Manual of Smoking Cessation A Guide for

Manual of Smoking Cessation provides the crucial knowledge required if you are involved in helping smokers to stop. The manual provides facts, figures, suggested interventions and sources of further information to assist in providing evidence-based treatment for smokers wishing to stop. This manual covers the core content areas and key learning outcomes described in the Standard for Training in Smoking Cessation (Health Development Agency, 2003). Manual of Smoking Cessation is structured in two concise parts: Part 1 provides essential information on smoking demographics, along with the risks of smoking and the benefits of stopping; Part 2 offers a range of practical advice to implement with clients. The Smoking Cessation Manual is an essential text for all those involved in the provision of smoking cessation services, including smoking cessation counsellors, nurses, pharmacists, doctors, health promotion officers, dental professionals, and other members of the health care team. The book is an invaluable resource for those learning about smoking cessation, and a succinct aide-memoire to those already practicing in the field. The authors represent the 'who's who' in the field of smoking cessation and are affiliated to University College London and Cancer Research UK (Andy McEwen and Robert West), St Bartholomew's & Royal London School of Medicine and Dentistry (Peter Hajek), and the University of Auckland (Hayden McRobbie).

Andy McEwen is Senior Research Nurse at the Cancer Research UK Health Behaviour Unit at University College London. His current research includes surveys of smokers and health professionals, pharmacokinetic studies on nicotine delivery systems and clinical trials of behavioural treatments; he also retains an interest in nursing research. In 1997 he began his clinical and academic career in smoking cessation with Robert West. In 2003 he took up his current post and is Director of the Smoking Cessation Services Research Network (SCSRN) and Programme Director of the UK National Smoking Cessation Conference (UKNSCC).

Peter Hajek is Professor of Clinical Psychology, Head of Psychology, and Director of Tobacco Dependence Research Unit at Barts and The London, Queen Mary's School of Medicine and Dentistry, University of London. His research is concerned primarily with understanding smoking behaviour, and developing and evaluating smoking cessation treatments. He has authored or co-authored over 200 publications, holds various academic and editorial appointments, and had input into the UK Government’s initiative to establish smoking cessation services. His Unit is involved in examining both behavioural and pharmacological interventions, and in offering treatment to dependent smokers who seek help.

Dr Hayden McRobbie is a Research Fellow at the Clinical Trials Research Unit, University of Auckland, New Zealand where he specialises in smoking cessation research and treatment. He studied medicine at the University of Otago and after a several years in clinical medicine he moved to London to work with Professor Peter Hajek. He worked on a large number of projects and clinical trails looking at ways to help people stop smoking, as well pharmacological and behavioural methods that alleviate the symptoms of tobacco withdrawal. In New Zealand Hayden continues his research into treatment to help people stop smoking and retains close links with the UK where he is a Visiting Lecturer at Barts and The London, Queen Mary’s School of Medicine and Dentistry, and Programme Director of the UK National Smoking Cessation Conference.

Robert West is Director of Tobacco Studies at the Cancer Research UK Health Behaviour Unit at University College London. He has been researching tobacco and nicotine dependence since 1982 and has published more than 250 scientific works. His research involves surveys of smoking patterns, clinical trials of aids to smoking cessation and laboratory studies of nicotine withdrawal symptoms. He is co-author of the English National Smoking Cessation Guidelines that provided the blueprint for the English Stop Smoking Services and is also Editor-in-Chief of the journal, Addiction.

About the authors

ix

Acknowledgements

xi

Statements of professional interest

xii

Foreword

xiii

Introduction

xv

Part One: Essential Information

1

(32)

1 Smoking demographics

3

(12)

1.1 Smoking patterns

3

(5)

1.1.1 Smoking prevalence

3

(4)

1.1.2 Smoking consumption

7

(1)

1.1.3 Exposure to environmental tobacco smoke

7

(1)

1.1.4 Beliefs about smoking

7

(1)

1.2 Smoking cessation

8

(2)

1.3 Sources for updating prevalence statistics

10

(1)

1.4 Multiple choice questions

10

(5)

2 The health risks of smoking and the benefits of stopping

15

(18)

2.1 Smoking mortality

15

(4)

2.1.1 Lung cancer

17

(1)

2.1.2 Cardiovascular disease

17

(1)

2.1.3 Chronic obstructive pulmonary disease (COPD)

18

(1)

2.1.4 Other life-threatening diseases

18

(1)

2.2 Smoking morbidity

19

(4)

2.2.1 Non-life-threatening physical diseases linked to smoking

20

(1)

2.2.2 Smoking and mental health

20

(1)

2.2.3 Reproductive health

21

(1)

2.2.4 Environmental tobacco smoke

22

(1)

2.3 Health benefits of smoking cessation

23

(3)

2.3.1 Lung cancer

24

(1)

2.3.2 Cardiovascular disease

24

(1)

2.3.3 Chronic obstructive pulmonary disease (COPD)

24

(1)

2.3.4 Other life-threatening diseases

25

(1)

2.3.5 Smoking cessation and reproductive health

25

(1)

2.3.6 Smoking cessation and mental health

25

(1)

