The Counselling Process ebooksclub.org Tobacco or Health Physiological and Social Damages Caused by Tobacco Smoking Second Edition

If฀smokers฀who฀wish฀to฀quit฀do฀not฀receive฀NRT฀with฀nicotine฀doses฀that฀are฀similar฀to฀ those฀obtained฀from฀cigarette฀smoking,฀they฀relapse฀at฀once.฀Naturally,฀these฀high฀initial฀ doses฀must฀be฀reduced฀as฀rapidly฀as฀possible,฀but฀in฀a฀way฀that฀reliably฀prevents฀relapses.฀ The฀risk฀of฀adverse฀effects฀through฀to฀intoxication฀exists฀only฀if฀ex-smokers฀additionally฀ smoke฀larger฀quantities฀of฀cigarettes฀during฀this฀period.

15.3 Experiences with Outpatient Smoker Counselling

In฀the฀2.5฀years฀since฀the฀Centre฀has฀been฀in฀existence,฀a฀total฀of฀1,000฀smokers,฀primar- ily฀ from฀ Thuringia฀ but฀ also฀ from฀ other฀ regions฀ of฀ Germany,฀ have฀ enrolled฀ with฀ the฀ intention฀of฀quitting฀smoking.฀History-taking฀revealed฀that฀these฀patients฀were฀highly฀dis- satisied฀with฀their฀smoker฀status,฀and฀many฀of฀them฀admitted฀that฀for฀years฀they฀had฀ wanted฀to฀quit฀the฀habit,฀but฀had฀been฀prevented฀from฀doing฀so฀by฀their฀degree฀of฀depen- dence.฀Over฀the฀intervening฀period,฀smokers฀for฀whom฀smoking฀cessation฀is฀an฀urgent฀ necessity฀on฀medical฀grounds฀have฀also฀been฀referred฀to฀the฀Centre฀by฀their฀doctors.฀After฀ an฀ initial฀ consultation,฀ patients฀ from฀ other฀ German฀ regions฀ have฀ then฀ undergone฀ tele- phone฀counselling฀and฀successfully฀achieved฀smoking฀cessation.฀Among฀the฀patients฀at฀ the฀Centre,฀ive฀had฀already฀withdrawn฀from฀alcohol฀and฀successfully฀remained฀tobacco- abstinent฀for฀6฀months. On฀average,฀female฀smokers฀have฀smoked฀20฀cigarettesday฀for฀17฀years,฀while฀male฀ smokers฀have฀smoked฀25฀cigarettesday฀for฀20–25฀years.฀The฀very฀heaviest฀smokers฀consume฀ 80–100฀cigarettesday.฀Attempts฀at฀smoking฀cessation฀initiated฀by฀the฀smokers฀themselves฀ have฀lasted฀for฀a฀maximum฀4฀weeks฀in฀women฀and฀generally฀for฀only฀1฀week฀in฀men. The฀Fagerström฀Test฀in฀women฀has฀revealed฀scores฀of฀4–6฀for฀the฀most฀part,฀with฀scores฀ of฀7–10฀in฀isolated฀cases฀only,฀whereas฀in฀men฀scores฀of฀4–6฀or฀7–10฀were฀recorded฀with฀ equal฀frequency.฀At฀the฀start฀of฀treatment,฀the฀smokers฀had฀an฀average฀CO฀level฀in฀expired฀ air฀of฀21฀ppm.฀On฀the฀completion฀of฀successful฀treatment,฀levels฀of฀5฀ppm฀were฀recorded.฀ CO฀levels฀of฀80฀ppm฀were฀measured฀initially฀in฀four฀cases.฀For฀ex-smokers,฀the฀measure- ment฀of฀this฀variable฀was฀an฀important฀marker฀of฀success฀in฀cases฀where฀smoking฀cessation฀ was฀achieved. Further฀ appointments฀ with฀ ex-smokers฀ at฀ weekly฀ or฀ fortnightly฀ intervals฀ are฀ useful,฀ particularly฀at฀the฀start฀of฀treatment.฀Approximately฀25฀of฀smokers฀who฀attend฀a฀irst฀ appointment฀fail฀to฀return฀subsequently.฀A฀further฀25฀give฀up฀the฀treatment฀after฀4–8฀ weeks฀because฀they฀have฀relapsed.฀Also฀of฀importance฀is฀the฀patients’฀experience฀of฀leav- ing฀the฀irst฀consultation฀–฀supplied฀with฀NRT฀products฀–฀without฀having฀the฀craving฀to฀ smoke.฀ This฀ abstinence฀ from฀ smoking฀ was฀ also฀ conirmed฀ by฀ virtually฀ all฀ ex-smokers฀ 97฀during฀the฀following฀week฀and฀should฀be฀interpreted฀as฀a฀key฀experience:฀“The฀feel- ing฀that฀it฀is฀not฀necessary฀to฀smoke.”฀In฀this฀context,฀it฀is฀important฀that฀smokers฀obtain฀ their฀nicotine฀products฀immediately฀from฀a฀nearby฀pharmacy.฀If฀the฀continuous฀supply฀of฀ nicotine฀is฀not฀guaranteed฀immediately฀after฀the฀irst฀consultation,฀patients฀turn฀back฀to฀ cigarettes฀and฀thus,฀start฀to฀smoke฀again.

