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1. Tobacco Addiction and
Nicotine Dependence
2. Nicotine Replacement Therapy
and Treatment Approaches
1
Statistics of Hong Kong
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793,200 daily & occasional smokers in 2006, or
14% of population aged 15 or over
Of 2006 population, 24.5% of men and 4% of
women are every day smokers
59.6% of daily smokers started smoking before
age 19
Men on average smoked 14 cigarettes a day,
women smoked 10 cigarettes a day
2
Tobacco dependence
Tobacco dependence
=
Pharmacological
(nicotine)
+
Behavioural dependence
(hand-to-mouth ritual)
3
What is in tobacco smoke



Tobacco smoke contains over 4,000 chemicals,
including at least 50 that are known to cause
cancer
Three of the main components are nicotine,
carbon monoxide and tar
Nicotine is what makes smoking addictive, while
carbon monoxide and tar can cause serious
diseases
4
Nicotine


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
Powerful, fast-acting drug and is one of the most addictive
substances on the planet
Most people who smoke become dependent on the nicotine they
get from cigarettes
Nicotine has many complex effects on the body, including
increasing the heart rate and blood pressure, and speeding up the
metabolism
Nicotine also affects the mood and behaviour of the smoker
5
Nicotine


Nicotine acts as an agonist at nicotinic cholinergic receptors at
the autonomic ganglia, neuromuscular junctions and in the brain
Nicotine’s positive reinforcing properties are believed to be the
result of the release of neurotransmitters including

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Acetylcholine
Beta-endorphin
Dopamine
Noradrenaline
Serotonin and others
that mediate pleasure, arousal, elevated mood, appetite, and other
desirable psychological states
6
Nicotine



Nicotine activates the dopamine reward pathway in
midbrain, a network of nerve tissues that elicits feelings
of pleasure
Immediately after inhalation, a bolus of nicotine enters
the CNS, stimulating release of dopamine which
induces nearly immediate feelings of pleasure, along
with relief of symptoms of nicotine withdrawal
Rapid dose response reinforces repeated administration
and perpetuates smoking behaviour
7
Nicotine



Chronic administration of nicotine has been shown to
result in an increased number of nicotine receptors in
specific areas of brain
Receptor upregulations leads to development of
tolerance (repeated dose produce less of an effect than
did the initial exposure)
Tobacco users become adept (highly skilled) at titrating
their nicotine levels throughout the day to avoid
withdrawal symptoms, to maintain pleasure and arousal,
and to modulate mood
8
Tar
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Sticky brown substance that stains smokers’ fingers and
teeth yellowy brown
When a smoker inhales, about 70 per cent of the tar in
the smoke stays in the lungs
Many of the substances in tar are already known to
cause cancer
Irritants in tar can also damage the lungs by causing
narrowing of the bronchioles, and damaging the cilia
that help protect the lungs from dirt and infection
9
Carbon monoxide

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A poisonous gas found in high concentrations in
tobacco smoke
Large amounts can kill
Carbon monoxide lowers the oxygen in the
bloodstream by up to 15 per cent, cutting down the
efficiency of the lungs
Cells and tissues need oxygen to function efficiently
Carbon monoxide is especially harmful during
pregnancy as it reduces the amount of oxygen carried
to the womb and baby
10
Other chemicals in cigarette smoke
11
Risks of continued smoking
Heart and
circulation
Cancers
Respiratory
Others
Coronary heart disease, heart attacks,
arteriosclerosis
Lung, mouth, nose and throat, larynx,
oesophagus, pancreas, bladder, stomach,
leukemia, kidney
Chronic bronchitis, chronic obstructive
pulmonary disease, emphysema (swollen
with air), recurrent infections in airways,
loss in pulmonary functions
Impotence, peptic ulcers, adverse effects on
fertility
12
13
Why it is worth giving up
14
Benefits of quitting
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Save money
Provide your beloved ones a smoke-free environment
Be free from the odour of smoking
Get rid of tar-stained teeth and fingers
Establish a healthy look
Improve your sense of taste and smell
Be less likely in getting heart disease, stroke or cancer
15
16
Ways to stop smoking
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Cold turkey
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Cutting down
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Reducing the number of cigarettes over a period of time
If the period is too long, it may make giving up more difficult
Pharmacotherapy
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Stopping smoking immediately and completely
As assistance to smoking cessation
Alternative treatments
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Hypnosis, acupuncture and complementary therapies may help
No formal evidence for efficacy
17
Cold turkey
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Stopping without any kind of aid
Despite its addictive nature, nicotine does not
hang around in body long (about 48 hours) once
you have stopped smoking
Although physical symptoms can be more
extreme in the early few days, they fade away
within the first two or three weeks.
Most people give up smoking using this method
18
Cutting down
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Smoke only half of each cigarette
Each day, postpone the lighting of first cigarette 1 hour
Decide to smoke only during odd or even hours of the day
Decide beforehand how many cigarettes to smoke during
the day. For each additional cigarette, give a dollar to
favorite charity
Change the eating habits to help cutting down
Reach for a glass of juice instead of a cigarette for a "pickme-up”
Cutting down can help quitting, but it's not a
substitute for quitting
19
Pharmacotherapy

