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Rethinking the traditional approach to smoking cessation

Anne Joseph M.D., M.P.H.

Imagine you’d been diagnosed with high blood pressure and had started taking a medication to control it. At your follow-up appointment, if you hadn’t reached your target goal, would your doctor say, “Well, sorry that didn’t work out,” and send you on your way?

Of course not. He or she might adjust the dose, add a medication, or encourage you to lose weight.

Masonic Cancer Center researcher Anne Joseph, M.D., M.P.H., has designed a smoking cessation program that takes a similar stepped approach.

Typically, people who seek help with quitting receive one-time medications and counseling for six to 12 weeks.

“The odds are against their being successful,” says Joseph. “For the first few months after quitting, they’re quite vulnerable to relapse. To assume that people are going to be fine after treatment is not realistic.”

With this in mind, Joseph and her University colleagues in cancer prevention created a program that allows for setbacks, encourages interim goals—such as reducing smoking while working toward quitting altogether—and extends counseling and nicotine replacement therapy for as long as needed.

The group conducted a clinical trial that compared its year-long program with the eight-week “usual care” treatment for tobacco dependence. The longer-term approach proved about 75 percent more effective than the shorter treatment. Many participants said they felt a sense of accountability to their counselor, and relapse wasn’t seen as the end of the world.

Joseph notes that most smokers really do want to quit.

“Persistence is key,” she tells them. “Don’t give up easily if things don’t go perfectly well.”

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