Fact Sheet: Tobacco Cessation and Treatment
Worldwide, 1.3 billion people smoke and, unless urgent action is taken, 650 million of them will die prematurely due to tobacco use.1 According to the World Health Organization, “Current statistics indicate that it will not be possible to reduce tobacco-related deaths over the next 30-50 years, unless adult smokers are encouraged to quit”.2 Millions of people quit every year, but many more don't and quit attempt success rates remain low. Tobacco cessation can be a cost effective method of disease prevention for adults. In the United States, for example, it is more cost effective than mammograms, pap smears, and screenings for colorectal cancer or hypertension.3
Nicotine: The Basis Of Addiction
Tobacco contains nicotine, a powerful and highly addictive substance. Most tobacco products deliver nicotine to the brain very effectively, bringing on the rapid onset and maintenance of addiction. This addiction leads to the unfortunate situation where an otherwise rational, motivated, knowledgeable person, who understands the risks of tobacco, continues to use it.4
Evidence of the dependence-producing properties of tobacco has been accumulating for years. In 2000, The Royal College of Physicians summarized this body of research by concluding that nicotine is an addictive drug on par with heroin and cocaine and that the primary purpose of smoking tobacco is to deliver a dose of nicotine rapidly to the brain.5 Studies from numerous countries show that although an overwhelming majority of tobacco users want to quit, less than half make a quit attempt each year, and very few of those succeed in quitting long-term. While up to 40 percent of those using tobacco will make a serious quit attempt in any given year, as few as three percent actually achieve long-term abstinence.6
- Surveys in the United States have found up to 70 percent of tobacco users report a strong interest in quitting.7
- A 2002 report indicated that 45.6 percent of Australian smokers intended to quit smoking in the next six months.8
- A 2003 study on behalf of Ireland’s Office of Tobacco Control, indicated that 76 percent of Irish smokers intend to quit; 67 percent of those wishing to quit have previously attempted to quit.9
Tobacco Industry Impediments To Cessation
In addition to the impediments to cessation caused by insufficient government policies and the addictive nature of nicotine, the tobacco industry itself presents numerous barriers to cessation efforts through its significant economic and political resources.
Lack of significant regulation has allowed the industry to create and promote products, such as “light” or “low tar” cigarettes, that purport to offer harm reduction but do not reduce overall disease risks. The heavy promotion of these products to health conscious smokers “at risk” of quitting smoking has served to manipulate their addiction by offering justification for continued smoking, even though there is no evidence these products reduce the risk of disease. Either directly, or through bogus front groups, the tobacco industry attacks scientific evidence on the effects of smoking and states publicly that smoking is either not as harmful as critics contend or that “everything” is harmful. Several companies still do not admit that smoking is addictive. These public relations strategies are so far removed from science they would not work for most consumer products. Yet smokers are often strongly motivated to find ways to justify their dependence to smoking, and while others might recognize these strategies as attempts to trick consumers, smokers may view them as a beacon of hope in their efforts to justify continued smoking thereby avoiding the hardship of a cessation attempt.10
The Important Role of Health Care Providers
Article 14 of the World Health Organization Framework Convention on Tobacco Control (FCTC) – a treaty signed and ratified by 145 countries from all regions of the world - calls on governments to incorporate the “diagnosis and treatment of tobacco dependence and counseling services on cessation of tobacco use in national health and educational programmes.” As the International Union Against Cancer states, health-care professionals “have a duty to provide counseling and treat tobacco dependence as they would any other disease or addiction.”11 A 2002 report from the New Zealand National Advisory Committee on Health and Disability, Guidelines for Smoking Cessation12 (2002), found that “there is good evidence that even brief advice from health professionals has a significant effect on smoking cessation rates.”
Yet many healthcare providers lack the proper tools to treat tobacco dependence. A research paper on the United Kingdom’s 24 medical schools, for example, found that there was no mention of smoking or smoking cessation in the published curriculum material of 10 of those schools.13 In the United States, one study found that only 15 percent of tobacco users who saw a physician in the prior year were offered assistance with quitting, while only 3 percent were scheduled for a follow-up appointment to address the topic.14 If prevention and management of smoking are to become part of mainstream medicine, medical students and staff must be educated and trained in the necessary skills to enable them to treat tobacco addiction in their patients.15
Implementing the FCTC
Article 14 of the FCTC calls on countries to “promote cessation of tobacco use and adequate treatment for tobacco dependence.” Given the diversity of countries’ economic situations, regulatory regimes and health care systems, the effort to treat tobacco dependence requires a multi-faceted approach. Therefore, a tobacco control program should not only encourage tobacco users to quit but also provide assistance in doing so. Treatment services can be provided through health care providers, schools, government agencies and community organizations. These services can include: