National Lung Health Education Program
By Jennifer L. Gillespie
A patient has finally conquered nicotine addiction. But he is meeting some friends tonight at a bar. Now that he no longer smokes, how can he resist temptation when it seems everyone around him is lighting up?
The more support a smoker receives, the better the quit rate, says Carolyn M. Dresler, M.D., FCCP, Director of Medical Affairs of Smoking Control at SmithKline Beecham Consumer Healthcare in Parsippany, N.J. Support can come from friends, family, group cessation programs and health care providers.
ADoctors can serve as strong motivators to move people into the active stage of quitting,@ agrees David Daughton, Behavioral Researcher at the University of Nebraska Medical Center in Omaha.
Ways to draw on support include making alternative plans when in high-risk situations and having a buddy system to help tame cravings. A smoker also must be vigilant and know that even one cigarette is not good. But if he gives in, he must resolve to get back on track
Not only does a smoker have a physical nicotine addiction, but he has behavioral cues that associate one activity with another. A smoker needs to identify these cues and decide what to do in certain situations to avoid lighting a cigarette.
AThe best way to do this is to develop a personalized individualized behavioral therapy.@ Dr. Dresler says.
For example, one smoker habitually may light a cigarette after every meal or when he gets into his car. Another might need to keep her hands busy once she has quit to alleviate her hand-to-mouth reflex.
A recommendation in behavioral intervention is for smokers to write down why they don't want to smoke and to pull out that list whenever they have a craving, Dr. Dressler suggests.
APeople quit smoking if they have a reason and the ability to quit smoking,@ Daughton adds.
FINDING THE TIME
Physicians can find ways to provide smoking intervention help even in a busy primary care environment, Daughton explains. A nurse or receptionist can give the patient a quick assessment through a questionnaire regarding smoking habits. Important questions to ask:
Physicians can verify a patient=s smoking habit with carbon monoxide (CO) analyzers. AThe nice thing about the CO meter is that it provides immediate feedback,@ Daughton says. At certain times, during clinical trials such as the one-year quit visit, he tests for nicotine's metabolites in saliva, blood or urine.
Guidelines developed by the Agency for Health Care Policy and Research describe a series of steps that primary care clinicians can use to support a smoker in quit attempts, which strongly suggest including pharmacological and behavioral components.1 AWe used the model in a clinical trial, and we had reasonably good success rates,@ Daughton says. AIf a patient has quit smoking in the last two or three months, it's nice to capture that so the physician can reinforce quitting at that time.@
1. Helping Smokers Quit: A Guide for Primary Care Clinicians. Clinical Practice Guideline, Number 18. AHCPR Publication No. 96-0693, April 1996. Agency for Health Care Policy and Research, Rockville, MD. Accessed via the Web at http://www.ahcpr.gov/clinic/smokepcc.htm
Jennifer Gillespie is Assistant Editor of Advance.
Advance for Managers of Respiratory Care for MRC May, 2000;9:37.
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