General Principles of Treatment for Smokers

Having a fag in Amsterdam
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Since cigarette smoking has been seen as a form of drug abuse, new programmers of treatment have been developing rapidly. Many of these apply principles learned over the years in treating drug abuse and alcoholism. One is that the effect of the drug in the brain is the single most critical factor to consider. It is this effect which maintains the compulsive drug-taking behavior of a person for years, or even a lifetime. This is a fact essential to effective treatment programmes.

As mentioned earlier, the drug of abuse can be substituted with a similar but safer drug (like nicotine chewing-gum), or the effects of the drug can be blocked (for instance, mecamylamine like drugs can be used as a sort of immunization procedure). Alternatively, if nicotine is providing some therapeutic effects, like stress relief or weight control, then these effects might be replaced by appropriate treatment using either more appropriate drugs or non-drug treatments (for instance stress management or diet plans).
An equally important principle that has been learned from drug abuse treatment is that non-drug factors are also important and must be considered for effective treatment. It is probably obvious to smokers, if not to others as well, that the pleasures of smoking are many and include taste and smell, the social interactions which they make easier, and even the actual handling of the cigarettes.

Another important set of non-drug factors is the degree to which tobacco use can become an integral part of behavioural patterns. For instance, just as a tennis player may find it necessary to bounce the ball, or adjust his or her socks before feeling comfortable enough to serve, so too might a writer feel unready to face the typewriter without lighting up a cigarette first. The ability to function may be disrupted by the abrupt termination of smoking, and it may take years before the person “feels right” doing many things. Many writers, for instance, feel that to give up smoking would seriously impair their very livelihood. If we consider that a cigarette smoker may light 10,000 cigarettes and take 100,000 puffs per year, it should come as no surprise that smoking may become an important part of the smoker’s life.

Treatment of cigarette smoking must address the possibility that other drugs are also being abused by the smoker. People who abuse drugs tend to abuse several. For instance, sedatives and alcohol are often abused by the same people, morphine and cocaine are often used jointly, and people who abuse any drug are likely also to smoke cigarettes (more than 90% of opiate and alcohol-dependent persons smoke cigarettes). This finding has led to treatment programmes that focus on all of the drugs abused by individuals.

The last major set of findings that have emerged from studies of drug abuse is that stopping can be accompanied by years of sensitivity and susceptibility to relapse. In some cases the sensitivity may be partially due to physiological changes. For instance, with the upload drugs, a secondary and more subtle withdrawal syndrome may persist for six months or more after the initial withdrawal has subsided. Additionally, environmental stimuli may serve as cues which elicit withdrawal-associated discomfort. When this happens, relapse is more likely. In this regard, studies with bothopioid drugs and tobacco have shown that stimuli associated with the respective form of drug taking (pictures of needles for the opiate users, smell of cigarette smoke for the cigarette smoker ), can elicit such responses: both physiological, such as increased heart rate and sweating and psychological, such as discomfort and desire to take the drug.
Other kinds of stimuli may also enhance the likelihood of relapse. These include social situations, stress, and anxiety. In the context of drug abuse, relapse is simply one character-is tic. It does not mean that treatment has failed or that the person is a failure. It simply marks a point to restore, possibly with modification, treatment.

If all of the above does not make the treatment of cigarette smoking seem like a hopeful Endeavour, at least it should provide an appreciation of why success rates are generally considered good if a particular programmed achieves 30% abstinence on a one-year follow-up.

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