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NRT in the real world of smoking cessation
Renee Bittoun, Director of the Smokers Clinic, University of Sydney and Royal Prince Alfred Hospital, Australia
Abstract
Smokers are not an homogenous group. Nicotine levels derived from smoking vary. Responses to NRT vary. This may depend on baseline nicotine blood levels, metabolic factors, gender, ethnicity, comorbidities, concomitant medications and socioeconomic status; the "wherewithal" to quit. When using one form of NRT most smokers do not do well. Clinical Practice Guidelines are based on trials on the "oxymoronic" well smoker and exclude the smokers we are most likely to treat and who are the most cost-effective; the unwell. Guidelines lead to conflicting imperatives to the patient from pharmacists, doctors, Quitlines and Smokers' Clinics.Psychological input in Guidelines is minimal,often not evidence based, though substantiated behavioural advice does exist. Harm minimisation/temporary abstinence strategies are not included nor guides on how to better inform patients on the principals of NRT.
A combination therapy algorithm, a description explaining the basis of nicotine addiction, NRT and behavioural changes to the lay smoker have been developed and will be described.
The 3 (four) A's:
Analogy of an Allergy (explains the problem),
Allergory of "The Swimming Pool of Life" (explains the process) and
Algorithm (explains the NRT treatment.)
Biography
BioText: Renee Bittoun has been working and teaching in smoking cessation and started one of the world's first smokers clinics in Sydney more than 25 years ago. She has written and presented many papers and texts on the subject and is the Editor in Chief of the new peer-reviewed Journal of Smoking Cessation.
Renee Bittoun
Director, Smoking Research Unit
Brain Mind Research Institute,
University of Sydney
Sydney
2050
Australia
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