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Improving smoking cessation approaches at the individual level
  1. Paul Aveyard1,
  2. Martin Raw2,3
  1. 1Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
  2. 2UK Centre for Tobacco Control Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
  3. 3National Institute of Alcohol and Drug Policies, Federal University of Sao Paulo, Sao Paulo, Brazil
  1. Correspondence to Dr Paul Aveyard, Primary Care Clinical Sciences, University of Birmingham, Birmingham B15 2TT, UK; p.n.aveyard{at}bham.ac.uk

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Why assist cessation?

Treatment of tobacco addiction

Most smokers show symptoms of addiction to nicotine.1 The symptoms and signs of addiction are described by diagnostic classification systems, such as the Diagnostic and Statistical Manual of Mental Disorders. However, perhaps the most important symptom in this context is the failure of attempts to stop smoking when a person tries to accomplish this. Frequent smoking is thought to set up a subconscious learning process linked to the release of nicotine from cigarettes.2 When a person decides to stop smoking, s/he is afflicted by urges to smoke, often in places where smoking has previously taken place.3 Furthermore, such a person usually experiences withdrawal symptoms.4 These are mostly adverse moods, but with some physical symptoms as well. It is thought that these urges to smoke are primarily responsible for the failure of most attempts to stop smoking. Without support around half of all attempts to stop fail within the first week of attempted abstinence.5 The typical smoker who seeks treatment for cessation has never managed more than a few weeks without smoking.6 The period of withdrawal varies by symptom, but typically lasts a few weeks.4 Therefore most smokers' experience of not smoking is state of withdrawal and perhaps beliefs that smoking is a stress reliever, for example, stem from experiencing withdrawal during abstinence.

The two main approaches to assist cessation are pharmacotherapy and behavioural support. Pharmacotherapy for smoking cessation aims primarily to reduce the intensity of urges to smoke and/or ameliorate the aversive symptoms. Behavioural support aims to boost or support motivation to resist the urge to smoke and develop people's capacity to implement their plans to avoid smoking. These interventions last typically only a few months. It is thought that during these months, the strength of the associative learning between smoking and …

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