A multi-component program for cigarette, hookah, or e-cigarette dependence that includes motivation assessment, behavioral support, and when needed, medications such as nicotine replacement therapy, varenicline, or bupropion.
Indication
- All adults using any amount of cigarettes, rolling tobacco, hookah, or e-cigarettes daily
- Individuals who have tried to quit unsuccessfully or wish to quit for the first time
- People experiencing nicotine withdrawal symptoms (irritability, difficulty concentrating, increased appetite)
- Conditions in which smoking causes rapid harm: COPD, asthma, coronary artery disease, diabetes, pregnancy
- Patients deciding to quit to accelerate pre- or post-surgical recovery
- Individuals considering quitting for the sake of family members exposed to second-hand smoke
- People with co-occurring depression, anxiety, or alcohol use disorder who want to quit
Preparation
- Measurement of dependence severity using the Fagerström Test for Nicotine Dependence
- Exhaled carbon monoxide (CO) measurement and pulmonary function testing if needed
- Screening for co-occurring mental health conditions (depression, anxiety) and other chronic illnesses
- Assessment of motivation to quit, prior attempts, and trigger situations
- Setting a quit date and planning to inform close circle
How it's performed
- The 5R approach is applied: Relevance (personal impact of smoking), Risks, Rewards, Roadblocks, and Repetition (reinforcement at each visit)
- Behavioral support includes motivational interviewing, cognitive behavioral techniques, and relapse prevention work
- Nicotine replacement therapy (patch, gum, lozenge, spray, inhaler) is prescribed based on dependence severity
- In suitable cases, the physician may recommend varenicline or bupropion; side effects are explained
- Removing triggering objects such as cigarettes and lighters before the quit date; developing alternative coping strategies
- Integration with phone, text message, or mobile app-based support (such as the ALO 171 Quit Smoking Helpline)
Post-procedure
- Weekly follow-up in person or by phone in the first month, with decreasing frequency over the next 6 months
- Assessment of withdrawal symptoms, medication side effects, and relapse triggers
- Monitoring weight, blood pressure, and changes in respiratory function after quitting
- If relapse occurs, a new quit plan is created without stigmatization
- Family members are also referred to cessation support
Risks
- Withdrawal symptoms: irritability, insomnia, increased appetite, headache, transient increase in cough
- Skin irritation, oral discomfort, or dizziness from nicotine replacement
- Nausea, sleep disturbances, mood fluctuations with varenicline or bupropion
- Average weight gain of 2-5 kg in the 3-6 months after quitting (manageable with lifestyle measures)
- High relapse rate with solo attempts; regular support is therefore recommended
FAQ
Is joining a program really different from quitting on my own?
Behavioral support and appropriate medication can increase quit success rates several-fold. The program offers an individualized plan to manage withdrawal periods and relapse.
Can e-cigarettes be used to quit smoking?
E-cigarettes are not routinely recommended as an evidence-based cessation method, and their long-term safety is uncertain. Nicotine replacement therapy, varenicline, or bupropion — which have stronger evidence — are preferred.
Do the medications cause dependence?
Varenicline and bupropion are not addictive medications. Nicotine replacement has a much lower dependence potential than cigarettes and is safely used under medical supervision.
How long does it take for my lungs to recover after quitting?
Carbon monoxide in the blood begins to normalize within 24 hours; respiratory capacity improves over months, and after one year, cardiovascular disease risk drops significantly. Full benefit accrues over years.
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