Putting Out that Cigarette For Good

CigaretteSmoking is the leading cause of preventable death in the United States; however, while the majority of smokers want to quit, only five percent achieve their goal annually.[1] In the past ten years, only one new anti-smoking medicine has reached the market—Chantix—and electronic cigarettes have not statistically declined quit-rates.1 More is needed on the pharmacological front to help people quit smoking.1

Currently, combining pharmacological treatments with behavioral treatments are the way to maximize the likelihood of success.1 A number of years ago, the American Cancer Society and the American Lung Association have developed behavioral treatments that are offered around the country, such as Freshstart Smoking Cessation Program and Freedom From Smoking.1 More recently, a new wave of behavioral treatments have surfaced, based on the idea that if someone is able to be mindful of and accept their cravings to arise without falling prey to them, they may be less likely to smoke.1

Several studies completed recently have shown that these new interventions show promise. For example, a study of Acceptance and Commitment Therapy (ACT) that was delivered over seven weeks in 90-minute sessions found a 30 percent quit rate, compared to the 13 percent quit rate with cognitive-behavioral therapy.1 Another study of mindfulness training that was delivered twice weekly over four weeks found a 36 percent quit rate compared with the 15 percent of the American Lung Association’s Freedom From Smoking.1

While these quit rates are encouraging, how does being mindful and accepting one’s urges to smoke actually help a person quit? Positive and negative reinforcement loops foster smoking; therefore, if a person smokes when they are stressed, this sets up the conditioning loop to smoke again the next time they are stressed, as it gives them temporary relief.1 The underpinnings of mindfulness have been known for over 2,500 years.1 Buddhist teachings are famous for their noble truths: there is suffering, suffering is caused by craving, and letting go of craving ends suffering.1

Science is realizing that there are more similarities than differences between the mechanisms of mindfulness and conditioning.1 Elwafi and colleagues found that mindfulness practice moderated the relationship between craving and smoking.1 During their study, at baseline, craving and smoking were tightly correlated; however, after the four-week intervention, the relationship was no longer there.1 The more mindfulness was practiced, the more the relationship between craving and smoking began to fade away.1

Patients are taught to recognize what cravings feel like: tightness, heat, burning, restlessness, etc.1 As they are often unpleasant feelings, smokers habitually react to make them go away by smoking.1 Instead of taking a puff, smokers are taught to instead investigate how these sensations feel moment to moment.1 The more curious they become about these sensations, the more they can ride them out as they build and subside.1 Each time this is done, they weaken the link between craving and smoking, until eventually they are able to ride out any craving and quit.1

Larger scale studies of these treatments are warranted, as the preliminary success has been high.1

[1] Brewer, J. (2013, November 19). Smoking Cessation: What’s Next?. Psychiatric Times. Retrieved November 21, 2013, from http://www.psychiatrictimes.com/addiction/smoking-cessation-what-is-next

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