Question Title: Need kickstarted

Liane

Dear Liane,

You're not alone. Most smokers who have succeeded in quitting are successful after an average of 10 quit attempts. Tobacco dependence is a very tough addiction to shake!

The most effective treatment involves aggressive pharmacotherapy, prescribed by an M.D. who really knows about smoking cessation, in conjunction with a counseling program. The standard counseling most widely used involves psychoeducational group therapy, like the Freedom from Smoking series sponsored by the American Lung Association. Other counseling options range from intensive individual therapy (two meetings a week with a therapist experienced in smoking cessation) to intensive inpatient treatment, like Dr. Richard Hurt's program at the Mayo Clinic.

What I mean by aggressive pharmacotherapy is the concurrent use of nicotine replacement (often in high doses, and sometimes with more than one source of nicotine) with the medication bupropion (also known as Zyban and sustained release Wellbutrin). Some smokers I have worked are able to avoid tobacco only by continuing the pharmacological treatment for longer periods of time than currently recommended by the Food & Drug Administration. Maintenance pharmacotherapy for smoking cessation is a concept which I believe we will be hearing and learning more about in the next several years.

So find a smoking expert in your area, and get to work - stopping smoking is much more difficult for some people than for others (because our brains and nervous systems are not identical), and you sound like someone who would benefit from the expertise that is currently available.

For a lot more information about tobacco dependence and smoking cessation, check out my Ask DrSteve web site, conveniently hyperlinked below. Good luck!

Steve Adelman, M.D. (a.k.a. DrSteve)

This information is for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.

Keywords: smoking cessation, nicotine replacement, bupropion

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