Behavioural interventions for tobacco smoking and nicotine dependence
Behavioural interventions are important in every management plan for tobacco smoking and nicotine dependenceThe Royal Australian College of General Practitioners (RACGP), 2021. They can be accessed by referral to a service such as Quitline, which offers individually tailored counselling; approaches include cognitive behavioural therapy, acceptance and commitment therapy and motivational interviewing. Financial cost is the most common motivation for reducing or stopping smoking, but effects on physical health, social stigma, medication efficacy or mental health may also be important. Referral to a service is more likely to engage a patient with that service than simply providing the person with their contact details.
See Psychosocial supports in disorders of substance use and additive behaviours for a brief summary of therapies used in behavioural interventions. Ways to support behavioural change in tobacco smoking and nicotine dependence lists additional steps that clinicians can take to support behavioural change in tobacco smoking and nicotine dependence.
Encourage the patient by reinforcing that change is possible and support is available; resources include:
- Quitline counselling—available nationally on 137 848
- MyQuitBuddy app—provides help in setting goals, tracking progress and accessing support.
Identify cues that trigger a craving, for example having an alcoholic drink.
Discuss the nature of cravings as time-limited intrusive thoughts and feelings, and explain how to ‘surf the waves’ of cravings; a guided activity is available on the Insight website.
Suggest the use of strong peppermints or other sweets for managing cravings and keeping the mouth busy.
Reassure the patient that any weight gain that may accompany smoking reduction is still associated with reduced risk of death; the weight gain (compared to people who have never smoked) is usually less than 3 kgSahle, 2021.
Recommend brief periods of exercise of any form.
Suggest progressive muscle relaxation, deep controlled (box) breathing or any other relaxation technique.
Suggest that patients break down the financial cost of smoking and see where money saved could be used instead. Visual aids can be useful, such as keeping a separate account or jar of money or tracking savings on an app.
Recommend that patients revisit motivations for change and reflect on the impact of changes made (eg money saved, control over decision-making gained).
Acknowledge that nicotine dependence is a chronic relapsing illness.