Tobacco Treatment: Behavioral Approaches

The effects of nicotine on the body are one reason why it is so difficult to quit smoking. People become physically dependent on nicotine, and when they try to quit, they experience unpleasant withdrawal symptoms. One way they try to relieve these symptoms is to take up smoking again. However, the addictiveness of nicotine is not the only reason why quitting smoking is difficult. Cigarette smokers may smoke to regulate their moods or deal with stress. In this way they are psychologically dependent on tobacco. In addition, tobacco users tend to connect certain behaviors with smoking. To quit successfully, they need to change their behavior. While medications such as nicotine gum and skin patches can help smokers and nicotine addicts deal with their physical addiction to nicotine, behavioral approaches can help them to change certain behaviors that go along with smoking. The most effective treatment for tobacco combines medications with behavioral approaches.

Behavioral Treatments

Since the 1960s, many behavioral techniques have been developed to help smokers and smokeless tobacco users quit, but only a few techniques have proved to be effective. One important part of any treatment is the support and encouragement that doctors and other health-care professionals can give. Doctors can improve a person's chances of becoming abstinent by recognizing the discomfort of quitting and expressing sympathy, by emphasizing that half of all smokers have quit for good, and by recommending therapies. Family members can also provide support by participating directly in treatment.

Problem Solving and Skills Training. In a behavioral treatment known as problem solving and skills training, people learn to recognize their patterns of tobacco use and the situations in which they are most likely to smoke. For example, they may realize that their urge to smoke is strongest when they wake up in the morning, or that high-pressure situations lead them to light up a cigarette. By monitoring themselves, they learn how to deal with high-risk situations, or situations in which they are most likely to experience craving for tobacco.

A common problem for people trying to quit smoking is relapse, or a return to smoking after a time during which they do not smoke. Problem solving and coping skills are essential to preventing relapse. In skills training, the smoker learns to avoid situations that trigger the smoking urge, such as sitting in the smoking section of a restaurant. Instead, the smoker is encouraged to choose nonsmoking restaurants. Or the person can choose to take a night out in places where no smoking is allowed, such as movie theaters. Some situations that trigger the smoking urge are unavoidable, so for these times the person learns how to turn his or her attention away from smoking by using distractions, such as exercising. Craving to use tobacco products lasts only minutes, so using distractions can help the smoker wait out the time until the craving passes. Tobacco users are also taught to practice refusing tobacco or asking others not to use tobacco around them.

Rewards. Behavioral approaches also make use of rewards for not smoking. For example, the person trying to quit can use the money that is saved by not buying cigarettes to pay for a healthy and enjoyable activity like a vacation. Or the person could go to a movie as a reward for not smoking for seventy-two hours or some other short period.

Aversive Techniques. One behavioral approach to quitting smoking makes use of aversive techniques. An adverse, or aversive, reaction is a negative reaction against a particular thing or event. For example, in a technique known as rapid smoking, smokers are asked to smoke several consecutive cigarettes rapidly so that they will experience immediate adverse, unpleasant effects (such as nausea). The person then begins to connect the adverse reaction with the act of smoking, and feels less desire to smoke.

Relapse Prevention

Once a tobacco user has quit smoking, the challenge is to prevent re- lapse. "Relapse" means a return to the full program of smoking in which the individual had previously engaged. A slip, on the other hand, means smoking only one or a few cigarettes after a period of abstinence. Research has shown that slips, especially during the first few weeks after quitting, generally lead to relapse. As a result, smokers are advised not to take even one puff of a cigarette in order to prevent relapse. To remain abstinent, a person must change his or her behavior for good—not only during the period of treatment. Getting exercise, eating healthy foods, getting enough sleep and rest, and managing stress all contribute to remaining tobacco-free.

Conclusion

Combining medications and behavioral treatments for quitting smoking can increase success rates. These combinations can target different aspects of nicotine addiction. Nicotine gum or the prescription drugs can reduce the smoker's physical dependence on tobacco, which then allows the tobacco user to focus on the behavioral or psychological aspects of smoking.

Most cigarette smokers try to quit on their own, without medications or behavioral treatment. Their quit rates are the lowest of any approach. Society has changed in its attitudes to smoking, with more and more public places banning smoking on their premises. This trend, together with increased taxes on tobacco products, will put pressure on smokers to seek help in quitting the habit.

see also Nicotine; Nicotine Withdrawal; Tobacco: Dependence; Tobacco: Smokeless; Tobacco Treatment: An Overview; Tobacco Treatment: Medications.