Treatments


 * Categories of Treatment **

Different treatments incorporate different mechanisms, but generally fall under certain principles. Treatments may work by: (Cahill, Stevens, Perera & Lancaster, 2013)
 * reducing the craving and withdrawal symptoms associated with a quitting
 * reducing the reward experienced from smoking by indirectly disrupting dopamine release or by desensitizing receptors
 * delivering some positive reinforcement that is not from a cigarette

**The mechanism of action and the related therapy and/or medicine ** (Cahill et al., 2013)
 * to block nicotine or reduce the effects of nicotine on its receptors or receptors in pharmacological pathways affected by nicotine: bupropion, opioid antagonists
 * to relieve withdrawal: nicotine replacement therapies, varenicline, Nicobrevin
 * to substitute for nicotine's effects: anxiolytics, antidepressants, bupropion
 * aversion therapy: rapid smoking


 * Types of treatment **


 * Nicotine Replacement Therapy **

Nicotine replacement therapy (NRT) are one of the oldest drugs for smoking cessation and include products such as gum, lozen <span style="font-family: Arial,sans-serif; font-size: 10pt; line-height: 1.5;">ge, inhaler, nasal spray, mouth spray and skin patches. It is widely available and can be costly as well <span style="background-color: #ffffff; font-family: Arial,sans-serif; font-size: 10pt; line-height: 1.5;">(Silagy, Mant, Fowler & Lodge, 1994) <span style="font-family: Arial,sans-serif; font-size: 10pt; line-height: 1.5;">. NRT products are used for delaying or relieving withdrawal symptoms by providing lower levels of nicotine compared with smoking products like cigarettes. In other words, the nicotine's high peak plasma levels achieved from smoking are not reached Nicotine is transferred in the bloodstream in different ways depending on the product, producing similar effects to regular smoking. The products are used for approximately 6-12 weeks while steadily reducing the daily dose, which is paralleled to a decrease in withdrawal symptoms (Tonnesen, 2009). <span style="font-family: Arial,sans-serif; font-size: 10pt;">

<span style="font-family: Arial,sans-serif; font-size: 10pt;">Side effects of nicotine g <span style="font-family: Arial,sans-serif; font-size: 10pt; line-height: 1.5;">um can include jaw pain, gastrointestina <span style="font-family: Arial,sans-serif; font-size: 10pt; line-height: 1.5;">l problems, and hiccoughs. Skin patches may create sensitivity and irritation to the skin. Local irritation can occur at the site of administration when using nicotine sprays and inhalers. Lozenges may cause hiccoughs, dry lips, sore throat, coughing, and mouth ulcers (Cahill et al., 2013)

<span style="font-family: Arial,sans-serif; font-size: 10pt;">Bupropion has its effect by inhibiting the reuptake of dopamine and norepinephrine in additio <span style="font-family: Arial,sans-serif; font-size: 10pt; line-height: 1.5;">n to possibly producing an effect on nicotine receptors. The exact mechanism on how it effects smoking cessation is unknown, but it has been developed an anti-depressant drug. The typical dose is 150mg once a day for 3 days, which is then increased to 150mg twice a day. This process is continued for around 7 to 12 weeks (Tonnesen, 2009). <span style="font-family: Arial,sans-serif; font-size: 10pt;">The side effects of bupropion are dry mouth and insomnia and s <span style="font-family: Arial,sans-serif; font-size: 10pt; line-height: 1.5;">eizures in severe cases. It has also been said that bupropion minimizes weight gain after taking it, but the effect on weight are lost after 1 or 2 years (Cahill et al., 2013).
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">N **** <span style="font-family: Arial,sans-serif; font-size: 10pt;">on-nicot  **** <span style="font-family: Arial,sans-serif; font-size: 10pt;">ine Medications  **
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Bupropion (Zyban) **

