motivation involves addressing current, measurable conflicts with personal values and issues of daily living and not concern over long-term health status. For example, an increasing number of smokers are seeking help because they now believe that secondhand smoke can, and does, harm the health of their children and other family members. Smokers often rationalize harming themselves, but find it difficult to reconcile harming loved ones.

Motivational enhancement therapy

A relatively new form of supportive therapy is based on the principles of motivational psychology. Motivational enhancement therapy (MET) encourages participants to address their values and conflicts, assess personal resources, set reasonable goals and make lifestyle changes. In general, MET addresses the following issues during smoking cessation:

• specific interest in quitting and current motivation

• level of attachment to smoking

• health problems

• effects of smoking on family

• perceived benefits of quitting

• cessation process

• cigarette craving

• withdrawal symptoms

• social/family support

• depression or anxiety

• smoking patterns and rituals

• previous quitting experience

• obstacles to quitting

Many professionals address these issues in the form of a tailored questionnaire or brief interview during the initial phase of treatment. Also, because depression is more common among smokers and can negatively effect motivation, experts may use a quick, self-scored depression questionnaire at the beginning of smoking cessation treatment.

MET, like most supportive therapy, focuses on providing practical strategies for confronting daily routines and stubborn smoking rituals. Family members and friends are encouraged to participate in treatment by offering emotional and practical alternatives to highly habituated smoking routines and behaviors. For example, offering to take a walk after dinner instead of having the usual cup of coffee and a cigarette may be helpful.

Remember, quitting takes hard work and a lot of effort. But with proper motivation and professional help you can quit smoking. If you are interested in learning more about smoking cessation, talk with your health-care provider or call the toll-free phone number shown on this site.

Sources:
Brown RA, Evans DM, Miller IW, et al. (1997) Cognitive-behavioral treatment for depression in alcoholism. Consult Clin Psychol; 65:715-726.

Carmody,T.P. (1992) Preventing relapse in the treatment of nicotine addiction: current issues and future directions. J Psychoactive Drugs; 24:131-158.

Gold, MS, Edwards, DW. (2000) Treating cigarette smokers in 2000. Your Patient & Fitness, 14(4): 6-11.

Law, M,Tang, JL. (1995) An analysis of the effectiveness of interventions intended to help people stop smoking. Arch Intern Med;155:1933-1941.

By Drew Edwards
© 2003 Achieve Solutions