Pharmacotherapy in smoking cessation can be
classified as
Nicotine replacement therapy
 Non-nicotine replacement therapy

20
Nicotine replacement therapy (NRT)


Allow smokers to overcome the physiological
dependence on nicotine by gradually reducing
nicotine intake
Provides smokers with craving relief, but
without the other harmful ingredients in
tobacco
21
How nicotine replacement therapy
(NRT) works
22
How nicotine replacement therapy
(NRT) works

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Nicotine from NRT is well absorbed
Onset of action of NRT is not as rapid as
cigarette smoking
Patients who use NRT become less habituated
to the nearly immediate, reinforcing effects of
nicotine
23
Nicotine replacement therapy (NRT)

Clinical efficacy
Reduces physical withdrawal symptoms and lets one
concentrate on the other changes needed to make as
one quits smoking
 Studies have shown that the use of NRT could
double the chance of success

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Up to 6 times if receiving thorough counseling
However, the most important factor for successful
smoking cessation still lies on the will to quit
24
Nicotine replacement therapy

Includes
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Nicotine gum
Nicotine patch
Nicotine inhaler
Nicotine sublingual tablet
(available in other
countries)
Nicotine nasal spray
(available in other
countries)
25
Nicotine gum
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Nicotine in an ion-exchange resin in gum base
Absorption occurs at the buccal mucosa
Intermediate in CNS delivery speed
Serum nicotine levels reach a peak in 20-30
minutes
26
Nicotine gum
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Products available
Nicotinell®
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Fruit/mint chewing gum
2 mg, 4 mg
Nicorette®

Ordinary/freshmint
chewing gum 2 mg, 4 mg
27
Nicotine gum

Which smokers are most suitable
Smokers with an irregular smoking pattern
 Provides oral gratification
 4 mg gum most suitable for highly dependent
smokers
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More than 20 cigarettes per day
 First cigarette within 20 minutes of waking
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28
Nicotine gum
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Reference dosage and duration of use
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For people who smoke more than 20 cigarettes per day, they
may require 4 mg preparation
For those who smoke less than 20 cigarettes per day, the 2 mg
preparation is usually sufficient
Initial dosage 8 to 12 pieces per day
Daily dosage should not exceed
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25 pieces of 2 mg gum
15 pieces of 4 mg gum
The optimal duration of use for most people is about 12
weeks
29
Nicotine gum

Instruction to use nicotine gum
“Bite-park” chewing method
 Each gum can last for 30 minutes
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30
Nicotine gum
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Tips for using nicotine gum
Avoid acidic beverages such as coffee, juice or soft
drink 15 minutes before or while using the gum
 Correct usage of NRT is very important. Incorrect
method of chewing not only affect the effectiveness
of the nicotine gum, it may also cause side effects
such as sore throat, hiccup or heartburn
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31
Nicotine gum
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Contraindications and Warnings
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Nicotine gum should be avoided in individuals with recent
myocardial infarction, unstable angina pectoris, serious
cardiac arrhythmias, or active duodenal or gastric ulcers
Pregnant smokers should always be advised to stop smoking
completely without using NRT
Use of nicotine gum by the pregnant smoker should only be
initiated following advice from a physician.
32
Nicotine gum
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Side effects
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flatulence
Indigestion
Nausea
Unpleasant taste
Hiccup
Sore moth, throat and jaw
Correct use of the gum is important in maintaining
sufficient nicotine levels while minimizing side effects
33
Nicotine lozenge
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Product available
Nicotinell® lozenge
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1 mg nicotine in a sugarfree mint flavoured base
34
Nicotine lozenge
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Absorption occurs at the buccal mucosa
Intermediate in CNS delivery speed, similar to
nicotine gum
Serum nicotine levels reach a peak in 20-30
minutes
Unlike gum, lozenge actually provides more
nicotine because it dissolves completely,
delivering the entire dose
35
Nicotine lozenge

