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after a relapse (Knoke et al. 2006). The ability to reduce smoking levels may prime relapsed smokers to be more successful in latter quit attempts. Results from the Community Intervention Trial for Smoking Cessation (surveys from 1988, 1993, and 2001) found a significant increase in quitting among participants who were able to reduce their daily cigarette consumption by 50 percent. Those who reduced their cigarette consumption by more than 50 percent were 1.7 times more likely to quit smoking by 2001 than those who did not reduce their cigarette consumption (Hyland et al. 2005).

Smokers who attempt to quit smoking with the use of some assistance tend to fare better than self-quitters; however, many smokers may not be informed about effective cessation methods (Hammond et al. 2004). Although it is not the intention of the committee to provide an exhaustive review of cessation therapies, it is important to highlight current guidelines for assisting smokers with quitting. The U.S. Department of Health and Human Services’ Clinical Practice Guideline for Treating Tobacco Use and Dependence identifies three counseling and behavioral therapies that are effective in helping smokers quit. These include providing smokers with practical counseling that focuses on (1) problem-solving skills and skills training for relapse prevention and stress management, (2) providing social support as part of treatment, and (3) helping smokers obtain social support outside of treatment.

Current guidelines also recommend eight effective pharmacotherapies that can assist smokers in their attempts to quit. Five therapies are nicotine-based (nicotine gums, patches, nasal sprays, inhalers, lozenges/tablets), two are antidepression medications (bupropion and nortriptyline), and one is a medication (clonidine) that is used for the treatment of hypertension (Fiore et al. 2000; Foulds 2006; Henningfield et al. 2005). Recently, varenicline, a nicotinic cholinergic receptor partial agonist, has been marketed for smoking cessation. Bupropion, nicotine inhalers, nasal sprays, and nicotine patches are considered first-line medication treatments that double long-term abstinence rates compared with those achieved with placebo. Nicotine gum, also a first-line treatment, improves the long-term abstinence rate by about 30 to 80 percent. There is emerging evidence from a few studies that selected use of combinations of nicotine replacement therapies (a nicotine patch with either a nicotine gum or a nicotine nasal spray) may have greater efficacy than a single form of nicotine replacement, but this has not been proven (Fiore et al. 2000).

Summary

The previous sections can be summarized succinctly: nicotine in cigarettes and other forms of tobacco is highly addictive. Once addiction takes



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