<span style="font-family: Arial,sans-serif; font-size: 10pt;"> <span style="font-family: Arial,sans-serif; font-size: 10pt;">Varenicline works by affecting nicotine receptors in the brain by a binding to specific nicotine receptors as agonists. Varenicline mimics the effect of nicotine. It also acts as an antagonist by prohibiting pleasure gain from smoking by preventing nicotine binding to its receptors ( <span style="background-color: #ffffff; font-family: Arial,sans-serif; font-size: 10pt;">Tonnesen, 2009 <span style="font-family: Arial,sans-serif; font-size: 10pt;">). <span style="font-family: Arial,sans-serif; font-size: 10pt;"> In clinical trials, varenicline appears to be even more effective than bupropin, but Health Canada has since issued warnings of heart problems for people with cardiovascular disease ( <span style="background-color: #ffffff; font-family: Arial,sans-serif; font-size: 10pt;">Hart, Ksir, Hebb, Gilbert & Black, 2012). Nausea is also not uncommon (Cahill et al., 2013).
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Varenicline (Chantix/Champix) **

<span style="font-family: Arial,sans-serif; font-size: 10pt;">A meta-analysis was used to analyze 12 Chochrane reviews of the p <span style="font-family: Arial,sans-serif; font-size: 10pt; line-height: 1.5;">harmacotherapies used in assisting with smoking cessation. The results are as follows: <span style="font-family: Arial,sans-serif; font-size: 10pt;">Nicotine replacement therapy and bupropion are both equally effective in helping people quit (compared with a placebo), but varenicline was found to be more effective than the others. Varenicline also demonstrates to be more superior than any single type of NRT or bupropin. Despite the effectiveness of varenicline, combinations of NRT may be equally as effective (Cahill et al., 2013).
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Summary of Effectiveness **


 * <span style="color: #2e2e2e; font-family: Arial,sans-serif; font-size: 10pt;">Alternative Therapies **

<span style="color: #2e2e2e; font-family: Arial,sans-serif; font-size: 10pt;">Aversion therapy is a form of psychological treatment that works by pairing an unpleasant stimulus with a pleasurable one (ie. smoking a cigarette). The basis of this therapy is to condition a smoker to associate a stimulus (smoking) to an unpleasant sensation. One common procedure used is rapid smoking, (a person is instructed to puff more quickly) resulting in nausea ( <span style="background-color: #ffffff; font-family: Arial,sans-serif; font-size: 10pt;">Tonnesen, 2009).
 * <span style="color: #2e2e2e; font-family: Arial,sans-serif; font-size: 10pt;">Aversion therapy **

<span style="color: #2e2e2e; font-family: Arial,sans-serif; font-size: 10pt;">Other alternatives include acupuncture, hypnosis, and cue exposure (exposing smokers to smoking cues without the actual smoking). There is little to no evidence supporting the effectiveness of these alternative therapies. For example, a meta-analysis was conducted to compare control and active acupuncture in addition to a placebo. They found that acupuncture was no more effective than a placebo <span style="background-color: #ffffff; font-family: Arial,sans-serif; font-size: 10pt;"> (Tonnesen, 2009).

<span style="color: #2e2e2e; font-family: Arial,sans-serif; font-size: 10pt;">Exercise has only moderate effects on nicotine withdrawal, but it has been indicated that exercise can have a positive effect on the protective factors of relapse prevention. The evidence is insufficient to actually show that exercise has positive effects on smoking cessation ( <span style="background-color: #ffffff; font-family: Arial,sans-serif; font-size: 10pt;">Tonnesen, 2009).

<span style="color: #2e2e2e; font-family: Arial,sans-serif; font-size: 10pt;">Opioid antagonists are types of drugs that reduces the effects of narcotics (eg. heroin and morphine) by blocking receptor sites. It is thought to be able to help reduce nicotine addiction by blocking some rewarding effects of smoking. A Chochrane study conducted provided participants nicotine replacement therapy and tested for additional benefits from naltrexone (an opiod antagonist). What they found was that compared to a placebo, naltrexone did not increase the amount of people who had stopped smoking at the end of treatment, or even 6 months after. The same effect occurred with naltrexone taken alone or added to the nicotine replacement therapy <span style="background-color: #ffffff; font-family: Arial,sans-serif; font-size: 10pt;">(David, Lancaster, Stead, Evins & Prochaska, 2013).
 * <span style="color: #2e2e2e; font-family: Arial,sans-serif; font-size: 10pt;">Opioid Antagonists (Naltrexone) **