2.3.7 Morbidity and smoking cessation

25

(1)

2.3.8 The protective effects of smoking

26

(1)

2.4 Sources for updating health information and statistics

26

(1)

2.5 Multiple choice questions

26

(7)

Part Two: Practical Advice

33

(93)

3 Brief interventions

35

(27)

3.1 Assessment and recording of smoking status

35

(3)

3.1.1 Asking about smoking status

36

(1)

3.1.2 Recording smoking status

37

(1)

3.2 Advising smokers to stop and assessing interest in quitting

38

(3)

3.2.1 Advising clients to stop smoking

38

(2)

3.2.2 Assessment of interest in quitting

40

(1)

3.2.3 Recording advice given and responses

41

(1)

3.3 Compensatory smoking

41

(2)

3.3.1 Evidence of compensatory smoking

41

(1)

3.3.2 Cutting down

42

(1)

3.4 Reasons why stopping smoking can be difficult

43

(6)

3.4.1 Perceived benefits of smoking

43

(1)

The special case of 'stress relief'

43

(1)

3.4.2 Nicotine dependence

44

(3)

3.4.3 Tobacco withdrawal syndrome

47

(2)

The special case of anxiety

48

(1)

3.5 Treatment to help with stopping smoking

49

(4)

3.5.1 Principles of specialist treatment

49

(1)

3.5.2 Types of medication

49

(3)

Nicotine replacement therapy (NRT)

50

(1)

Bupropion (Zyban)

51

(1)

3.5.3 Other treatments and interventions

52

(1)

3.6 Referral to local services

53

(1)

3.7 Wider context

53

(3)

3.8 Multiple choice questions

56

(6)

4 Intensive one-to-one support and advice

62

(46)

4.1 Smoking cessation treatments and their outcome

62

(6)

4.1.1 Evaluation of smoking cessation methods

62

(2)

4.1.2 Short-term treatment outcomes

64

(1)

4.1.3 Long-term treatment outcomes

65

(1)

4.1.4 Relapse

65

(3)

4.2 Assessment

68

(6)

4.2.1 Nicotine dependence

68

(1)

4.2.2 Interest in quitting and willingness to attend for treatment

69

(2)

4.2.3 Smoking characteristics

71

(1)

4.2.4 Carbon monoxide monitoring

72

(2)

4.3 Pharmacotherapy

74

(16)

4.3.1 Nicotine replacement therapy (NRT)

74

(6)

Nicotine transdermal patch

75

(1)

Nicotine nasal spray

76

(1)

Oral products

76

(1)

Nicotine chewing gum

77

(1)

Nicotine sublingual tablets

78

(1)

Nicotine inhalator

78

(1)

Nicotine lozenge

78

(2)

4.3.2 Bupropion

80

(2)

4.3.3 Explanation of medications

82

(1)

4.3.4 Supplying medications

83

(4)

4.3.5 Treatment points in special populations of smokers

87

(2)

4.3.6 Other medications

89

(1)

4.4 Behavioural support - withdrawal oriented treatment

90

(8)

4.4.1 Preparation

90

(2)

4.4.2 Quit date

92

(1)

4.4.3 Urges to smoke and what to do about them

93

(2)

4.4.4 Post-quit sessions

95

(1)

4.4.5 End of treatment and relapse prevention

96

(2)

4.5 Monitoring

98

(2)

4.5.1 National monitoring

98

(1)

4.5.2 Local monitoring

99

(1)

4.6 Multiple choice questions

100

(8)

5 Telephone counselling

108

(5)

5.1 Recruiting smokers into treatment by telephone

108

(2)

5.2 Behavioural support by telephone

110

(1)

5.2.1 Telephone counselling

110

(1)

5.2.2 Combined telephone and face-to-face counselling

110

(1)

5.2.3 Telephone follow-ups to treatment

111

(1)

5.3 Multiple choice questions

111

(2)

6 Group interventions

113

(13)

6.1 Recruitment and assessment

113

(3)

6.1.1 Recruiting for groups

113

(2)

6.1.2 Assessing clients for group treatment

115

(1)

6.1.3 Logistics of group treatment

116

(1)

6.2 Treatment programme for groups

116

(1)

6.3 Group treatment content

117

(6)

6.3.1 Preparation

117

(2)

6.3.2 Quit date

119

(2)

6.3.3 Post-quit groups

121

(1)

6.3.4 End of treatment, relapse prevention and ongoing support

122

(1)

6.4 Monitoring and follow-up

123

(1)

6.4.1 Record keeping

123

(1)

6.5 Multiple choice questions

123

(3)

Answers to multiple choice questions

126

(2)

Appendix 1 Bupropion (Zyban) — special patient groups

128

(2)

Appendix 2 Bupropion (Zyban) — drug interactions

130

(2)

Appendix 3 Effect of tobacco abstinence on metabolism of some drugs

132

(2)

Appendix 4 Resources

134

(4)

Appendix 5 Examples of what to say when intervening with smoking clients

138

(8)

Index

146

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Manual of Smoking Cessation A Guide for Counsellors and Practitioners

Summary

Author Biography

Table of Contents

Supplemental Materials