There are some approaches that have the potential to assist with maintaining long-term smoking cessation, but have not been adequately investigated for use.
Health professionals should be aware of extravagant claims of success for interventions that have not been subjected to rigorous testing and for which there is no clinical evidence.
Other nicotine-related agents
Nicobrevin is a patented product containing quinine (claimed to reduce cravings), menthyl valerate (supposed sedative properties), and camphor and eucalyptus oil (decongestants).42 NicoBloc and Nicobrevin are occasionally recommended by some healthcare professionals. These products are available in some pharmacies,43 despite a lack of any empirical evidence of effectiveness.44
Aversive or rapid smoking
Aversive therapy aims to extinguish the urge to smoke through pairing the act of smoking with an unpleasant stimulus. In the context of smoking cessation, this is usually the use of rapid smoking. There is no evidence to suggest that rapid (or aversive) smoking may be effective.45
Strategies used as a motivational tool for smoking cessation in primary care include spirometry, expired carbon monoxide levels, vascular ultrasounds and genetic susceptibility. There is little scientific evidence of an effect on quitting smoking for most biomedical tests.46
Demonstrating the effects of smoking on estimates of lung age has not been shown to increase quit rates,47 although it might increase levels of motivation in patients with chronic obstructive pulmonary disease (COPD) to quit smoking in the early stages of the disease.
There are two major aspects to quitting tobacco use:
- overcoming nicotine addiction
- managing the cues for smoking.
It is known that increased physical activity has many benefits for a healthy life. Exercise has been investigated as a way of helping with symptoms of nicotine withdrawal and cravings during attempts to quit. Exercise may also help by increasing self-esteem, improving mental health and managing the weight gain that often follows quitting. However, there is currently no evidence to show higher abstinence rates in the long term with aerobic exercise, resistance exercise, physical activity, and combined aerobic and resistance exercise.48 A slight positive effect on smoking cessation at the end of treatment has been shown where yoga plus CBT was used.49
Increased physical activity should be encouraged as part of a support program as it brings other health advantages to people who are trying to quit smoking. Exercise should be advised for everyone quitting.
Allen Carr method
Although the Allen Carr method has considerable popular support, there has been a lack of high-quality, empirical evidence that it is effective.50 A recent randomised controlled trial involving 300 adults who smoke in Ireland found that Allen Carr’s ‘easy way to stop smoking’ was superior to a standard online national smoking cessation program at 12 months follow-up (22% versus 11%).51 The intervention consisted of a one-off, five-hour group seminar with a maximum of 20 participants in a routine seminar session. Participants smoke during smoking breaks until there is a ritualistic final cigarette, followed by a 20-minute relaxation exercise. The mechanism of the effect found is not clear and further research is needed.
St John’s Wort
St John’s Wort (Hypericum perforatum) is an antidepressant herb extract that has not been shown to aid in smoking cessation. As yet, there is no convincing evidence that St John’s Wort, alone or with individual motivational and behavioural support, is likely to be effective as an aid in smoking cessation.40,52,53