In my last post, I began to discuss how the medical expert David Katz, MD, sees smoking as part of a bigger picture of problems, including dependence on other substances, depression, anxiety, and trouble with weight. I wrote about how the presence of these other factors makes quitting smoking harder, but also sheds light on how to maximize a person’s attempts to quit. For example, identifying and treating depression or anxiety with counseling and (if needed) medications might improve a person’s chances of quitting. Now I’d like to discuss some of Dr. Katz’s research findings and talk about what the research tells us about how to find better ways towards quitting. Dr. Katz identified 7 factors that complicate the quitting process:

• Nicotine dependence
• Dependence on other substances (that is, drugs or alcohol)
• Stress
• Anxiety
• Depressions
• Concerns over weight gain
• Another smoker in the household

In his research, Dr. Katz discovered that a substantial number of smokers have at least one of these issues. All smokers suffered from chemical dependence on nicotine. Anxiety and concerns about weight gain were also very common, occurring in 58% and 79%, respectively. One third reported problems with drugs or alcohol, and one-third stated that they suffered from stress or depression. Sixteen percent reported sharing their homes with another smoker. Dr. Katz described interventions that could be tailored to each of these difficulties:

• Nicotine dependence--patients received buproprion (Zyban) and nicotine patches for 2-3 months at the beginning of the quitting period.
• Dependence on other substances (that is, drugs or alcohol)—patients who were dependent on other substances were referred to addiction programs.
• Stress—patients were enrolled in a stress-management program with yoga, guided relaxation and stress management classes
• Anxiety--patients with anxiety were prescribed an anti-anxiety drug (buspirone—Buspar)
• Depression—patients diagnosed with depression were referred to a specialist, who treated at his or her discretion
• Concerns over weight gain—patients concerned about weight gain received four hours of dietary counseling, participated in organized walking groups, and received discounted 3-month memberships to the local YMCA
• Another smoker in the household—family dinner meetings for group counseling were arranged

The patients who participated in the study found the interventions helpful, and quit rates were about 50% after one year and 25% after two years, which is substantially better than quit rates associated with other treatments.

It is important to recognize the limitations of these findings. First, this was a research protocol, conducted by highly motivated doctors, nurses, and assistants. In addition, patients who participate in research are often more motivated than other patients, so the research results might be better than we could expect from a “real world” situation. (On the flip side, the good news is that the methods used to diagnose and treat the 7 complicating problems are simple ones, available to almost all primary doctors in the USA.) Second, the study was conducted on a small group, so the results may not hold up to scrutiny in a study with more patients. Third, the treatments given in the study may not be right for everybody. Only you and your doctor can decide whether treatment with buproprion, nicotine patches, anti-depressants, or anti-anxiety medications are likely to be safe and effective for you.