Opinion
In-depth smoking history leads to proper selection of therapies
LETTER — Posted Sept. 8, 2008
Regarding "Don't quit on smokers: If at first they don't succeed ..." (Article, Aug. 4): Although I agree with the general thrusts, the phrase used in the article, "parting with those villainous cigarettes" fails to understand that for the smoker, villainous or not, their cigarettes are an essential part of their lives -- both on an addictive level and in terms of a constant behavioral pattern.
The medications noted are useful.
Nicotine-substitution products (inhaler, patch, etc.) must be prescribed calculating the total milligrams of nicotine demanded daily: number of cigarettes times milligrams in each cigarette brand.
Counseling is essential, from supportive to cognitive therapy.
Omitted are treatments such as hypnotherapy and biofeedback. For some of my patients, these provided the breakthrough.
My patients undergo a full hour of smoking history, which formulates the selection of the combination therapies appropriate for the individual. As reported to my colleagues at Mount Sinai School of Medicine, the usual five sessions resulted in 68% smoking cessation.
Programs and guidelines are useful, but the clinician's traditional adjustment of multiple therapies after history and examination yields historically proven success.
Elliot Wineburg, MD, New York
Note: This item originally appeared at http://www.ama-assn.org/amednews/2008/09/08/edlt0908.htm.
