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Medical Edge Newspaper Column from Mayo Clinic

INPATIENT TREATMENT SUREST WAY TO QUIT SMOKING

DEAR MAYO CLINIC: I’ve smoked for 50 years and never wanted to quit — until now. I tried a few times with classes at the community center and such, but I haven’t had any luck. I smoke two packs a day. But now the cost is so high and my grandkids are begging me to quit. Now that I’m retired and don’t have the pressure of work, I think I need to check into a hospital to quit. Can you give me an idea of what sort of things are available to treat cigarette addiction? — Phoenix

ANSWER: You’re wise to consider a treatment program offered by a medical center. A few years ago, we conducted a study comparing quit rates of patients in our inpatient (residential) vs. outpatient treatment programs, and found that patients who attended our residential program were nearly twice as likely as outpatients to be smoke-free a year later.

We have documented that smokers are eight times more likely to quit through an evidence-based program than by trying to quit on their own. We also know that there is a “dose response” — that is, the more time and effort you put into a program, the better the outcome will be. The key message is to seek help.

Inpatient programs can be very effective at helping people quit smoking because doctors and nurses directly monitor a patient’s withdrawal symptoms and response to nicotine replacement therapy, or NRT, as well as tailor the counseling to fit the patient’s needs. Regardless of the setting, however, the most successful treatment programs combine medication, individual counseling and follow-up support, and education about the biology of tobacco dependence.

— Medications. Because nicotine stimulates the release of the feel-good chemical dopamine in the brain, nicotine withdrawal often causes irritability, anxiety, headache and difficulty concentrating. NRT can reduce these unpleasant withdrawal symptoms and cravings. Studies show that it may be best to combine two forms of NRT when trying to stop smoking.

For example, a nico tine patch can help control symptoms by providing a steady dose of nicotine through the skin and into the bloodstream. Patients can use a second form, nicotine gum or nicotine lozenge, to control cravings. NRT has been shown to increase a person’s success rate and decrease the relapse rate when it’s administered for more than just a few weeks. Though available over-the-counter, NRT is most effective when administered by a clinician, who can adjust the dose for the individual.

Bupropion is a non-nicotine medication, available by prescription, that has been shown to help smokers stop, and if administered for up to a year, to prevent relapse to smoking. This medication acts on the brain chemistry to help smokers stop.

— One-on-one counseling and follow-up. Individual counseling with a doctor, nurse or counselor is also an important component of a successful program. The clinicians help you develop a personal plan to stop smoking. They offer encouragement and support, and will help you learn ways to modify your behavior and manage the stress of daily life. Follow-up counseling sessions or telephone calls will help motivate you to stay the course.

— Education. Education is a key to making this major change in your life. In a comprehensive treatment program, you will gain a sound understanding of a range of topics, from the biology of addiction to the psychology of change; your personal nutritional needs; and how to develop an exercise regimen that will support your new smoke-free lifestyle.

— Richard Hurt, M.D., Nicotine Dependence Center, Mayo Clinic, Rochester, Minn.

Additional Resources:
Nicotine Dependence Center
Appointment Information
More Information on Quitting Smoking
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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.