Smoking+Cessation;+Psychotherapy


 * Smoking Cessation**

Smoking cessation is the act of stopping smoking. Smoking cessation has two aspects of treatment; it is a combination of medicines and behavioural methods.

There are several quitting smoking aides currently approved my health Canada;
 * Medications:**

Nicotine Replacement Therapy includes the use of gum, patch, inhaler or lozenge. These are nonprescription and help to delay or relieve nicotine withdrawal symptoms. They put nicotine into the bloodstream to help reduce and control intake of nicotine (The Lung Association, 2012). Bupropion SR (Zypan and Wellbutrin) is a medication that is taken a week before you stop smoking to help control cravings. This product does not contain nicotine (The Lung Association, 2012). Varenicline Tartate (Champix) is a pill that helps to make smoking feel less enjoyable. Pills are generally taken for 12 weeks, but sometimes it can be prescribed for up to another 12 weeks (The Lung Association, 2012).

Paired with medication it is often beneficial to have some form of psychotherapy involved. The challenges with smoking cessation is the physical withdrawal symptoms but also the psychological withdrawal symptoms that cannot always be treated with medications alone (Roberts, Maddison, Simpson, Bullen, Pravessis, 2011). Following are Several examples of smoking cessation psychotherapy approaches. **The STOP Program: Smoking Treatment for Ontario Patients (STOP) Program** The STOP program is a program that offers counselling support to over 80 000 people in Ontario using medication paired with behavioural support. The STOP program uses current healthcare initiatives as well as new means to reach out to smokers. This provides free smoking cessation medication paired with counselling support (CAMH, 2012) **The Nicotine Dependence Clinic** The Centre for Addictions and Mental Health in Toronto runs a tobacco addiction treatment clinic called the Nicotine Dependence Clinic (NDC). NDC offers outpatient services for people who want to stop or reduce tobacco use. The services offered are assessment, medical examinations, group counselling and medications. There are also programs such as; psycho-education sessions, support groups, workshops, and consultations with health professionals (CAMH, 2012). **Brief Counselling & Decisional Balance** Brief counselling allows the counsellor to use a variety of different techniques including active listening, stress management, motivation strengthening, and behavioural strategies (McLean, 2008). Decisional balance is another form of counselling that helps a counsellor to get the client to look at the benefits versus consequences of smoking and their values regarding smoking. The goal of decisional balance is to elicit change in how the client feels about smoking, as well as to prepare the client for how they will be able to cope in high risk situations (McLean, 2008). **Processes of Change:** The processes of change model is used by //The Program Training and Consultation// //Centre// which has resources for health professionals working on the Smoke-Free on Ontario Strategy. This helps people to move through specific stages, and outline a counsellors approach to each stage. This helps for a client to gain insight into where they are in the process of quitting smoking (PTCC, 2013). **Stages of Processes of Change Model (McLean, 2008):** **Consciousness-raising (becoming informed);** Becoming more aware of the problem **Dramatic Relief (emotional arousal);** Triggered by an event related to the problem  **Environmental re-evaluation;** Looks at the possibility of changing social environment  **Social Liberation (increasing alternatives); S** eeing society is more inclusive of smoke-free initiatives and alternatives  **Self re-evaluation (creating a new self image);** Looking at how smoking conflicts and fits with values and goals about oneself  **Commitment (or self-liberation)** Making a change  **Rewards (or reinforcement management);** Rewarding certain steps of change  **Countering (or counter-conditioning);** Replace one problem behaviour with another, for example replacing tobacco use with another drug; usually to deal with stress or withdrawal symptoms  **Environmental (stimulus);** Steps to reduce temptation, to sustain cessation; removing objects related to smoking  **Helping Relationships;** Support from others
 * Benefits of Smoking Cessation Therapy**

Research has shown that smoking cessation therapy has a very positive impact on individual’s quality and quantity of life (Britton, 2004). Smoking cessation interventions are among the most cost effective interventions available (Britton, 2004). Smoking cessation therapy is also the most effective non-pharmacological intervention for smokers who are motivated to quit and when paired together, smoking cessation therapy and pharmacological therapy, there is an increase in an individual’s success (Britton, 2004). Results from a meta-analysis show that 1 in thirteen smokers who attend individual smoking cessation counselling are able to quit as a result of smoking cessation therapy (Britton, 2004).

A study by Wilson et al. (1988) randomly assigned patients who were trying to quit smoking to one of the groups: a usual care group, a gum only group and a gum plus group. In the gum plus group, the patients were given advice on how to quit smoking, set a quit date, offered nicotine gum and set follow-up visits. The results of the study show that individuals who were given smoking cessation therapy were more likely to quit. Specifically, in a one year follow up period, 4.4 percent of the patients from the usual care group had quit smoking, 6.1 percent of patients in the gum only group had quit smoking and 8.8 percent of the patients that received smoking cessation therapy had stopped smoking. The results of this study show that the effect of nicotine replacement therapy combined with smoking cessation therapy have the highest success rates.