Smoking Cessation and Hypnotherapy

Mesut Çetin, M.D. Professor of Clinical Psychiatry, Head, Department of Psychiatry, Editor in Chief Bulletin of Clinical Psychopharmacology Gulhane Medical Academy, Haydarpasa Training Hospital,Kadikoy 81327 Istanbul-TURKEY

mesutcetin@yahoo.com www.hipnoz.net www.psikofarmakoloji.org

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17th ECNP Congress 2004 Stockholm, Sweden

Bergama / Asceplion- TURKEY

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Who Smokes

Cigarette Smoking in the U.S.

0

10

20

30

40

50

60

1965 1970 1975 1980 1985 1990 1995 2000

Prev

alen

ce %

MenWomen

Broadcast Ads Ban 1973

Cigarette Tax Doubles 1983

Tobacco Companies Law

Suits 1995

Tax Doubles Again 1989

Surgeon General’s

Report 1964

Tobacco Free Schools 1997

Prevalence of Smoking In Turkey: 30% of reproductive age women and 35% of men are cigarette smokers. Female smokers are increased among adolescents teenage girls.

Educational Status and Smoking

05

1015202530354045

1975 1980 1985 1990 1995 2000

Prev

alen

ce %

High SchoolDropoutHigh SchoolGraduateSome College

College Graduate

Why People Smoke

Smoking Among Young People Compared to teens that don’t smoke,

teens who smoke are: • 3 times more likely to use alcohol; • 8 times more likely to use pot; and • ~20 times more likely to use cocaine!

Factors in Smoking Psychosocial Factors • Social Acceptability • Modelling

– Well-being out of 1,000 kids who smoke, 750 come from families where one or both parents smoke!

Physiological Factors • Nicotine Addiction • Secondary Gains

Substances in Smoke

• (active and passive ): – > 4.000 chemical compounds, – 43 carcinogens or poisons – > 300 polycyclic aromatic

hydrocarbons. – methyl isocyanate( lethal

poison). – bezene,( a potent toxicant) – Nicotine and its metabolites,

cotinine – Polonium 210 (a carcinogenic

radioactive elem), – Cadmium

How Smoking Causes Disease

00,5

11,5

22,5

33,5

0 5 10 15 20 25 30 35 40

Average # of Cigarettes Smoked / Day

Dea

th R

ates

Lung Cancer Death Rates (British Physicians, 1951-1961, per 100,000)

Cigarette Smoking and Lung Cancer

Risk Factors for Heart Disease

Most Common Cancers

Men Incidence Mortality 1. Prostate 1. Lung 2. Lung 2. Prostate

3. Colorectal

Women Incidence Mortality 1. Breast 1. Lung 2. Lung 2. Breast

3. Colorectal

Commit to Help – Take Action

“Quitting smoking is easy, I’ve done it a thousand times” -Mark Twain Tobacco dependence is a chronic disorder. 70 % of the smokers have made at least one prior quit attempt, and approximately 46 % try to quit each year. Unfortunately, only about 7 % were still abstinent 1 year later.

2 to 12 weeks: 3 to 9 months:

1 year: 10 years: 15 years

circulation improves coughs, wheezing and breathing

problems improve risk of heart attack halved risk of lung cancer halved risk of heart attack equal to never-smoker’s

Effects of quitting

40 55 70 85 100

Age

0

20

40

60

80

100

% A

live 59

12

80

33

80

33

Doll et al BMJ 1994

7.5 years

Current cigarette smokers

Never smoked regularly

Overall risk to smokers and never-smokers

40 55 70 85 100

Age

0

20

40

60

80

100

% A

live

40 55 70 85 100

Age

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Age

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% A

live

40 55 70 85 100

Age

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60

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% A

live

Former smokers stopped 35-44

Former smokers stopped 45-54

Former smokers stopped 65+

Former smokers stopped 55-64

Effects on survival after ages 45, 55, 65 & 75 of stopping smoking in previous decade

Doll et al BMJ 1994

Nonsmokers 1-14 cigs 15-24 25 +

Smoking habit

0.0

4.0

8.0

12.0

16.0

20.0

Rat

e pe

r 100

0 pe

rson

yea

rs

CPS2

0.0 0.6 0.6 1.1

45-54

0.1

1.7 2.7

3.9

55-64

0.3

4.5

7.1

9.2 65-74

0.6

7.0

13.2

17.9

75-84

Lung cancer risk by age and smoking habit

40 50 60 70 80 Age

0

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Lung

can

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eath

s pe

r 100

,000

Current smokers

Never smokers

quit 30-39

quit 40-49

quit 50-54

quit 55-59

quit 60-64

Halpern JNCI 1993: CPS2 data

Lung cancer risk by age of quitting

Commit to Quit

Pharmacotherapies are effective for smoking cessation

• First line drugs are bupropion SR, nicotine gum, inhaler, nasal spray and patch.

• Second line drugs include clonidin and nortryptyline.

• Choice of a specific first-line pharmacotherapy must be guided by factors: – Clinician familiarity with the medications, – Contraindications for selected patients, – Patient preference, – Previous patient experience, – Patient characteristics (e.g., history of

depression, concerns about weight gain).

Hypnosis is effective

• Hypnosis is clearly effective in smoking cessation. However, there are contradictory results on the success rates of single session therapies. Single session therapies seem to result in 17%-45% success (Hammond, 1990).

Success rates increase dramatically in multisessions

• By using these longer formats, abstinance rates over %65 can be achieved. When a multisession approach will be used, it is preferable to conduct the second session two or three weeks after the first session since most of the relapses occur during this time interval.

Suggestions must be individualized!!

• Hypnosis must be tailored for individual motivations and need of the patients.

• One of the most important part of the therapy is to investigate the benefits derived from smoking for each patient (decrease anxiety, facilitate social relations, establish independence).

A clinical study in private practice setting

• The sample consisted of 46 cases treated with hypnotherapy.

Inclusion Criteria: 1-A definite decision to stop smoking 2-Willing to have hypnotherapy 3- Being age 18 to 65. Exclusion Criteria: Having DSM-IV Axis I or Axis II diagnosis.

Sociodemographic features of cases

Cases Male

(n=26) Female (n=20)

Age (years) 32.5 (± 6.3) 38.2 (± 9.4) Duration of

smoking (years) 10.2 (± 5.4) 11.7 (± 7.1)

Education Primary

High school University

%11.5 %50

%38.5

%20 %40 %40

Procedure

• The subjects were conducted 1-7 (3.6 on average) sessions of direct or indirect, depending on the structure of their personality, hypnosis in a room specially prepared for this purpose.

• Each session lasted approximately 60 minutes, each week. The subjects were thought to do autohypnosis and their situation was assessed at the end of first, second and the fourth week.

Procedure

• In the first session relaxation was taught. • Suggestions were individualized. I used

suggestions to enhance self-esteem, increase motivation.

• Images of hospital scenes, aversive experiences related with smoking were also used.

Results

After an average of 3.3 sessions, 60 % of the patients quitted smoking. The rate of quit smoking was 68 % at the end of first week, 75 % at the end of second week and 60 % at the end first month. Female volunteers were observed to be more successful than the male ones.

Conclusions

• The number of the sessions required changed considerably among the cases, owing to individual differences.

• Thus, the most important message is to adapt an individualized method of treatment.

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