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Smoking Cessation: the pharmacotherapeutic and non-pharmacotherapeutic approaches to addictive behavior

Andrea C. McKean

February 22, 2007

smoking facts
Smoking Facts
  • Cigarette smoking is the #1 cause of preventable disease and death in the United States
  • Smoking causes an estimated 440,000 premature deaths annually in the United States (1 in every 5 deaths)
  • The highest state estimates for cigarette smoking include:

Men Women

Kentucky (30.6%)Kentucky (26.9%)

Indiana (29.7%) West Virginia (26%)

Alabama (29.5%) Indiana (25.1%)

  • The lowest state estimates include: California (11.3%), Utah (13.7%), and Massachusetts (18.1%)
  • One half of all lifetime smokers will die early because of their decisions to smoke , shortening their own life span by an average of 13.2 years in men and 14.5 years in women
the health consequences of smoking
Diseases/Conditions caused by Smoking 

Cardiovascular Dz: stroke, HTN, CAD, Aortic aneurysms, and peripheral vascular disease

Cancer: larynx, oral cavity, esophagus, lung, stomach, cervix, pancreas, kidneys, and bladder

Respiratory Dz: chronic bronchitis, COPD, Emphysema, Pneumonia

Other: osteoporosis, cataracts, gum disease, gastric and duodenal ulcers

The Health Consequences of Smoking
the benefits of quitting
The Benefits of Quitting

Compared to smokers …

Stroke risk is reduced to that of a person who never smoked after 5 to 15 years of not smoking.

Cancers of the mouth, throat, and esophagus risks are halved 5 years after quitting.

Cancer of the larynx risk is reduced after quitting.

Coronary heart disease risk is cut by half 1 year after quitting and is nearly the same as someone who never smoked 15 years after quitting.

Chronic obstructive pulmonary disease risk of death is reduced after you quit.

Lung cancer risk drops by as much as half 10 years after quitting.

Ulcer risk drops after quitting.

Bladder cancer risk is halved a few years after quitting.

Peripheral artery disease goes down after quitting.

Cervical cancer risk is reduced a few years after quitting.

Low birthweight baby risk drops to normal if you quit before pregnancy or during your first trimester

  • The U.S. Public Health Service has set goals to reduce smoking in our country by the year 2010.
  • First goal:
    • cut smoking rates among high school aged youth from 22% to 16%.
    • cut smoking rates among all adults from 23% to 12%.
  • Another goal:
    • increase the number of 1° care providers who routinely provide smoking cessation counseling for their patients who smoke by 75%
  • If these goals are met ~ 7.1 million early deaths will be prevented after 2010 !!!
addictive nature of nicotine
Addictive Nature of Nicotine
  • Addictive characteristics of nicotine are a result of its action on the nicotinic acetylcholine receptors
    • nicotine reaches the brain within 10 seconds upon inhalation
  • Nicotine is known for its ability to both stimulate and depress the CNS
    • small rapid doses produce alertness and arousal
    • long drawn out doses induce relaxation and sedation
  • Tobacco use is more likely to lead to dependence than any other drug
    • Among those who ever tried one cigarette, approximately 1/3rd develop nicotine dependence
  • Similar to addiction associated with cocaine, amphetamines and opiates, nicotine addiction is a “chronic relapsing medical condition” that warrants clinical intervention.
clinical intervention for smoking cessation
Clinical Intervention for Smoking Cessation
  • Smoking cessation is the most important, cost effective preventive clinical intervention that healthcare providers can offer to their patients that smoke.
  • At least 70% of smokers see their primary care clinician annually  which means that many practitioners are missing a prime opportunity to improve the health of their smoking patients
  • Primary care providers play a KEY role in the identification, assessment and treatment of smokers.
  • It is essential for smoking cessation to be implemented into the clinical setting during each patient visit!
treatment options
Non-Pharmacotherapies (Behavioral Therapies)

Brief counseling (< 3 min)

5 A’s

5 R’s


Support groups Web Sites Quit-lines



polacrilex gum

polacrilex lozenge

transdermal patch

nasal spray



Bupropion Hydrochloride

Varenicline Tartrate

Treatment Options
types of behavioral therapy
“5A” Model

Ask (about smoking)

Advise (to stop)

Assess (will to stop)

Assist (will to stop)

Arrange (f/u visits)

“5R” Model

Relevance (personally)

Risks (of tobacco use)

Rewards (of quitting)

Roadblocks (to cessation)

Repetition (every visit)

Types of Behavioral Therapy
  • Other – social support groups, group/individual counseling, pamphlets, books, U.S Dept Health and Human Services telephone quit line 1-800-QUIT NOW, websites:,, also many pharmacotherapies now offer support plans with purchase of their product.