Technical Paper 2:
Tobacco Control in Australia: making smoking history
3.3.1 Therapies that increase success rates
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Medicines and supportive counselling
A very large body of research now confirms that an individual’s chances of quitting can be increased by taking medications that lessen withdrawal symptoms[324, 325] or reduce the reinforcing effects of tobacco-delivered nicotine.[326-330] While success rates outside clinical trials may be a little lower, there is ample evidence that such medications are still effective with more limited or even without any professional supervision.[332, 333]
There is also overwhelming evidence that a structured program of cognitive behavioural advice and coaching can also be helpful, regardless of whether the assistance is provided one to one, over the phone or in a group (in the community or through work). Well-designed brochures help some people, but this is not enough for most. Success rates are better where advice can be personalised. This can be achieved through computer technologies (such as the QuitCoach available through the government’s website), which can be delivered at a much lower cost than printed materials. Programs using text messaging, especially when combined with internet resources, can also be effective. Structured programs generally achieve greater success with increasing contact: four to eight sessions optimises chances at reasonable cost.37
People are also more likely to quit successfully if they use a combination of approaches. Adding medication to counselling (or vice versa) increases success rates – for further detail see the US Department of Health’s clinical guidelines: www.surgeongeneral.gov/tobacco/treating_tobacco_use08.pdf.
Interaction with the healthcare system provides the opportunity for health professionals to personalise the health risks of smoking to each individual, often at highly ‘teachable moments’ when they are suffering a serious illness or health incident. Whether carried out by a doctor, dentist, nurse or other health professional, this interaction can motivate quit attempts.
Doctors and other health professionals sometimes feel disquiet about the high number of smokers who relapse, despite their best efforts to provide firm, motivating advice and medications. But as Russell noted back in 1979, because as a workforce general practitioners see a large proportion of smokers each year, even small effects can contribute significantly to reducing population prevalence. Small effects of treatments are clinically significant because of the very large health gains that accrue from stopping smoking. An effect of as little as 1% on six-month continuous abstinence rates would result in at least three additional years of life for every 100 40-year-old smokers treated. This compares extremely favourably with other clinical interventions.
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