Which smokers are most suitable
Smokers with low nicotine dependency (less than 20
cigarettes per day)
 Also good for those who cannot chew gum, e.g.
dentures
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Instructions
Suck a lozenge until flavour becomes strong
 Hide lozenge between the gum and cheek
 Each lozenge lasts about 30 minutes
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36
Nicotine lozenge
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Reference dosage and duration of use
1 lozenge every 1 to 2 hours
 8 to 12 lozenge per day
 Not more than 25 pieces per day
 Aim to cut down in 3 months
 Not to be used for more than 6 months

37
Nicotine lozenge

Contraindications and warnings
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Similar to nicotine gum
Side effects (due to swallowed nicotine)
Heartburn
 Hiccup
 Nausea
 Headache
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38
Nicotine patch
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Transdermal delivery system
The skin patch delivers a steady dose of nicotine
through the skin
This reduces craving for nicotine and lets one
focus on changing the behaviors which associate
with tobacco use
39
Nicotine patch
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Delivers nicotine to CNS more slowly than
other dosage forms
6-8 hours to reach peak serum levels
Higher doses of transdermal nicotine appear to
be more effective than lower doses
Largest strength and moderate strength patches
for initial treatment
Lowest strength for tapering only
40
Nicotine patch
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Products available
Nicotinell TTS®
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21 mg (30 cm2)
14 mg (20 cm2)
7 mg (10 cm2)
per 24 hours
Nicorette®
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15 mg (Step 1)
10 mg (Step 2)
5 mg (Step 3)
per 16 hours
41
Nicotine patch
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Nicotinell® TTS patch
24-hour patch
 Useful if patient usually gets up for a cigarette
during the night
 May disturb sleep
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Nicorette® patch
16-hour patch
 For regular smokers
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42
Nicotine patch
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Which smokers are most suitable
Smokers with a regular smoking pattern
 Moderately dependent smokers (10-20 cigarettes per
day)
 Those who prefer

The convenience of a patch
 Not to chew gum or suck lozenge, e.g. dentures, dental
problem
 Those with gastric ulcer or diabetes
 Those with low behavioural dependence

43
Nicotine patch
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Tips for using Nicotine Patch
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16-hour patch
Keep the patch attached at all times except sleeping hours
 Remove the patch before you go to bed
 Apply a new patch in the morning
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24-hour patch
The patch should be attached at all times
 Change it daily at a regular time
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44
Nicotine patch
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Tips for using nicotine patch
Apply to clean, dry and non-hairy sites on upper
body including arms and back
 Do not apply to inflamed or broken skin
 Do not apply any sorts of cream, powder or
medication over the same site of the patch
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45
Nicotine patch
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Tips for using nicotine patch
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Gently press the patch onto the site you have chosen for 10
minutes
Avoid touching the adhesive side of the patch during
application
Do not peel it off to check whether it is fixed or not
Usually the patch will not drop off even during bathing or
swimming
If it comes off, apply a new one
Wash hands after application to avoid local contamination of
the eyes
46
Nicotine patch
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Tips for using nicotine patch
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Daily change the patch site so as to avoid skin irritation
Wait for at least 3 days before using the same area again
Unnecessary prolonged application not only affects the
effectiveness of the nicotine patch, it may also cause skin
irritation
Before disposing a patch, fold it in half with the sticky sides
together
Dispose patches out of reach of children
47
Nicotine patch

Reference dosage and duration of use
16-hour and 24-hour patches to suit different
people's needs
 Treatment begins with
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15 mg (Step 1) or 10 mg (step 2) for 16-hour patch
 21 mg (30 cm2) or 14 mg (20 cm2) for 24-hour patch
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Transfer to lower dose patch after 12 weeks then
taper off
48
Nicotine patch
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Side effects
Generally well tolerated
 Patients discontinue nicotine patch because:
 Pruritus at the patch site
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Patient may be able to tolerate a different brand
Insomnia or vivid dreams
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Remove the patch at bedtime (i.e. using the 16-hour patch)
usually minimizes or eliminates sleep disturbances
49
Nicotine inhaler
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
The size and shape of
the inhaler resembles a
cigarette
A replaceable cartridge
that fits inside the inhaler
releases small amount of
nicotine when one
inhales air through it
50
Nicotine inhaler
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Inhalation causes air saturated with vaporized
nicotine to be drawn into the upper respiratory
tract
Absorption occurs in the buccal mucosa
Useful for people who miss the hand-to-mouth
action of smoking
51
Nicotine inhaler
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Product available
Nicorette® inhaler
10 mg nicotine in porous polyethylene catridges
packed in closed blister trays
 With reusable mouthpiece inhaler

