Editor’s Note: This is part 2 of a 2-part series on complementary and alternative approaches to smoking cessation. Find part 1 here.
As stated in part 1 of this series, nicotine is the most used addictive substance with about 1.1 billion individuals who smoke tobacco worldwide. Tobacco smoking is the leading cause of premature mortality.1
Fortunately, many tobacco users would like to quit, and there is growing interest in using complementary and alternative methods (CAM). Again, as mentioned previously a Mayo Clinic survey showed 67% of 1,1175 respondents were interested in the future use of CAM for tobacco cessation, and 27% had already tried some form of CAM. The methods perceived to be most successful among respondents were hypnosis, herbal products, acupuncture, yoga, and massage.2
Part 2 of this review aims to familiarize clinicians with additional CAM methods their patients may be using and the available data on their efficacy.
Exercise
In a Cochrane database review analyzing 24 trials with more than 7,200 participants, exercise was not found to help patients quit smoking.12 However, some studies have shown beneficial effects when exercise has been combined with other smoking cessation approaches.
Cravings were found to decrease13 when exercise was undertaken in addition to using nicotine lozenges. Abstinence rates increased in sedentary women when exercise was combined with cognitive behavioral therapy (CBT).14 In people with high anxiety who enrolled in a smoking cessation program, the addition of exercise increased rates of quitting.15
Yoga
Although yoga is generally seen as a form of exercise in the United States, yoga, as an ancient philosophy and a spiritual practice, may also offer benefits other types of physical activity do not.
As there is no standardized approach followed by all yoga practitioners and many different schools exist, it is difficult to gather objective data. However, yoga is generally perceived to be helpful in patients who are motivated to try it. In a study combining CBT with a form of yoga called Iyengar yoga, abstinence rates were 37% higher in the combined modality group.16 Yoga helps to reduce stress and negative emotions associated with smoking cessation and is generally considered safe. Pregnant women and people with certain medical conditions, such as uncontrolled blood pressure, abdominal hernias, glaucoma, or sciatica, should modify some yoga poses.
Social Media
As an increasing number of people worldwide gain access to the Internet, social media can be used to help patients quit smoking. Interactive websites, smartphone apps, Facebook, WhatsApp, and Twitter groups abound and can help motivated individuals in their smoking cessation efforts. A review of social media interventions suggested that these approaches are feasible, highly acceptable, and may improve outcomes, but more research is needed.17
Acupuncture & Acupressure
A Cochrane database review did not find objective evidence of beneficial effect when using either acupuncture or acupressure.18 However, the authors of the review said that the many ways of performing acupuncture, acupressure, and related modalities made it difficult to make firm conclusions and more research was warranted.
Notably, acupressure focused on the ear—or auricular acupressure—has been considered a viable approach for smoking cessation by many CAM practitioners. A small study from Korea supports this theory. The study had only 55 participants, but researchers found that when auricular acupressure was combined with behavioral therapy, the smoking cessation rate at 1 year was 22% compared to about 5% in those who did not receive auricular acupressure.19
Supplements
Although there is no evidence that herbal supplements are effective as smoking cessation treatments, cravings may decrease with their use. St John’s wort is commonly used as an herbal antidepressant and, in one small trial, appeared to help with smoking cessation.20 However, some other trials did not find it helpful.21,22
A trial conducted in Thailand randomized 100 smokers between small pieces of lime taken by mouth vs. regular nicotine gum.23 At 9-12 weeks of follow-up, there was no significant difference in abstinence rates. Sixty one percent of individuals in the lime group and 66% in the nicotine group abstained from smoking. Given the small cost and the absence of adverse effects with small pieces of lime, this approach could be considered for people interested in using alternative methods for smoking cessation.
In another small study, 48 participants were randomized between inhaling the vapor from essential oil of black pepper, menthol, or an empty cartridge using an inhalation device. Black pepper essential oil inhalation appeared to decrease cravings.24
Combination Therapies
Combining CAM approaches with conventional smoking cessation modalities may lead to better outcomes although the literature is not conclusive.25 Research needs to continue. One recent study has combined CBT with psilocybin as a complimentary approach within a structured smoking cessation program. Psilocybin is a mushroom-derived serotonin 2A receptor agonist. When used with CBT and conventional smoking cessation approaches, long-term abstinence (16-57 months) was observed.26
Although there are many CAM practices described in the literature, there is a lack of robust scientific evidence to support their use. Nonetheless, it is important for oncologists and other health providers to encourage their patients to quit smoking using current best practices, in addition to any other modality that the patient perceives as helpful to achieve cessation. This is particularly important for practitioners in low- and middle-income countries where smoking cessation pharmacotherapy may not be readily available.
References
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Acknowledgements:
- Andrew Weil Center for Integrative Medicine, University of Arizona, Tucson, AZ, USA
- Dr. Rajeev Kurapati, Medical Director of Integrative Oncology, St. Elizabeth Healthcare, Florence, Kentucky, USA.
- IASLC Tobacco Control and Smoking Cessation Education Subcommittee