15.4 Success in Smoking Cessation

An฀analysis฀of฀the฀116฀smokers฀attending฀our฀Centre฀during฀the฀irst฀6฀months฀of฀2,000฀ reveals฀that,฀of฀those฀seen฀for฀the฀irst฀time,฀a฀total฀of฀86฀smokers฀returned฀for฀further฀consul- tations฀after฀the฀irst฀session.฀These฀86฀individuals฀evidently฀intended฀to฀undergo฀smoking฀ cessation฀therapy,฀whereas฀the฀remaining฀30฀patients฀attended฀simply฀to฀obtain฀information฀ and฀were฀not฀included฀in฀the฀analysis฀because฀they฀did฀not฀even฀attempt฀smoking฀cessation.฀ In฀a฀speciic฀telephone฀interview,฀21฀male฀and฀17฀female฀patients฀reliably฀stated฀that฀they฀had฀ been฀abstinent฀from฀cigarettes฀for฀at฀least฀6฀months฀corroborated฀by฀CO฀measurements.฀The฀ calculated฀success฀rate฀was,฀therefore,฀44.7฀for฀males฀21฀out฀of฀47฀and฀43.6฀for฀females฀ 17฀out฀of฀39.฀These฀percentages฀are฀clearly฀higher฀than฀the฀success฀rates฀of฀20–30฀reported฀ in฀the฀literature.฀In฀the฀meantime,฀we฀included฀200฀smokers฀into฀a฀controlled฀study฀to฀evalu- ate฀the฀eficacy฀of฀NRT฀under฀standardized฀conditions.฀The฀results฀will฀be฀evaluated฀in฀the฀ beginning฀of฀2003.

15.5 Concluding Remarks

PR฀campaigns฀and฀notices฀in฀the฀press฀should฀be฀used฀repeatedly฀to฀reinforce฀the฀exis- •฀ tence฀and฀availability฀of฀Smoker฀Counselling฀Centres. Smoking฀cessation฀therapy฀is฀successful฀particularly฀if฀the฀physician฀simultaneously฀ •฀ shows฀“strong฀support”฀for฀the฀patient฀in฀terms฀of฀counselling฀input฀and฀initiates฀NRT฀ with฀suficiently฀high฀nicotine฀doses.฀It฀is฀also฀important฀for฀smokers฀to฀realise฀that฀they฀ can฀ leave฀ the฀ counselling฀ session฀ in฀ the฀ afternoon฀ without฀ smoking฀ a฀ cigarette฀ afterwards. In฀addition,฀patients฀should฀be฀supplied฀promptly฀with฀nicotine฀replacement฀drugs฀from฀ •฀ a฀nearby฀pharmacy฀to฀ensure฀that฀the฀decision฀to฀quit฀smoking฀is฀not฀frustrated฀right฀at฀ the฀outset฀by฀an฀organisational฀obstacle.