Long-term medication and counseling helps smokers quit

People who want to quit smoking have an improved chance of success if they receive long-term comprehensive drug and psychological interventions, according to a new study by UCSF researchers.

An article in the November issue of the American Journal of Psychiatry details a study describing the success of a treatment program for smoking cessation.

Forty of 160 participants were given the antidepressant nortriptyline, coupled with counseling for one year. Compared to 39 participants who received the drug and counseling short-term, those receiving long-term medication and counseling had much better results. The 41 who received a placebo and long-term counseling also did well, though not as well as those who received both the medication and counseling. The remaining 40 participants who received a placebo and short-term counseling had the lowest success rate for quitting smoking.

"There have been few, if any, studies with such good results," said lead author Sharon Hall, PhD, a professor in the UCSF Department of Psychiatry. "This is very exciting."

"We had 160 patients, all of whom were motivated to quit smoking," Hall explained. "For the first three months all got nicotine patches and five counseling sessions with master's-level psychologists or health educators who received special training." The two groups in long-term counseling also received monthly counseling sessions and phone calls from their therapists in between counseling sessions for the next nine months.

At the end of one year, 50 percent of those receiving the extended counseling and medication were abstinent. Of those who received the extended counseling and placebo, 42 percent were abstinent. While there is not a huge gap in those percentages, Hall explained that those in the group taking the medication were more consistently abstinent.

"Smoking is a horrendous addiction; it's not just a bad habit," Hall said. "This is what you have to do to be successful. It's a long process, but worth it to stop doing something that can kill you."

For those who cannot take nortriptyline because of contraindications or who do not want to take it, Hall advised long-term counseling. "Although the results were not quite as good for the group not taking the medication," she said, "the results were still good enough that I believe long-term counseling could benefit many people who wish to stop smoking."

Hall and her colleagues hope the information from this study will help convince smokers to invest the time and effort into long-term treatment.

"It can be argued that many smokers may not be willing to engage in such intensive, long-term treatment," the researchers write. "We propose publication of data such as these may be needed to convince practitioners (and smokers) that substantial abstinence rates can be achieved, but treatment commensurate with tobacco's addictive properties is required."

The success of this study has spurred UCSF researchers to continue to investigate other long-term methods to help people quit smoking, including studying bupropion, a prescription drug approved for smoking cessation, and nicotine gum, an over-the-counter drug for smoking cessation.