Each year, millions of people vow to finally kick the cigarette habit, only to watch their optimistic expectations go up in smoke. But if they've tried and failed with conventional smoking cessation approaches -- whether it's the use of nicotine gum, counseling, or behavior modification -- they often look outside the mainstream, motivated by the hope that alternative medicine might finally deliver them from a life cluttered with cigarette packs and tarnished by nicotine-stained teeth.
But both smokers and health-care professionals agree that the challenge of quitting remains formidable.
"When it comes to smoking cessation, there's no magic bullet -- I think everyone agrees with that," says Thomas Kiresuk, PhD, a clinical psychologist at the Minneapolis Medical Research Foundation and former director of the Center for Addiction and Alternative Medicine Research in Minneapolis, Minn. And while many alternative approaches are available -- ranging from acupuncture to guided imagery to self-hypnosis -- they're certainly no panacea, and for every smoker they help, they may leave another one frustrated and feeling a slow burn at the end of the day while they light up their next cigarette.
True, some people swear by the acupuncture needles stuck in their bodies or the nicotine-averse images implanted in their minds, crediting these unconventional techniques with thoughts of conquering their nicotine cravings for good. But when you examine all of the scientific research, the success stories are interspersed with the disappointments. "There's really nothing out there that has set itself apart as a winner in the treatment of smoking cessation," says Kiresuk, a professor in the department of psychiatry at the University of Minnesota in Minneapolis.
A Powerful Addiction
More than 50 million Americans smoke, and nearly 7 million more use smokeless tobacco. The numbers are even higher in other parts of the globe, with worldwide statistics showing that one out of three men and women over the age of 18 are smokers.
Without doubt, smoking remains a risky business. In the U.S. alone, tobacco kills more than 440,000 people each year, according to the CDC.
Yet most experts concur that no matter how strong your will for kicking the habit, there are some powerful, addictive forces plotting against you. Certainly, no single smoking-cessation technique works for everyone, and the failure rate can be discouraging, with most people quitting at least three times in the past before finally finding a way to stop for good.
"There's nothing more difficult than quitting smoking," says David Bresler, PhD, clinical professor of anesthesiology at the David Geffen School of Medicine at UCLA and president of the Academy of Guided Imagery in Malibu, Calif. "No one smokes because it feels good and because they enjoy the feeling of hot toxic gases moving down their throat," he says. "These people are addicts -- they're addicted to nicotine."
Kiresuk agrees. "When you see what happens to people who are in the stages of withdrawal, you know that this is a very serious affliction," he says. Committed smokers, he says, are "willing to risk death to keep smoking."
Still, the alternative approaches to smoking cessation have a growing number of converts -- and they've turned some cigarette cravers into permanent ex-smokers. A primary benefit of most of these unconventional methods is their ability to empower people to change. "Individuals learn that they have control over their body that they didn't think they had before. It's a learning experience that prepares them to make changes like quitting smoking," says Kiresuk.
Hypnosis: Heightened Awareness
Along with weight management, smoking cessation is the most popular medical use of hypnosis. Using this technique, individuals enter a state of focused attention and concentration and become more susceptible to suggestions that weaken their craving for cigarettes and strengthen their will to stop.
However, when researchers at Ohio State University reviewed nearly five dozen studies of the use of hypnosis for smoking cessation, they concluded that while smokers participating in hypnosis programs were more successful in abstaining from cigarettes than smokers who did not use any stop-smoking intervention, this approach appeared to have no advantages over other popular stop-smoking programs.
"When you look specifically at the well-controlled clinical trials of hypnosis, they have not yet confirmed the benefits of this method," says Timothy Carmody, PhD, clinical professor of psychiatry at the University of California San Francisco and director of health psychology at San Francisco Veterans Affairs Medical Center.