52
Nicotine inhaler

How supplied
Each cartridge contains 10 mg nicotine
 Continuous puffing (e.g. 3 to 4 times a minute), the
cartridge can last for about 20 minutes

53
Nicotine inhaler

Which smokers are most suitable
Highly behavioural-dependent smokers
 Smokers of 20 or less cigarettes per day
 Those with dental problems or cannot chew gum or
suck lozenge

54
Nicotine inhaler

Reference dosage and duration of use
Initial treatment period is normally 3 months
 Gradually reduce dosage during next 6 to 8 weeks
 Use beyond 6 months is not recommended
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55
Nicotine inhaler
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Instructions for the use of Nicotine Inhaler
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Pull apart the two sections of the inhaler
Place a cartridge inside the inhaler
Re-assemble the inhaler. As you push the two sections
together, the inhaler pierces the seal on each end of the
cartridge
56
Nicotine inhaler

Instructions for the use of Nicotine Inhaler
Suck the mouthpiece. Breathe in gently drawing the
air into the mouth and hold the air for a few seconds
before breathing out.
 One may also puff on the inhaler for several times
(e.g. 3 to 4 times a minute)

57
Nicotine inhaler

Tips for using the nicotine inhaler
No difference between shallow puffing and deep
inhalation
 Works best at room temperature
 One may feel a slight soreness or dryness in mouth
and throat in the first few days. Drink more water to
relieve the sensation
 Avoid acidic beverages such as coffee, juice or soft
drink 15 minutes before or while using the inhaler

58
Nicotine inhaler

Tips for using the nicotine inhaler
Nicotine strength is reduced when the sealing is
broken
 Open cartridges should not be used the next day
 Cartridges contain nicotine even after use and
should be disposed of as normal household waste
out of the reach of children
 Always keep cartridges and inhaler in closed plastic
container provided when not in use

59
Nicotine inhaler

Side effects
Minor mouth and throat irritation
 Cough
 Rhinitis

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Tolerance to irritating effects usually occurs
within a day or two
60
Other nicotine replacement therapy
dosage forms

Other nicotine replacement therapy forms (not
available in Hong Kong)
Nicotine sublingual tablet
 Nicotine nasal spray

61
Nicotine sublingual tablet
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Nicorette® microtab
2 mg microtab packed in
blister disks
With dispenser to assist in
removing the tablets from
the blister
To be dissolved under the
tongue and NOT swallowed
or chewed

First-pass effect will decrease
the amount of nicotine
62
Nicotine sublingual tablet

Dosage
< 20 cigarettes per day: 1 microtab every hour
 > 20 cigarettes per day: 2 microtabs every hours if
required
 Not more than 40 microtabs per day
 Aim to reduce dosage after 12 weeks
 Do not use microtabs for more than 6 months

63
Nicotine nasal spray
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Nicorette® nasal spray
0.5 mg/spray nicotine
Absorption of nicotine
through the nasal lining
64
Nicotine nasal spray
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Delivers a peak level to CNS in 5 minutes
By far the fastest of all nicotine formulations
(but still much slower than cigarettes)
May use the spray in each nostril up to twice in
any hour
Do not use more than 64 sprays in any period
of 24 hours
65
Nicotine nasal spray
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Side effects
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Transient burning and stinging of nasal mucosa
Throat irritation
Coughing
Sneezing, rhinorrhoea
Lacrimation
Nausea
Usually lasting only a few seconds, and diminishing
after about a week
66
Nicotine replacement therapy (NRT)
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Available without prescription at pharmacy
Requires strong will to quit
Must not smoke while using NRT ?
Does not “replace” tobacco, just a less harmful
substitute to tobacco
Aim at
Sufficient duration of therapy
 Tapering down nicotine at regular time intervals

67
Can anyone use NRT?

Caution in patients with
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Cardiovascular (hypertension, arrhythmia, severe or
worsening angina, during immediate post-myocardial
infarction period)
Peripheral vascular diseases
Renal or hepatic insufficiency
Diabetes
Peptic ulcer
Thyroid disorders
Elderly, pregnancy and lactation
68
Pregnancy and NRT
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Nicotine is classified as pregnancy category D drug by
the FDA
Pregnant smokers should always be advised to stop
smoking completely without using NRT
Despite potential risks, use of NRT during pregnancy is
probably safer than smoking in selected patients who
are unable to quit using non-pharmacological methods
alone
Pregnant smokers should always seek medical
consultation on smoking cessation
69
Key points for NRT
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A minimum of 6 weeks initial treatment period
Highlight the importance of strong will and
gradual reduction in dosage
Differentiate the symptoms of withdrawal from
side effects of nicotine therapy
Cautions, contraindications and pregnancy
70
Advice on NRT
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Advise them to pick a Quit Day, a not-too-distant date when
they will give up smoking completely and start using NRT
Suggest that they ask a friend to give up smoking with them.
Sharing a goal with someone else will help them know they're
not alone
Tell them to get rid of temptation by throwing out any cigarettes
or other smoking materials and by avoiding smoky places like
pubs. Suggest that they ask smokers they know not to offer them
cigarettes
Tell them to take it one day at a time. They should see each
smoke-free day as an achievement
71
Advice on NRT
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Advise them to keep busy whenever they feel the urge for a
cigarette.
Remind them of the money they'll save when they give up
buying cigarettes. Suggest they put this money aside in a pot
labelled 'Cash not ash' until they have enough to reward
themselves with a treat
Advise against replacing cigarettes with food - ex-smokers often
put on weight when they've given up. If your customer does
want to diet, suggest that they concentrate on giving up smoking
first, for about a month say, and then think about dieting.
Reassure them that if at first they don't succeed they can try
again with NRT at a later date. Most successful long-term exsmokers had to try to stop several times.
72
Non-nicotine replacement therapy

FDA-approved


Bupropion
Other non FDA-approved medications
Clonidine
 Nortriptyline

73
Bupropion
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
Bupropion (Zyban®)
A medication originally developed and marketed to
treat depression under the name of Wellbutrin®
The first non-nicotine medication shown to be effective
for smoking cessation and indication approved by the
U.S. Food and Drug Administration (FDA)
Available in Hong Kong upon a prescription
74
Bupropion

Mechanism of action
Dopaminergic-noradrenergic reuptake inhibitor
 Inhibit weakly the neuronal uptake of dopamine,
noradrenline and serotonin but does not inhibit
monoamine oxidase
 Its mechanism in enhancing the ability of patients to
abstain from smoking is unknown


Product available

150 mg sustained release tablet
75
Bupropion

Dosage
Treatment should begin 1 week before patient stops
smoking
 150 mg in the morning for 3 days, then increase to
150 mg twice daily for 7-12 weeks
 Maximum daily dose 300 mg
 Can be used alone or with nicotine replacement
therapy

76
Bupropion
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Side effects
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dry mouth
difficulty sleeping
headache
decreased appetite
dizziness
sweating
nausea
increased or irregular heart beat
agitation / anxiety
These side effects usually lessen with continued use of
the medication
77
Bupropion

Contraindications and warning


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
Seizures (or taking medication that might increase the likelihood of
having a seizure)
Epilepsy (or a family history of epilepsy)
Significant head trauma
Stroke
Brain tumour
Brain surgery
Anorexia or bulimia
Taking monoamine oxidase inhibitor (MAOI) within the previous 14 days
Patients undergoing abrupt discontinuation of alcohol or sedatives
(including benzodiazepines)
78
Bupropion

Points to note
Patients should be made aware that Zyban®
contains the same active ingredient as Wellbutrin®
 Significant drug interactions (CYP450 2D6)



Enzyme inducing anticonvulsants e.g. phenytoin,
carbamazepine, phenobarbitone may decrease bupropion
levels
Possible drug interactions, e.g.
Fluoxetine may decrease bupropion levels
 Bupropion may increase levels of imipramine

