Transcript The PRIME Theory of motivation and its application to smoking

The need and demand for treatment to
help smokers to quit
Robert West
University College London
April 2008
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Need for treatment: cigarette addiction
• Cigarettes are addictive
– less than 25% of serious quit attempts survive one week
– less than 5% of serious quit attempts survive 6 months
– smokers experience powerful compulsion to smoke when they
try to stop
– smokers experience unpleasant withdrawal symptoms when
they are deprived of nicotine
• This is because nicotine causes a disorder in the brain
pathways involved in motivation
• Addiction is a matter of degree and not all smokers need
help but many more need it than think they do
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Need for treatment: cost of failure of
quit attempts
• Every year that quitting is postponed after the age of 40
loses and average of 3 months of life so every quit
attempt is a precious resource
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Treatments
• Treatment can improve success rates by up to 300%
• Pharmacological treatments
– reduce compulsion to smoke by normalising activity in brain
pathways underpinning those urges that have been disordered in
nicotine dependence
– these include nicotine patches and gum, bupropion, nortriptyline,
varenicline and probably cytisine
• Psychological treatments
– reduce psychological motivations to smoke, bolster motivation
not to smoke and provide skills and techniques necessary to
exercise self-control
– these can be provided face-to-face individually or in groups, or
possibly by telephone
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Demand for treatment
• Most smokers:
– do not think they need help with stopping
– do not understand the benefits of treatment to aid cessation
– do not use treatments to aid cessation even in the UK where it is
free or very cheap and widely available (less than 50% use
pharmacological treatments and less than 10% use
psychological treatments
• Most health professionals:
– have a limited understanding of the need for, and benefits of,
smoking cessation treatments
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Recommendations
• All health professionals should:
– have a basic understanding of why it is so hard for smokers to
stop and the effectiveness of smoking cessation treatments
– be able to explain to patients the benefits of treatments to aid
cessation and encourage smokers to use those treatments
• All agencies involved in communication with smokers
should:
– educate smokers about the benefits of psychological and
pharmacological treatments to aid quit attempts
• All agencies that fund healthcare provision should:
– place treatments to help smokers to quit at least on a par with
other life-saving treatments in terms of availability and
affordability
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Reading
• West R and Shiffman S Smoking Cessation. Oxford:
Health Press (2007)
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