Diverse interventions for cessation of smoking, pharmacological and otherwise, have been studied, with less attention being paid to unassisted cessation. Tobacco and pharmaceutical industries, too, have interests in cessation, assisted or otherwise.
To review evidence for interventions for smoking cessation.
The search included the Cochrane Tobacco Addiction Group, PubMed and Google Scholar.
Most ex-smokers have quit without professional input. Motivational interviewing (MI), nicotine replacement therapy (NRT), varenicline, bupropion and nortriptyline show effectiveness. Clonidine is effective but has serious side effects. Naltrexone is ineffective. Brief interventions by doctors, structured interventions by nurses, MI and other individual therapies, mobile phone-based interventions, and telephone counselling are effective. E-cigarettes have opposing evidence of effectiveness and harm.
Pharmacological methods seem to focus on managing withdrawal, and hold little promise in managing or preventing relapses, except varenicline. Despite heavy emphasis placed on NRT, nortriptyline seems to be safer, cheaper and equally effective. Brief advice given by doctors is as effective as NRT.
Which non-pharmacological method work best with regards to relapse prevention is yet to be determined. Psychiatrists may use MI or personalized psychoeducation with or without nortriptyline, NRT, bupropion or varenicline. Clonidine is reserved as a second line intervention for inpatients. NRT may also be useful for temporary withdrawal of tobacco use for heavy smokers who are unwilling to quit. E-cigarettes are not to be recommended. Further research on unassisted cessation, safer interventions such as simple advice, and the role of tobacco and pharmaceutical industries is needed. New treatment guidance, better informed by evidence, is warranted.