Proactive Approach by Doctors Helps Smokers Quit

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Nicotine addiction is a common condition in people who regularly smoke cigarettes. Unfortunately, most of the smokers who try to break their nicotine addictions do not use methods with proven scientific effectiveness or seek the help of trained specialists. In a study published in March 2014 in the American Medical Association journal JAMA Internal Medicine, researchers from eight U.S. institutions sought to determine if doctors and public health officials can successfully go beyond traditional approaches by reaching out to cigarette smokers and proactively addressing the impact of nicotine addiction.

The Basics

Figures compiled by the federal Substance Abuse and Mental Health Services Administration indicate that roughly 57.5 million American adults and teenagers smoke cigarettes at least once a month. Roughly 61 percent of these individuals smoke every day; this is a critical statistic, since most of the people who use cigarettes on a daily basis have a physical dependence on the brain effects of nicotine. As a rule, any given person’s chances of becoming a daily smoker increase as he or she grows older. While only about 22 percent of smokers between the ages of 12 and 17 use cigarettes every day, fully 66 percent of all users over the age of 25 smoke cigarettes on a daily basis. In addition, while only approximately 11 percent of daily smokers between the ages of 12 and 17 consume at least a pack of cigarettes per day, approximately 45 percent of daily smokers over the age of 25 consume at least a pack a day.

Nicotine Addiction Treatment

Smokers addicted to nicotine can rely on a number of scientifically verified methods to gradually reduce their cigarette intake and break their reliance on the drug. The most widely available option is probably nicotine replacement therapy, which uses regular, controlled doses of nicotine to ease smokers out of cigarette consumption without exposing them to the full force of potentially highly disruptive nicotine withdrawal. Some forms of nicotine replacement (specifically, nicotine-containing lozenges, gum and certain types of patches) are available without the need for a doctor’s prescription. However, others (including nasally or orally inhaled products and certain types of patches) require a doctor’s approval. Two medications that don’t contain any nicotine, buproprion and varenicline, can also help ease a person out of cigarette use. Non-medication-based therapies used to help nicotine addicts stop smoking include in-person group or individualized counseling, remote counseling through phone interactions or the Internet, behavior retraining and informative sessions called brief interventions.

Proactive Encouragement

In the study published in JAMA Internal Medicine, researchers from the Veterans Administration, the Mayo Clinic, the University of Minnesota and several other institutions used data from a large-scale project called the Veterans Victory Over Tobacco Study to assess the potential for doctors to proactively reach out to smokers and encourage involvement in smoking cessation treatment. They chose to undertake their work, in part, because current approaches typically require smokers to initiate treatment on their own or wait for doctors to express concern, and therefore likely miss large segments of the cigarette-smoking population.

All told, 5,123 current cigarette users between the ages of 18 and 80 participated in the study. Half of these individuals were exposed to proactive efforts in the form of an outreach campaign conducted through the mail and offers for smoking cessation treatment delivered either face-to-face or over the phone. The remaining 50 percent of the participants were not exposed to this proactive approach. One year after the study began, the researchers compared the smoking cessation outcomes for the two groups and looked at how many individuals from each group successfully avoided cigarette use for at least six months.

The researchers were able to gather information from two-thirds of the study participants at the one-year follow-up. After analyzing the results for these individuals, they concluded that 13.5 percent of the participants who received proactive treatment offers had successfully abstained from cigarette use for the minimal six months. The successful abstention rate among those participants who did not receive proactive offers was 10.9 percent.

Significance and Considerations

It might not seem like the relatively small difference in outcomes produced by proactive treatment offers would be statistically significant. However, after reviewing all of the factors involved, the authors of the study published in JAMA Psychiatry concluded that proactive efforts do significantly improve the odds that any given smoker will successfully halt his or her cigarette intake for an extended period of time. This is an important finding, since only about 6 percent of all smokers quit using cigarettes for more than a few days, weeks or months.