Smoking Cessation Disease
DESCRIPTION
23 % of U.S. adults smoke and 90% of these are nicotine dependent. Strong correlation exists with history of smoking within 5 minutes of awakening and >25 cigarettes/day. Suspected similarities with noncigarette forms of nicotine/tobacco use such as cigar and pipe smoking, chewing tobacco and snuff.
CAUSES
N/A
TREATMENT
Stages
- Precontemplation - does not want to quit - need awareness of smoking/nicotine related diseases. Literature available from Am Lung Association, American Cancer Society, and the National Cancer Institute (1-800-4-CANCER)
- Contemplation - wants to quit, but not within month - review prior attempts and identify barriers. Discuss consequences of continued behavior, more education.
- Action - wants to quit or has just quit within 1 month - plan quitting and strategies for relapse. Consider:
- Nicotine replacement with transdermal patches, gum, nasal spray or lung inhaler available over the counter
- Bupropion (Zyban) 150 mg qd to bid begun 1 week before and continued for 7-12 weeks after smoking cessation. Other antidepressants (eg, nortriptyline) may be effective.
- Both nicotine and bupropion
- Maintenance - has quit for > 1 month - deal with relapses immediately, seek cause, and consider nicotine replacement and slow withdrawal
- Relapses - again smoking daily - identify trigger for relapse, develop strategies to deal with triggers, assess stages above, consider adding behavioral modification techniques (eg, classes, hypnosis, acupuncture) or other drugs (eg, clonidine, anxiolytics, nicotine antagonist)
- Physician counseling is critical to patient quitting smoking, doubles success rate
Clinical Investigations
- Cardiology
- Dermatology
- General Destistry
- Cardiology
- Dermatology
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