At UCSF, Carmody and his co-researchers are conducting a carefully designed study to help definitively answer the question of whether hypnosis really works for smoking cessation. All participants are receiving nicotine patches (for eight weeks) and standard behavioral counseling, and half of them also have gone through self-hypnosis training sessions.
These individuals are taught to relax and enter an attentive, receptive state. "Then," says Carmody, "they're given suggestions for focusing on and strengthening their reasons for quitting smoking, and picturing themselves as nonsmokers effectively overcoming and reducing the experience of urges or cravings to smoke." The UCSF participants are being asked to practice the self-hypnosis technique at least once or twice a day, as well as use it as needed to successfully manage situations where they may experience a desire to smoke.
A unique component of the UCSF study is that it is not relying solely on patient self-reports of successful quitting. "Our patients who say they have quit provide a saliva sample, which is analyzed for the presence of cotinine," a chemical byproduct of nicotine, says Carmody.
A Picture's Worth a Thousand Words
If you can mobilize vivid images in your mind at the drop of a cigarette ash, guided imagery may be a technique worth trying. Using this method, individuals enter a state of relaxation and then create mental pictures that help tap into their unconscious mind and reprogram the nervous system to resist the temptation to smoke.
"Guided imagery is most helpful in preparing people to quit smoking," says Bresler. It can help them get ready on the inside, clearing away internal conflicts and obstacles that can block the path to quitting.
Bresler notes that many people are attracted to smoking by Madison Avenue's imagery that has convinced them that they can feel cool, macho, or seductive if they smoke. Guided imagery, he says, taps into a person's own imagination and helps them create other images that can counter the purported appeal of smoking, showing instead that it is a toxic poison that you're inhaling. "The key is to break the habit, break the addiction, and recognize that you don't need a cigarette to feel cool," he says.
Part of guided imagery's power is its ability to instill strength and resolve to toss those cigarettes aside. "It is a means of learning to relax, talking to your creative self, and mobilizing and growing your determination and will to make changes that are important to your well-being," says Bresler.
Poking Holes in Smoking
Acupuncture, the ancient Chinese technique, has been used for thousands of years for a variety of ills -- and these days, for some people who have recently gotten the point, it has helped them rise above the cigarette haze for good. In a study at the University of Oslo in Norway, published in the journal Preventive Medicine in 2002, participants who had smoked for an average of 23 years were given acupuncture treatments, with needles inserted at points believed to influence organs associated with smoking (such as the lungs, airways and mouth). Over a five-year period, these participants smoked less and had a decreased desire to smoke, compared with a control group.
"In a clinical setting, you'll meet many people who say they quit smoking by using acupuncture, and they swear by it," says Kiresuk. But taken together, the available clinical studies have not provided persuasive evidence of acupuncture's benefits, with much of research raising doubts about the alternative technique's ability to help kick the habit, he says.
Researchers at the University of Exeter in Exeter, England, conducted an analysis that combined data from all of the existing randomized, controlled trials of acupuncture. Their conclusion: Acupuncture was no better than sham acupuncture techniques in helping people become smoke-free.
Bresler, who has been a practitioner of acupuncture for pain relief and other health problems for more than 30 years, has found that acupuncture can be helpful in managing the physiological nicotine-withdrawal symptoms, probably by stimulating the release of brain chemicals called endorphins. "Acupuncture can help relieve the 'nicotine fits,' the jitters, the cravings, the irritability, and the restlessness that people commonly complain about when they quit," he says.
A Shot in the Arm
Meanwhile, the ultimate answer to smoking cessation may come not from an acupuncture needle, but from a different kind of needle - namely, one that administers a nicotine vaccination. A number of vaccines are now being developed, with at least one of them (called NicVAX) now being tested in clinical trials for the prevention and treatment of nicotine addiction.
NicVAX stimulates the body's own immune system to block nicotine molecules from reaching the brain, and thus interfering with the addictive process, including the triggering of nicotine cravings. Researchers hope that the effects of the shot, which would be administered in a doctor's office, will last for up to a year per shot.