1

Health Professionals Role in Helping Smokers to Quit

Smoking

Dr. Sallehudin Abu BakarPublic Health Physician & Epidemiologist

2

Findings from the STOP survey

69

81

97

92

87

53

0 20 40 60 80 100

Smoking is a lifestyle choice

Smoking is a medical condition

Smoking is addictive

Stopping is primarily down to willpower

Helping patient stop is part of job

Other things have higher priority

PercentPfizer-sponsored survey: Interviews with 2836 smoking and non-smoking general practitioners in 16 countries in 2005

3

Apparent paradoxes

Smoking is an addiction stopping is a matter of willpower

Smoking should be regarded as a medical condition

is primarily a lifestyle choice

Helping patients to stop is part of the job

other things have a higher priority

but

4

What does this mean?

Need a message that recognises the duality of beliefs about smoking

“Smokers must take responsibility for stopping smoking, and they will need determination to succeed; but when

determination is not enough, the health professional has effective tools to help the

smoker succeed.”

5

A simple model of nicotine dependence

Chronic intake of nicotine from

cigarettes

Changes to the neural circuits controlling

motivation

Nicotine hunger Nicotine habit False beliefs

A biologically driven “need” to smoke

when nicotine levels in the brain are low

Cues associated with smoking trigger nicotine-driven reward seeking

Experience of relief of nicotine withdrawal

symptoms leads to expectations of more

general mood enhancement

6

The process of stopping smoking

Motivational tension

Triggers

Treatment

When smokers think about their smoking most, they are unhappy about it, but many of them:

Something needs to prompt them to make a quit attempt using a method that maximises their chances of success

The treatment needs to be of a type and intensity that meets the individual smoker’s needs, and available whenever and for as long as the smoker needs it

1. Think it meets certain needs2. Is a source of enjoyment3. Think stopping will be difficult

7

The Health Professional’s Role

The Health professional role is:

Patients will often respond to a clear, firm message that:

• To give professional, expert advice on health matters

• To provide treatment to those who want and need it

• Now is a good time to stop• It is always worth having another attempt• There are things available that will make it

easier

8

A simple consultation model

Yes, I know I should stop, but...

I enjoy smokingtoo much

Every month you put off stopping, you may lose another week off your life

Now is not a good time

Now is always a good time for stopping, smoking doesn’t really help with stress

I am worried that I will fail

Most smokers make many attempts before they succeed

I am addicted Addictions can be conquered, especially when you get help

We now have effective treatments available that will make it a lot easier for you to succeed

Are you smoking at the moment?

You have to question whether it is worth the pain and suffering you will endure later