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Stopping smoking

MagazineApril 2009 (Vol. 20 Issue 1)Stopping smoking

There are drugs available on prescription to help you give up smoking, but many come with side-effects

There are drugs available on prescription to help you give up smoking, but many come with side-effects.

Bupropion (Zyban), for instance, is an antidepressant that works for some 20 per cent of smokers. But the risks include insomnia, dry mouth and seizures. If overdosed, it can cause heart problems (Expert Opin Drug Saf, 2002; 1: 303-5).

The new drug varenicline (Champix) reportedly has fewer side-effects than bupropion, but patients may still experience nausea, headache, abnormal dreams, insomnia, constipation and abdominal pain (CNS Drugs, 2006; 20: 945-60).

Nicotine replacement therapy (NRT) is also available on prescription as a skin patch, nasal spray, inhaler, tablet or chewing gum. NRT counteracts nicotine withdrawal by supplying nicotine in a less harmful way than smoking. The long-term success rate is about 20 per cent, compared with 10 per cent among those who try to quit without NRT.

But those who have conditions such as heart disease, over-active thyroid, diabetes, severe kidney or liver disease, or stomach ulcers may find that NRT worsens the condition. Moreover, in pregnant women, NRT may have the same negative effects on the growing fetus as smoking has (NICE Technology Appraisal Guidance 38, March 2002).

NRT can also cause mild skin irritation, including the tissues of the mouth and nose (BMJ, 2000; 321: 355-8).

Happily, there are many alternatives with good evidence of success.

Acupuncture

This form of traditional Chinese medicine is widely used as a drug-free way to quit smoking. As one study reports, it can reduce the desire to smoke as well as the negative psychological symptoms associated with quitting (Int J Neurosci, 2007; 117: 571-8). In one Norwegian antismoking trial, 31 per cent of the participants given acupuncture treatment had quit smoking completely by the end of the study, compared with none of those given sham acupuncture (Prev Med, 1997; 26: 208-14).

A number of other researchers have found that acupuncture is effective for smokers who have failed to quit by other methods (J Tradit Chin Med, 1994; 14: 56-63). The evidence suggests that acupuncture success is similar to that reported with nicotine gum and behavioural therapy, all of which are complementary treatments (J Tradit Chin Med, 1994; 14: 56-63).

Electroacupuncture using ear acupoints can also help stop-ping smoking, with a 41 per cent one-year success rate (Forsch Komplementarmed Klass Naturheilkd, 2004; 11: 8-13).

Diet and lifestyle

Smoking cessation often leads to weight gain, which can bea barrier against giving up for good (Ann Ig, 2007; 19: 73-81).

However, a moderate increase in physical activity after quit-ting can minimize weight gain (Am J Public Health, 1996; 86: 999-1004). One study found that adding exercise to behavioural counselling to stop smoking significantly improved rates of abstinence (Arch Intern Med, 1999; 159: 1229-34).

Calorie restriction through dieting, on the other hand, can increase the risk of relapse (Am J Public Health, 1992; 82: 799-803). But, in one US study, a high-carbohydrate diet combined with tryptophan supplementation (50 mg/2.2 lb body weight/day) lessened withdrawal symptoms and helped study participants to smoke fewer cigarettes (J Behav Med, 1991; 14: 97-110).

Herbs

The well-known herbal alternative to antidepressants, StJohn's wort, is believed to raise levels of the brain chemical dopamine, which fall when smokers quit, resulting in cravings and depression. In one trial, 38 per cent of patients taking 450-mg capsules of standardized St John's wort twice a day successfully quit smoking after 12 weeks. Moreover, none ofthe quitters put on weight, a common side-effect of smoking cessation (Complement Ther Med, 2006; 14: 175-84).

Rhodiola rosea may also have antidepressant effects, which could ease the negative feelings associated with quitting smoking (Altern Med Rev, 2001; 6: 293-302).

There is also evidence suggesting that lobeline, derived from Lobelia inflata, also known as Indian tobacco, and an alcoholic extract of common oats (Avena sativa) may be useful for treating smoking addiction (Biochem Pharmacol, 2002; 63: 89-98; Nature, 1971; 233: 496). Other herbs that may help include alfalfa, eucalyptus, gotu kola, liquorice, passionflower, and skullcap, although none of these has been evaluated scientifically.

Counselling

Having the support of a counsellor or joining a support group will increase the chances of success. The quit rate is about the same as with NRT, but without the side-effects. Individual counselling is the most effective form of behavioural support (BMJ, 2000; 321: 355-8) and combining it with NRT, if appropriate, appears to offer the best long-term chances of success (BMJ, 2004; 328: 397-9).

Joanna Evans

Kicking the habit

- Self-massage (of the hand or ear) can alleviate cravings, anxiety and depression and, after one month, reduced the number of cigarettes smoked per day (Prev Med, 1999; 28: 28-32).

- Guided imagery and mindfulness meditation can reduce stress and help people to succeed in stopping smoking (J Nurs Scholarsh, 2005; 37: 245-50; BMC Comple-ment Altern Med, 2007; 7: 2).

- Glucose (dextrose) tablets keep blood sugar from dropping, as low levels can trigger cravings (CNS Drugs, 2001; 15: 261-5).


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