Nursing Involvement ebooksclub.org Tobacco or Health Physiological and Social Damages Caused by Tobacco Smoking Second Edition

to฀be฀broken฀down฀in฀stages฀by฀recording฀them.฀Key฀aspects฀of฀the฀treatment฀strategy฀are฀ the฀ initial฀ boosting฀ of฀ motivation฀ non-smoking฀ is฀ better,฀ increased฀ self-observation฀ documenting฀cigarette฀consumption฀to฀make฀smoking฀habits฀transparent฀and฀developing฀ individual฀techniques฀for฀coping฀with฀cravings.฀Smokers฀must฀gradually฀realise฀that฀absti- nence฀is฀attractive฀and฀they฀must฀be฀prepared฀for฀the฀possibility฀of฀relapses.฀The฀system฀ also฀enables฀smokers฀to฀learn฀a฀relaxation฀technique฀that฀should฀always฀be฀used฀when฀crav- ings฀arise.฀Since฀the฀possibility฀of฀weight฀gain฀can฀undo฀the฀beneit฀of฀cessation,฀quitting฀ smokers฀should฀be฀prepared฀for฀this฀eventuality฀ Chap.฀11 ,฀Sect.฀ 11.5.3 .฀It฀is฀important฀to฀ develop฀new฀behaviours฀and฀to฀set฀rewards฀for฀goals฀achieved.฀However,฀since฀the฀physi- cal฀dependence฀also฀has฀to฀be฀treated,฀adjunctive฀NRT฀also฀alleviates฀the฀symptoms฀of฀ withdrawal฀see฀ Chap.฀11 ,฀Sect.฀ 11.1.1 . The฀treatment฀uses฀elements฀of฀behavioural฀therapy฀sanctions฀or฀“punishments”฀[for- merly฀also฀learning฀aversive฀responses฀such฀as฀nausea฀and฀vomiting],฀identifying฀alterna- tive฀actions,฀support฀measures฀for฀quitting฀smoking฀and฀may฀be฀conducted฀individually,฀ in฀a฀group฀or฀with฀a฀self-help฀manual.฀In฀13฀studies฀comparing฀a฀group฀programme฀with฀a฀ self-help฀programme,฀there฀was฀an฀increase฀in฀smoking฀cessation฀with฀a฀group฀programme฀ OR฀=฀2.10;฀CI:฀1.64–2.70.฀Group฀programmes฀were฀more฀effective฀than฀no฀intervention฀ or฀minimal-contact฀interventions฀OR฀=฀1.91;฀CI:฀1.20–3.04.฀There฀was฀no฀evidence฀that฀ manipulating฀the฀social฀interactions฀between฀participants฀in฀a฀group฀programme฀had฀an฀ effect฀on฀outcome฀ [70] .฀In฀every฀case,฀however,฀biochemical฀markers฀should฀be฀included฀ when฀assessing฀success.฀Overall,฀interpretation฀of฀results฀is฀rendered฀dificult฀because฀the฀ study฀objectives฀were฀very฀differently฀deined.฀Behavioural฀therapy฀can฀be฀implemented฀in฀ weekly฀group฀sessions฀10–15฀smokers,฀particularly฀since฀individual฀treatment฀is฀far฀too฀ personnel-intensive฀ and฀ will,฀ therefore,฀ fail.฀ For฀ the฀ most฀ part,฀ a฀ 5–10-week฀ course฀ of฀ treatment฀is฀required฀ [71,฀72] .฀Shorter฀treatments฀often฀leave฀the฀ex-smoker฀to฀cope฀alone฀ with฀the฀late฀symptoms฀of฀withdrawal.

10.7 Aversion Therapy

Aversion฀therapy฀is฀based฀on฀pairing฀the฀“pleasurable”฀event฀with฀an฀unpleasant฀physical฀ stimulus.฀It฀may฀be฀regarded฀as฀a฀form฀of฀behavioural฀therapy฀designed฀to฀correct฀certain฀ behaviours฀such฀as฀dependence฀e.g.฀on฀cigarettes฀or฀excessive฀eating฀ [73] .฀In฀this฀context,฀ the฀best-known฀technique฀is฀that฀of฀rapid฀and฀increased฀cigarette฀consumption฀ [74] ,฀the฀ target฀being฀one฀puff฀every฀6–10฀s.฀After฀3฀min,฀generally,฀the฀smoker฀reaches฀the฀point฀at฀ which฀nausea฀develops.฀Some฀smokers฀need฀three฀cigarettes฀in฀this฀period.฀This฀“mild”฀ nicotine฀overdose฀dizziness,฀nausea,฀vomiting฀is฀intended฀to฀develop฀aversion.฀These฀ methods฀are฀hardly฀used฀at฀all฀today฀and฀they฀may฀even฀be฀dangerous฀for฀patients฀who฀are฀ at฀risk฀coronary฀heart฀disease,฀etc.฀ [75] ,฀though฀the฀contrary฀view฀also฀exists฀ [9,฀26,฀76] .฀ As฀soon฀as฀the฀symptoms฀of฀overdose฀have฀resolved,฀the฀procedure฀may฀be฀repeated,฀with฀ 3–10฀such฀sessions฀being฀reported฀in฀different฀studies.฀As฀far฀as฀possible,฀smokers฀should฀ not฀ smoke฀ between฀ sessions.฀ One฀ summary฀ review฀ of฀ 35,000฀ smokers฀ who฀ have฀ been฀