Review Confirms Value of Combined Approach to Quitting Smoking

Release Date: October 17, 2012 | By Joan Vos MacDonald, Contributing Writer
Research Source: The Cochrane Library


  • Smoking cessation programs that combine medication or nicotine replacement with behavioral counseling are 70 to 100 percent more effective than simply advising smokers to quit.
  • Behavioral therapy to support smoking cessation can be delivered by clinicians in a normal health care setting as part of routine care.
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Smokers who try to quit would be more successful if they combined medication or nicotine-replacement therapy with behavioral counseling, finds a new review in The Cochrane Library. Few lifestyle changes deliver as many positive health benefits as quitting smoking, including improved circulation, lowered blood pressure and a decreased risk of cancer and heart disease.

“Since we know that both types of treatment are effective, the assumption has certainly been that offering both will be better than offering either alone,” said lead researcher Lindsay Stead of the department of primary health care sciences at the University of Oxford. She and her coauthor sought to confirm this observation by measuring the effects of combining behavioral and medication therapy versus no intervention or medication therapy alone.  The reviewers pooled findings from 41 studies involving more than 20,000 smokers.

The review found that providing a combination of medication and behavioral therapy improved quit rates by as much as 70 to 100 percent compared to no treatment or minimal intervention. Behavioral therapy interventions typically included four to eight sessions with smoking cessation counselors or physicians. ”Health care providers have an important role in convincing smokers of the importance of attempting to quit and making pharmacotherapy and behavioral support available,” the researchers stated.

“Usual care in most health care systems for smoking cessation typically consists of brief pre-quit counseling, a recommendation to use, and possible provision of cessation medication, and a follow-up visit or phone call a few weeks later,” said Stevens S. Smith, Ph.D., associate professor in the department of medicine at the University of Wisconsin’s Center for Tobacco Research and Intervention.

 “For patients motivated to make a quit attempt, counseling and assistance with medications—if medically appropriate—should be provided,” said Smith. “For patients not motivated to quit, the doctor should use motivational interventions. Another option is referral to tobacco quit lines, such as 1-800-QUIT-NOW, where smokers can receive free medication, counseling, and other support to quit smoking.”

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The Cochrane Library ( contains high quality health care information, including systematic reviews from The Cochrane Collaboration. These reviews bring together research on the effects of health care and are considered the gold standard for determining the relative effectiveness of different interventions.

Stead LF, Lancaster T. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD008286. DOI: 10.1002/14651858.CD008286.pub2.

Tags for this article:
Smoking   Evidence-Based Medicine  

Comments on this article
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Donna Borowski says
October 18, 2012 at 9:39 PM

I support this study. I have worked in a tobacco cessation program for 16 years.
The program maintains a high success rate. We use medication, motivational interviewing, and Intrinsic Health Coaching. We also encourage developing an exersize program when making this lifestyle change.
The people that enroll in the program see us every 2 weeks while on medication. We then see them monthly for as long as the person needs the support. If they relapse a large percent will return to quit again. Developing trusting relationship with each person is at the core of our practice. Recovery from this addiction is ongoing and people are always one choice away from a slip or relapse.

Michael Gannon says
November 5, 2012 at 7:28 AM

What about Alan Carr.

Changing mind sets.

Nicotine replacement therapy is just another marketing ploy for the tobacco companies.
The talk therapies don`t work either.

Fern Webb says
November 5, 2012 at 5:07 PM

The article mentioned that the hotline provides free medication. This is no longer true in our state (NC) due to the budget cuts and the loss of use of the Master Settlement funds tobacco companies are required to pay by court order. Tobacco users for the most part seem to be low income and assistance with medications would be a wonderful tool to have access to.

Nicotine replacement therapy is not a marketing ploy for the tobacco companies. These FDA approved medications are supplied by pharmaceutical companies. One of the major tobacco companies has developed a nicotine replacement product for cessation, but it does not seem to be on the market or well known in the main stream market. The purpose of nicotine replacement therapy is to give the tobacco user time to learn how not to use and rely on tobacco. NRT is not satisfying to the addiction. Once the user has established new routines and coping skills, they can reduce the use of NRT gradually. Their chances of continued success can be greatly enhanced by supportive counseling and learning how to practice relapse prevention.

"Talk therapies" do work. That is how education is delivered and barriers are discussed. It takes full participation by both parties.

Alan Carr has a great book out. Some people may only need the book, but many more need a more well rounded approach. I think the book is a good purchase for anyone wanting to quit tobacco.