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Health Professionals Role in Helping Smokers to Quit
Smoking
Dr. Sallehudin Abu BakarPublic Health Physician & Epidemiologist
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Findings from the STOP survey
69
81
97
92
87
53
0 20 40 60 80 100
Smoking is a lifestyle choice
Smoking is a medical condition
Smoking is addictive
Stopping is primarily down to willpower
Helping patient stop is part of job
Other things have higher priority
PercentPfizer-sponsored survey: Interviews with 2836 smoking and non-smoking general practitioners in 16 countries in 2005
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Apparent paradoxes
Smoking is an addiction stopping is a matter of willpower
Smoking should be regarded as a medical condition
is primarily a lifestyle choice
Helping patients to stop is part of the job
other things have a higher priority
but
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What does this mean?
Need a message that recognises the duality of beliefs about smoking
“Smokers must take responsibility for stopping smoking, and they will need determination to succeed; but when
determination is not enough, the health professional has effective tools to help the
smoker succeed.”
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A simple model of nicotine dependence
Chronic intake of nicotine from
cigarettes
Changes to the neural circuits controlling
motivation
Nicotine hunger Nicotine habit False beliefs
A biologically driven “need” to smoke
when nicotine levels in the brain are low
Cues associated with smoking trigger nicotine-driven reward seeking
Experience of relief of nicotine withdrawal
symptoms leads to expectations of more
general mood enhancement
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The process of stopping smoking
Motivational tension
Triggers
Treatment
When smokers think about their smoking most, they are unhappy about it, but many of them:
Something needs to prompt them to make a quit attempt using a method that maximises their chances of success
The treatment needs to be of a type and intensity that meets the individual smoker’s needs, and available whenever and for as long as the smoker needs it
1. Think it meets certain needs2. Is a source of enjoyment3. Think stopping will be difficult
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The Health Professional’s Role
The Health professional role is:
Patients will often respond to a clear, firm message that:
• To give professional, expert advice on health matters
• To provide treatment to those who want and need it
• Now is a good time to stop• It is always worth having another attempt• There are things available that will make it
easier
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A simple consultation model
Yes, I know I should stop, but...
I enjoy smokingtoo much
Every month you put off stopping, you may lose another week off your life
Now is not a good time
Now is always a good time for stopping, smoking doesn’t really help with stress
I am worried that I will fail
Most smokers make many attempts before they succeed
I am addicted Addictions can be conquered, especially when you get help
We now have effective treatments available that will make it a lot easier for you to succeed
Are you smoking at the moment?
You have to question whether it is worth the pain and suffering you will endure later
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