Steve Maina has struggled with tobacco addiction for over a decade. During this period, he has tried twice to stop smoking using commonly prescribed pharmaceutical drugs to no avail.
“I usually take the treatment drugs but end up backsliding along the way – after just a few months. I feel like the craving can’t go away. So I go back to smoking even though I know it’s bad for me.”
For a long time, health experts have relied on certain recommended medications to help people like Maina quit smoking.
However, new research published in the Journal of the National Cancer Institute shows that smoking cessation drugs alone may not be improving the chances of successful quitting.
The study, conducted by researchers from the University of California San Diego School of Medicine assessed the effectiveness of three first-line medications recommended by clinical practice guidelines. They include varenicline, bupropion and nicotine replacement therapy (patch).
“We found no evidence that the pharmaceutical cessation aids that we assessed improved the chances of successfully quitting,” said Dr Eric Leas, first author of the study.
The researchers noted that the results were surprising since clinical trials which tested the efficacy of these drugs before their approval indicated that they could double cessation rates.
“But that hasn’t translated into the real world,” said Dr John Pierce, a senior author of the study.
According to the researchers, the promising results witnessed in these earlier clinical trials could have been as a result of scientists combining the treatment drugs with behavioural counselling services for addicts.
They thus urge doctors to combine the two treatment approaches when helping people to quit smoking.
"Evidence is pointing to an important role of behavioural counselling for better success rates. As it is, less than two per cent of smokers who use a pharmaceutical aid are using any behavioural counselling. Our research showed that this was a recipe for relapse to smoking," said Dr Pierce.
Tobacco products include cigars, cigarettes, water pipe (such as shisha or hookah) and dissolvable nicotine products as well as smokeless tobacco such as electronic cigarettes (e-cigarettes).
Dr Salim Hassanali, chest and lung specialist at Aga Khan University Hospital (AKUH) said that tobacco cessation is a complex process that requires an integrated approach.
“You can't just rely on drugs alone as there are certain behavioural and social factors that predispose people to smoking.”
He noted that treatment drugs should be combined with psychological support which may include individual or group counselling sessions. "Cessation journey is a long and difficult one. You don't take the drug today then quit the next day. People face many hurdles along the way and will therefore require someone to walk with them and encourage them."
Key among the reasons why it’s difficult to quit is the highly addictive nature nicotine, a drug found naturally in tobacco. When inhaled, it travels quickly to the brain, causing a feeling of relaxation and stress relief. It may also boost moods.
Yet, the nice feelings linked to tobacco use are just illusions as they are usually temporary or short-lived.
"After your body rids itself of the nicotine, which can happen after just a few hours or minutes depending on the level of addiction, you begin craving another cigarette.”
According to the World Health Organisation (WHO), tobacco kills up to 50 per cent of its users and is a major risk factor for non-communicable diseases (NCDs) such as cancer, cardiovascular disease, diabetes and chronic respiratory ailments.
Dr Hassanali said withdrawal symptoms associated with tobacco cessation can be unbearable.
These symptoms include sweating, nausea, headaches, anxiety, irritability, depression, insomnia (sleep problems), concentration difficulties, weight gain, abdominal pain, constipation or stomach gas, intense craving for nicotine, as well as tingling in the hands and feet.