79
Clinical efficacy of first line FDA
approved agents
80
Success Rate and Evidence Rating
Single therapies
Evidence
rating
Quit rate at 6 months
(%)
Brief physician advice
A
2-10
Telephone counseling
A
5-19
Self-help materials
B
7-27
Nicotine patch
A
8-21
Nicotine spray
A
30
Nicotine inhaler
A
23
Nicotine lozenge
A
24
Nicotine gum in highly
dependent smokers
A
24
Bupropion SR
A
21-30
81
Success Rate and Evidence Rating
Combination therapies
Evidence
rating
Quit rate at 6 months
(%)
Nicotine patch plus nicotine
gum
B
28
Nicotine patch plus nicotine
spray
B
37 (at three months)
Nicotine patch plus nicotine
inhaler
B
25
Niotine patch plus
bupropion
B
35
82
Second line pharmacotherapy

Clonidine (Catapress®)
Non-FDA approved
 Centrally acting alpha2-adrenergic agonist that
reduces sympathetic outflow from CNS
 Oral 0.1 mg twice daily or transdermal 0.1 mg daily
 Side effects include dry mouth, sedation, dizziness,
constipation

83
Second line pharmacotherapy

Nortriptyline (Pamelor®)






Non-FDA approved
Tricyclic antidepressant
Initiated 10 days before quit date
Oral 25 mg daily, increasing gradually to target dose 75 – 100
mg daily
Side effects include sedation, dry mouth, blurred vision,
urinary retention, light-headedness, tremor
Caution in patients with cardiovascular diseases because of
risk arrhythmias and postural hypotension
84
Nicotine withdrawal
symptoms and
management
85
Nicotine withdrawal symptoms

Cravings
An intense desire to smoke as the body is missing
the nicotine fix
 Craving will lesson over a few weeks
 Try NRT and or these tips:

Take a few long, low, deep breaths
 Drink a glass of water

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Nicotine withdrawal symptoms

Coughing, dry mouth
The lungs are clearing out the tar
 Usually be worse at the start and improve quite
quickly
 Warm drinks can ease the cough
 A sign that lung functions are recovering

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Nicotine withdrawal symptoms

Hunger

May feel extremely hungry due to
Changes in metabolism
 Food tastes better after quitting smoking

Put together a “survival kit” of fruits and vegetables
 Carry chewing gum and drink lots of water

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Nicotine withdrawal symptoms

Bowel changes
May suffer from constipation
 Will soon settle down
 Drink plenty of water
 If constipated, try to incorporate more fibre into the
diet by eating more cereals, fruits and vegetables

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Nicotine withdrawal symptoms

Trouble sleeping
Nicotine leaving the body can disturb sleep patterns
 Normal sleeping patterns will return in two or three
weeks
 Get more physical exercise and fresh air
 Decrease consumption on tea, coffee and other
stimulating drinks

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Nicotine withdrawal symptoms

Dizziness
Happens when more oxygen starts getting through
to the CNS when the effect of carbon monoxide
wanes
 Any dizziness will be gone after a few days

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Nicotine withdrawal symptoms

Mood swings, poor concentration, irritability
Signs of nicotine withdrawal as the body is missing
the stimulating effects of smoking
 Coping mechanisms that work
 Warn your family and friends, and ask for support

92
Role of healthcare
professionals in smoking
cessation
93
The Five A’s Model for Facilitating
Smoking Cessation
Ask about tobacco use
during every visit
Include questions about tobacco use when assessing
the patient’s vital signs
Advise all smokers to
quit
Advice should be clear, strong and personalized
Assess the patient’s
willingness to quit
Ask how motivated patient is to quit smoking, then
determine appropriate step
Assist the patient in his
or her attempt to quit
Help the patient make a quit plan, provide basic
information about smoking and cessation,
recommend pharmacotherapy and self-help material
Arrange follow-up
contact
First follow-up should occur within the first week and
second within the first month; can be by telephone, email, or in person
94
What we can do to help smokers




Advise smokers to quit
Assess the patient’s condition and suitability for
smoking cessation aids
Recommend suitable dosage form of nicotine
replacement therapy based on individual
smoking habits and patterns
Provide detailed counselling on correct use of
products
95
What we can do to help smokers





Draft a plan of gradual tapering and duration of
nicotine replacement therapy
Monitor progress
Suggest non-drug measures
Provide emotional support
Arrange follow-ups
96
Assessing level of care in smoking
cessation
97
Assessing level of care in smoking
cessation
98
People who successfully stop
smoking…








Really want to stop
Understand why they smoked in the past
Put time and effort into planning the attempt
Know what to expect when they stop smoking
Have support and encouragement
Take one day at a time
Plan ahead to avoid temptation
See themselves as non-smokers
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Make the first step to quit




