Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

124 III. SUBSTANCES OF ABUSEsmoking peers; (4) avoid lecturing, preaching, or nagging; and (5) ensure confidentialityfrom parents.Sussman, Dent, and Lichtman (2000) designed an innovative school quitsmokingprogram that featured interactive activities, such as “games” and “talkshows,” alternative medicine techniques (i.e., yoga, relaxation, and meditation),and behavioral strategies for smoking cessation. Two hundred and fiftyninestudents enrolled in the program at 12 schools and another 76 studentsserved as “standard care” controls (smoking status surveyed at baseline and at 3months). Objective measures of cigarette smoking were used. Elective classcredit and class release time were offered for participation in the program.Only 54% of the students (n = 141) completed the program, and only 14%of them were abstinent for 30 days at the end of group. Comparable outcomedata for controls were not obtained, nor was the end-of-group quit rate based onan intent-to-treat analysis (students who did not complete the group were notincluded in the immediate outcome data).A total of 128 (49%) of the clinic enrollees were contacted at 3 months,including 40 (42%) of the clinic dropouts (those who did not complete four sessions).Forty-four (58%) standard care controls were successfully contacted.The 30-day quit rate (no smoking in the past 30 days) for students who completedthe program was 30%, compared to 16% for students assigned to thestandard care condition. This difference was statistically significant. An intentto-treatanalysis, which assumed that students who were not contacted atfollow-up still were smoking, yielded more modest, although still significantlydifferent, quit rates of 17% and 8% for the program and control conditions,respectively.Hurt and colleagues (2000) studied the effects of nicotine replacementpatch therapy plus minimal behavioral intervention on smoking cessation inadolescents who expressed a desire to stop smoking. Out of 101 adolescents, 71completed the entire 6 weeks of patch therapy. Biochemical tests confirmedthat 7-day point-prevalence smoking abstinence rates were 10.9% at 6 weeks(end of patch therapy), 5% at 12-week follow-up, and 5% at 6-month followup.These outcomes are much poorer than those obtained for adults in similarstudies.Adult Smoking CessationNonpharmacological ApproachesOf the many nonpharmacological approaches to smoking cessation, here,behavioral approaches are the most germane. They have undergone the mostextensive experimental study, are suitable for office and clinic-based physicianinterventions, and often are used in combination with pharmacological ap-