1 Health Professionals Role in Helping Smokers to Quit Smoking Dr. Sallehudin Abu Bakar Public Health Physician & Epidemiologist

2 Findings from the STOP survey Pfizer-sponsored survey: Interviews with 2836 smoking and non-smoking general practitioners in 16 countries in 2005

3 Apparent paradoxes Smoking is an addictionstopping is a matter of willpower Smoking should be regarded as a medical condition is primarily a lifestyle choice Helping patients to stop is part of the job other things have a higher priority but

4 What does this mean? Need a message that recognises the duality of beliefs about smoking “Smokers must take responsibility for stopping smoking, and they will need determination to succeed; but when determination is not enough, the health professional has effective tools to help the smoker succeed.”

5 A simple model of nicotine dependence Chronic intake of nicotine from cigarettes Changes to the neural circuits controlling motivation Nicotine hungerNicotine habitFalse beliefs A biologically driven “need” to smoke when nicotine levels in the brain are low Cues associated with smoking trigger nicotine-driven reward seeking Experience of relief of nicotine withdrawal symptoms leads to expectations of more general mood enhancement

6 The process of stopping smoking Motivational tension Triggers Treatment When smokers think about their smoking most, they are unhappy about it, but many of them: Something needs to prompt them to make a quit attempt using a method that maximises their chances of success The treatment needs to be of a type and intensity that meets the individual smoker’s needs, and available whenever and for as long as the smoker needs it 1.Think it meets certain needs 2.Is a source of enjoyment 3.Think stopping will be difficult

7 The Health Professional’s Role The Health professional role is: Patients will often respond to a clear, firm message that: To give professional, expert advice on health matters To provide treatment to those who want and need it Now is a good time to stop It is always worth having another attempt There are things available that will make it easier

8 A simple consultation model Yes, I know I should stop, but... I enjoy smoking too much Every month you put off stopping, you may lose another week off your life Now is not a good time Now is always a good time for stopping, smoking doesn’t really help with stress I am worried that I will fail Most smokers make many attempts before they succeed I am addicted Addictions can be conquered, especially when you get help We now have effective treatments available that will make it a lot easier for you to succeed Are you smoking at the moment? You have to question whether it is worth the pain and suffering you will endure later