How can I help smokers quit?

Tobacco dependence is a chronic disease, and treatment requires a protracted battle. The importance of psychological support and advice should be emphasized in this process. Physicians need to help each smoker work toward the goal of quitting the last cigarette, addressing the smoker’s quitting process at least a little at a time. First, it is important to reinforce the smoker’s awareness of the need to quit. Tell the smoker to quit “without hesitation,” talk to the smoker about the importance of quitting, and tell the smoker why he or she should quit, taking into account the smoker’s medical history and symptoms, as well as the risks of passive smoking to the smoker’s children and family. For example, for an asymptomatic smoker you can tell the smoker that smoking makes you susceptible to various diseases, that smoking is a nuisance to your family and others around you, that your health status will improve if you quit, that more and more places are banning smoking, that your sense of taste and smell of food will improve if you quit, and that you will likely feel confident about everything if you quit. Reasons for quitting that persuade women smokers are: smoking irritates the skin making wrinkles increase, your skin will look better if you quit, smoking accelerates osteoporosis, smoking can cause infertility, etc. For those smokers who have decided to quit, specific support is needed for the smoker’s efforts to quit. Physicians must first establish the correct perception in order to help smokers properly understand the dangers of smoking and the benefits of quitting, and to correct biases. Physicians should explain in detail to quitters the harms of tobacco, the benefits of quitting, and the methods and principles of quitting, and should discuss issues related to tobacco control with quitters according to their level of knowledge and cultural background. Smokers should also take the initiative to inform their spouse, family members, friends, colleagues, and other close contacts that they have quit, so that they understand their desire to quit and can actively cooperate. Except in special cases, doctors should encourage smokers to use smoking cessation medications to assist in quitting. Smoking cessation medications include nicotine replacement therapy cessation medications and non-nicotine medications, such as nicotine chewable gum and nicotine oral tablets, the latter of which mainly include bupropion hydrochloride extended-release tablets and varenicline. At present, many hospitals in Beijing are running smoking cessation clinics, such as Tongren Hospital, China-Japan Friendship Hospital, and Chaoyang Hospital, where the physicians have good experience in quitting smoking and the success rate of quitting smoking is high. Although smoking cessation medications can help smokers quit successfully, willpower in the process of quitting is still necessary. The reduced nicotine concentration in the blood after quitting, along with psychological and behavioral reasons can lead to a cluster of withdrawal symptoms such as craving for cigarettes, dizziness, stomach upset, constipation, nervousness, irritability, inability to concentrate, depression, and insomnia, but these symptoms can disappear quickly after 2 to 3 weeks of quitting. Relapse prevention after quitting is the biggest challenge in quitting smoking, and tobacco dependence is a chronic disease that deserves active treatment and requires repeated interventions. We now have a number of effective treatments that can free tobacco-dependent individuals from addiction or even permanent abstinence, and no other clinical intervention to date has been as effective in reducing the incidence of disease, preventing death, and improving quality of life as interventions for smoking, but this will require the tireless efforts of all health care workers.