By Elizabeth M. Whelan, Sc.D., M.P.H.
Posted: Tuesday, February 13, 2001

EDITORIAL
Publication Date: February 13, 2001

Both cigarette smokers—and those who love them and worry about the health consequences of smoking—are familiar with the standard modes of quitting: cold turkey (simply stopping smoking completely without any special help), nicotine patches and gums, and more sophisticated smoking cessation approaches which may include prescription medication.

Unfortunately, for many these approaches, even when combined with counseling and self-help groups, simply do not work. In most of these cases the "quit smoking success rate" (as defined as not smoking for 6 or 12 months after the cessation program began) is under 30 percent. This is a challenge for the public health community, especially because those who make the decision to quit and ask for medical and other support are usually highly motivated individuals. The addictive power of cigarette smoking is truly impressive.
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But what is the unsuccessful quitter to do? Simply go back to the life-threatening smoking behavior?

What about putting addicted smokers in a facility and treating them much as we would alcoholics and other addictive-drug users? The idea may seem radical, but a number of hospitals around the United States have been attempting this approach and now a study just published in the Mayo Clinic Proceedings (February 2001) confirms that hospitalizing smokers who cannot quit using the patch, gum, medication and counseling, significantly increases the chances of turning an addicted smoker into a long-term ex-smoker.

The Nicotine Dependence Center at the Mayo clinic in Rochester, Minnesota was established in 1988. The center is directed by a physician and staffed by full-time professional counselors. In this study, a total of 146 patients who were treated in this residential program between 1992 and 1996 were evaluated. The program included eight days of hospital stay during which time patients received intense individual and group counseling and participated in comprehensive educational programs. Smokers attended sessions on stress management, the health consequences of smoking, spirituality, nutrition and exercise. Pharmaceutical smoking cessation aides were selected for the needs of each individual patient. And the results were indeed encouraging.

The 6 month abstinence rates for the residential group as compared with a control group of outpatients receiving more traditional smoking cessation assistance was 45 percent versus 26 percent. The 12 month abstinence rates for these groups were 45 percent versus 23 percent.

The authors concluded "residential treatment for tobacco dependence is superior to outpatient treatment in some smokers who are moderately to severely nicotine dependent." The results of this study strongly suggest that smokers who fail on their own or with the patches and gum and other interventions prescribed by their physicians should seriously consider hospitalization in an appropriate setting—and should argue forcefully to their health insurers that this type of medical care is indeed cost effective and should be covered.