Nicotine replacement therapy … - Carlos A ... - Entretiens du Carla

Can temporary abstinence
promote complete
smoking cessation?
This is an important issue to be considered
before health professionals could recommend
temporary abstinence. Recommendation of
temporary abstinence could be misunderstood
by some smokers as a permission to continue
smoking. Moreover, temporary abstinence
could lead to some smokers to a
misinterpretation of being able to control
their smoking and then have a bad influence
on their motivation to quit. So, it is important
to analize how temporary abstinence can
influence on the motivation to quit. Does
temporary abstinence increase or decrease
motivation to quit definitely?
To our knowledge there is no data on this
issue. Nevertheless, we know that reducing
the number of cigarettes smoked daily, using
or not NRT, promotes smoking cessation (1-27-
28). Even, we know that using NRT to obtain
smoking reduction produces higher smoking
cessation rates than using placebo (28).
Temporary abstinence can be considered as a
way of reducing smoking. So, from this point
of view it could be drawn that temporary
abstinence promotes smoking cessation.
Nevertheless, more studies are needed before
drawing substantive conclusions.
Although, there are not any direct data on
the relationship between temporary
abstinence and complete smoking cessation,
we have many indirect data which suggest
that temporary abstinence can promotes
smoking cessation.
Some of these data are as follows:
a) temporary abstinence during
hospitalization, in these cases, it has been
found that 1-year self-reported tobacco
abstinence rates after general hospitalization
tend to be higher than the rate of
spontaneous quitting in general population
(approximately 10% to 15% vs 3% to 5%,
respectively (17),
b) temporary abstinence before and after
surgery. Smokers who have kept temporary
abstinence before being operated on have
higher tobacco abstinence rates after surgical
intervention than the general population. The
highest rate of prolonged post-operative
abstinence are assocated with major surgical
procedures, such as lung resection for
carcinoma or coronary artery bypass grafting
(29). In general, it could be considered that
patients who underwent more extensive
surgical procedures were more likely to
remain abstinent from cigarettes for 30 days
after surgery than those who underwent more
minor procedures (30).
Recommendations
A smoker in temporary abstinence can be
defined as a smoker who does not want to
quit and, for different reasons, must refrain
from smoking during a period of time.
NRT for temporary abstinence can be
recommended in three different cases:
a) in those smokers who are forced to live
in smoke-free enviromments during a period
of time that is as large as causing them craving
or nicotine withdrawal syndrome (among
these patients we have to consider those who
are travelling frequently in public transports,
those who work in smoke-free worplaces,
those who like or are force to keep smoke-free
enviromment at home and those who visit
smoke-free recreational venues: discos, bars,
restaurants and so on.)
b) in those smokers who are hospitalized
for different reasons and
c) in those smokers who are going to be
operated on (“elective surgery”). In these
cases, temporary abstinence should be
strongly recommended at least 3 weeks before
surgery. Although it would cause more
benefits 2 months before. ■
69 Nicotine replacement therapy … - Carlos A. Jiménez-Ruiz