Smoking Cessation (Holistic)

While cigarette smoking is declining in many Western countries, more than 20% of US adults continue to smoke.¹ However, studies show that 70% of them would like to quit.^{2, 3} In many countries, major public health efforts are in place to encourage smokers to quit.^{4, 5} Since many attempts to quit smoking are not permanent, it may be important to take advantage of a variety of strategies to increase the chances of success.^{6, 7}

Smoking cessation can result in improved health, including reduced risk of heart and lung diseases, many cancers, pregnancy complications, and other health problems. Soon after quitting, most smokers notice that coughing declines and that ordinary activities no longer result in shortness of breath. Also, smokers find that their teeth stain less easily, their breath is fresher, and food tastes better as their senses of taste and smell return to normal. However, smoking cessation can lead to short-term symptoms such as irritability, depression, difficulty sleeping or concentrating, headaches, and fatigue, due to the physical effects of nicotine withdrawal and the psychological effects of giving up a habit. Quitting smoking often leads to weight gain as well.

Smoking cessation often leads to weight gain, which can dissuade smokers from trying to quit or cause them to resume smoking.^{8, 9} Increasing physical activity after quitting smoking can minimize weight gain, and a controlled trial found that adding exercise to a smoking cessation behavioral counseling program improved abstinence rates.^{10, 11} However, other, smaller studies have not shown that exercise either alone or added to a comprehensive program helps to maintain abstinence.^{12, 13} Adding weight control through dieting to smoking-cessation programs has resulted in either an increase in smoking relapses or no effect.^{14, 15} Changing the diet at the same time as quitting smoking may require more discipline than most people can achieve.

In the year 2000, the United States Public Health Service published updated smoking-cessation guidelines for doctors.¹⁶ This report identified counseling and behavioral therapies as proven effective components of a smoking-cessation program. Effective components include providing basic information about successful quitting, identifying factors that will increase the risk of relapse, and teaching problem-solving and coping skills. Also effective is social support provided either in a healthcare setting (for example, being able to talk about the quitting process with a doctor) or by strategies that teach the quitter to build a support network among friends, family, and the community. Guidelines issued in other countries have reached similar conclusions about the effectiveness of counseling and behavioral therapies.¹⁷ Government-sponsored, free counseling resources in North America include Quitline [800-QUIT-NOW] and SmokeFree (www.smokefree.gov). Group or individual counseling is often a component of successful smoking cessation programs offered in schools and the workplace.^{18, 19}

People tend to smoke more often under conditions of stress. Those who achieve long-term success in quitting smoking have been shown to have more social support and less stress than people who eventually relapse.²⁰ Stress-reduction techniques that have been shown in controlled trials to be effective for assisting smoking cessation include self-massage, guided relaxation imagery, and exercise.^{21, 22, 23}

Some research indicates that the effectiveness of acupuncture on abstinence from smoking is similar to that reported for nicotine chewing gum and behavioral therapy, and that these methods can complement each other.²⁴ One controlled trial showed that daily cigarette consumption decreased more significantly during acupuncture treatment to points associated with smoking cessation than in fake acupuncture treatment (i.e., acupuncture applied to points not associated with smoking cessation). Altogether, 31% of subjects in the treatment group had quit smoking completely at the end of the treatment, compared with none in the control group.²⁵ Electroacupuncture treatment to points on the ear has also been shown to aid in smoking cessation compared with fake ear acupuncture in a controlled trial.²⁶ However, most clinical trials have not achieved comparable results. An analysis of 22 studies found that while acupuncture is often as effective as other smoking cessation techniques, its effectiveness does not last very long. Moreover, in most studies the overall effect of real acupuncture was no better on average than fake acupuncture for smoking cessation.²⁷

A controlled clinical trial showed that people undergoing single hypnosis sessions smoked significantly fewer cigarettes and had a higher frequency of abstinence than a placebo control group.²⁸ However, most clinical trials have not corroborated these results.²⁹ A review of 59 studies of hypnosis and smoking cessation concluded that hypnosis "cannot be considered a specific and efficacious treatment for smoking cessation."³⁰