Set a quit date, get support from your family and
friends
Dispose of all cigarettes, ashtrays and lighters
Stay away from smoking situations
Seek information from health professionals
100
Most people start smoking again
because…







They thought they could get away with having ‘just one’.
They hadn’t thought about their smoking triggers, and
got caught out.
They didn’t do enough planning and preparation.
They didn’t work out other ways of handling stress.
They hit a bad patch or a pressurized day.
They put on weight.
They thought of themselves as ex-smokers, not nonsmokers.
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Sample of calculation on
cost of smoking (UK)
102
My smoking diary




Filling in a diary sheet will help you think about
your smoking patterns
Try to do it over the course of a few days
Understand when and why you smoke
Plan what you can do at those times instead of
smoking will help you get through the first few
days without cigarettes
103
My smoking diary
104
The “quit date” planner
105
Investigating your smoking habits
106
How to get through those tricky
times






Start a new project
Take a few slow, deep breaths
Go for a quick stroll (to walk in a relaxed and
slow manner) or even just into another room
Drink a glass of water
Talk to a friend about how you’re feeling
Refer to the list of reasons you have for
stopping
107
Not ready?






Remember why you want to be a non-smoker. Try copying
your reasons for quitting on to a card and carry it with you,
so you can read them if you get tempted.
Check through your ideas on handling the first week, and
practise some of those new habits before your quit date.
Make sure you’re fully prepared, and ready to manage without
smoking.
Lots of people fail because they rush into quitting before they’re
really ready.
If you’ve tried giving up before, think about what happened and
how you felt.
You can use your past experiences to help you cope better this
time.
108
5 Ds to tackle craving



Declare that you have quitted
Delay in getting a cigarette for a few minutes by
deep breathing and drinking plenty of water
Distract yourself from thinking about smoking
by doing something else like making a phone call
or keeping yourself busy
109
If you’ve just had a cigarette







Make the decision to stop again immediately
Throw away any remaining cigarettes
Call a friend or the Smoking Helpline
Go outside, or into a different room – get out of the
situation that made you want to smoke
Remember why you wanted to stop smoking in the first
place
Try to handle the ‘situation’ without another cigarette
Keep telling yourself, ‘I can choose not to smoke’
110
To sum up…
111
Thinking about giving up
- Ten top tips





Contact your local Stop Smoking Service for
practical help and advice from trained specialists
Plan ahead to help you cope with stressful situations.
Pick a quit date that will be stress-free, and stick to it.
Take it one day at a time, and congratulate yourself
every day.
Pair up with someone else who wants to stop so you
can support each other
112
Thinking about giving up
- Ten top tips





Use Nicotine Replacement Therapy (NRT) or
bupropion (Zyban) to help you manage the cravings
At first, avoid situations where you might be tempted
to smoke
Keep track of the money you’re saving – and treat
yourself!
There’s no such thing as having ‘just one’ cigarette
Think positive – you CAN do it!
113
Stay positive. Keep telling
yourself, “I don’t smoke”
and most importantly, be
very, very proud of
yourself !
114
Where smokers can get
help from
115
Department of Health



Regularly conducts smoking cessation activities
in various service units including chest clinics,
elderly health centres, etc.
Introduction of nicotine replacement of therapy
in the Education and Training Centre in
Family Medicine (Ngau Tau Kok)
DH smoking cessation hotline 2961 8883
116
Hospital Authority





Hospital Authority Smoking Counselling
and Cessation Centres
Established in some hospitals / GOPCs from
different clusters
Detailed counselling and nicotine replacement
therapy trials provided by pharmacists and/or
nurses
Breath carbon monoxide monitoring
HA smoking cessation hotline 2300 7272
117
Web resources from organizations
- Hong Kong

Tobacco Control Office, Department of Health


Hong Kong Council On Smoking & Health
(COSH)


http://www.tobaccocontrol.gov.hk/chi/
http://www.smokefree.hk/
Action on Smoking or Health

http://www.ash.org.hk/
118
Web resources from organizations
- Overseas

Giving Up Smoking (UK)


Action of Smoking and Health (US)


http://www.ash.org/
American Lung Association


http://www.givingupsmoking.co.uk/
http://www.lungusa.org
Tobacco Free Initiative (TFI)

http://www.who.int/tobacco/en/
119
Thank you
120