Nicotine Addiction Follow-up

  • Author: R Gregory Lande, DO, FACN; Chief Editor: Eduardo Dunayevich, MD   more...
 
Updated: Aug 2, 2011
 

Further Outpatient Care

Long-term follow-up is recommended because individuals who successfully quit smoking are at high risk for relapse. The health care deliverer should make provisions for support, measurement of progress, and a mechanism to deal with relapse. For motivated patients who have failed smoking cessation, consider referral to an expert for the treatment of a relapse.

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Deterrence/Prevention

  • More than 90% of first-time use of tobacco occurs before high school graduation. Because the average age at first use is 14.5 years, smoking prevention must start early.
  • Approximately 40% of teenagers who smoke eventually become addicted to nicotine.
  • Social attitudes and policies toward smoking can have a major impact on smoking behavior. Healthcare associations, public health organizations, and consumer groups should lobby for the following:
    • Restriction of access to tobacco products for minors
    • Restriction of smoking in public places
    • Restriction of advertisements
    • Increased prices through taxation
    • Increased awareness about the harmful health effects of smoking
  • Tobacco industry marketing and public health tobacco-control activities are 2 of the major determinants of cigarette smoking behavior. These vie with each other to influence the proportion of each generation who initiate smoking, the intensity level reached by smokers, and the time before smokers are able to quit successfully. The evidence for causality in this association is considered convincing. Strong evidence supports the notion that tobacco-control programs reduce smoking behavior.
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Patient Education

  • Patient education with regard to the health effects of smoking should occur with all patients who smoke. Patients should be provided with a variety of options and advice that will allow them to escape the harmful effects of tobacco use and the highly addictive drug, nicotine.
  • Family education should be a primary recommendation every clinician undertakes in an effort to reduce teen smoking. Preliminary results from well-designed randomized controlled studies suggest that family interventions can reduce teen smoking.[33]
  • School-based smoking prevention programs educate students about tobacco use. Although widely seen in school curricula, the scientific evidence supporting this approach is limited.[34]
  • Both print and visual media are saturated with antismoking messages. A systematic review of the scientific literature shows a weak impact in preventing smoking.[35]
  • Work-based smoking cessation programs that provide both behavioral treatment and medication support can be effective interventions with good quit rates.[36]
  • Naturally, many patients quit smoking on their own by going cold turkey. This would probably not be the typical patient seen in a clinician's office in the precontemplative or contemplative stage of change. For these patients, many clinicians may refer them to a variety of self-help materials such as books or pamphlets. As a sole treatment strategy, the evidence that self-help materials lead to smoking cessation is weak.[37] A better approach would use self-help materials as a tool to encourage personal education and to facilitate later dialogue between the clinician and the patient.
  • Patients interested in Web-based smoking cessation programs may find the following links helpful:
    • The American Lung Association offers " Freedom from Smoking."
    • Another helpful Web site is the Tobacco Control Research Branch of the National Cancer Institute.
    • Smoking cessation counselors are available to answer smoking-related questions in English or Spanish by telephone or confidential online chat at the National Cancer Institute’s (NCI) Smoking Quitline.
    • The American Cancer Society's website provides educational materials and can direct interested individuals to a community based smoking cessation program called FreshStart.
    • Nicotine Anonymous is a fellowship-based program modeled along the same lines as Alcoholics Anonymous.
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Contributor Information and Disclosures
Author

R Gregory Lande, DO, FACN  Clinical Consultant, Army Substance Abuse Program, Department of Psychiatry, Walter Reed Army Medical Center

R Gregory Lande, DO, FACN is a member of the following medical societies: American Osteopathic Academy of Addiction Medicine and American Osteopathic Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Sarah C Aronson, MD  Associate Professor, Departments of Psychiatry and Medicine, Case Western Reserve School of Medicine/University Hospitals of Cleveland

Sarah C Aronson, MD is a member of the following medical societies: American Academy of Family Physicians, American Medical Association, and American Psychiatric Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Harold H Harsch, MD  Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin

Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: lilly Honoraria Speaking and teaching; Forest Labs None None; Pfizer Grant/research funds Speaking and teaching; Northstar None None; Novartis Grant/research funds research; Pfizer Honoraria Speaking and teaching; Sunovion Speaking and teaching; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research; Merck Honoraria Speaking and teaching

Chief Editor

Eduardo Dunayevich, MD  Adjunct Assistant Professor, Department of Psychiatry, University of Cincinnati; Clinical Research Physician, Neuroscience, Lilly Research Laboratories

Eduardo Dunayevich, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Sat Sharma, MD, FRCPC, and Morley Lertzman, MD, FRCP(C), to the development and writing of this article.

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Smoking cessation strategies for clinicians.
 
 
 
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