Twenty-six percent of American adults, that is 48 million people, continue to smoke despite the risk of such serious diseases as cancer, heart attacks, stroke, or emphysema.  It is not that people don't try to quit, it's just that the vast majority of attempts are unsuccessful.  Every year about 45 % of adults who smoke daily make an attempt to quit, but less than 14% are able to last for more than a month. 
The Agency for Health Care and Policy and Research, after two years of extensive investigation, has presented its findings regarding the relative success of various smoking cessation programs:        

The Nicotine Patch:  The patch approximately doubles the 6-12 month abstinence rate when compared to a placebo.  The placebo, in this case, is a patch that looks like a nicotine patch but does not contain nicotine.  The nicotine patch is found to be even more effective when combined with psychological support.  

Nicotine gum:  Nicotine gum is the most extensively investigated program.  Nicotine gum improves cessation rates by 40 to 60 % when compared with other interventions, notably, nicotine patch, spray, or medication.  These results were observed in a 12-month follow up.  When psychological support was provided to smokers and their families, rates for absolute abstinence turned out to be even better.  For highly dependent smokers, the 4-mg. was more effective than the 2-mg gum.  

Nicotine nasal spray and nicotine inhaler:  These were recently approved for prescription use by the Food and Drug Administration, hence, not enough information is available to draw conclusions about their effectiveness.  

Medication:  Clonidine was not found to be effective.  Silver acetate didn't prove to be significantly beneficial, either.  Although anti-depressants and anxiety medications have been used as treatments for smoking cessation, the Agency for Health Care Policy and Research felt it did not have enough data to draw conclusions regarding their effectiveness.  

Counseling:  Analysis of 57 studies showed that when counseling was added to nicotine replacement therapies, results were better than those of using nicotine replacement alone.  These studies supply adequate evidence to conclude that optimal outcomes for smoking cessation require a combination of counseling and nicotine replacement therapies. 

Weekly counseling sessions lasting more than 10 minutes for eight weeks result in higher rates of smoking cessation.  However even very brief contacts of just a few minutes can increase cessation rates.  

In the counseling sessions, four things are found to be most helpful:  1.  Help with specific problems such as, "What should I do when my best friend lights a cigarette?"  2.  Learning stress management skills 3.  Education regarding relapse prevention.  4.  Tips for handling weight gain problem.  

Costwise, intensive counseling costs about the same as pharmacological interventions.  Brief counseling costs even less.  However, the higher cost of combined treatment of counseling and nicotine replacements are more than balanced by their higher rate of success.  

Weigh the cost of treatment against the direct and indirect savings.  Direct savings for a smoker who smokes pack a day is about $650 a year.  If the U.S. Congress decides to raise the tobacco tax, the cost of smoking would be substantially higher.  Indirect savings are in form of the better health.  A smoker who quits smoking has a better chance of avoiding the financial cost, suffering, and disability that can result from heart disease, cancer, stroke or other major illnesses.     

Only about half of smokers are ever advised to quit smoking by their physicians.  The Agency recommends that physicians should discuss the dangers of smoking with their patients and should continue to encourage them to quit.  Physicians are in an ideal position to advise against smoking because 70 % of smokers see their primary care physician about three to four times a year.        

Pregnant women, hospitalized smokers, smokers with emotional disorders, children and adolescents, and users of smokeless tobacco may be given higher priority for intervention.  In the case of highly dependent smokers and smokers with emotional disorders, counseling needs to be combined with pharmacological treatment.     

Since the nicotine patch and gum are now available over-the-counter, people are unlikely to receive professional smoking cessation advice or counseling.  Therefore, if you are a smoker and are unable to quit on your own, you should seek professional help such as pharmacological treatment and counseling 
 

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