Editor’s Note: This is part 1 of a 2-part series on complementary and alternative approaches to smoking cessation. Look for part 2 in the coming weeks.
Nicotine is the most addictive substance in common use globally. There are approximately 1.1 billion individuals who smoke tobacco worldwide, and tobacco smoking is the leading cause of premature mortality.1
There is a growing public interest in using complementary and alternative methods (CAM) for smoking cessation. A survey administered at the Mayo Clinic, Rochester, Minnesota, showed that 67% of the 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 were hypnosis, herbal products, acupuncture, yoga, and massage.2
Although attempts have been made to have a precise definition of CAM, it has been hard to reach universal agreement on what should or should not be included.3
In the United States, the National Center for Complementary and Alternative Medicine (NCCAM), a part of the National Institutes of Health (NIH) and the lead agency for scientific research on complementary and alternative medicine, states that “CAM is a group of diverse medical and healthcare systems, practices, and products that are not generally considered part of conventional medicine.” The center defines “complementary” as a modality used in conjunction with conventional medicine. Alternative modalities, on the other hand, are used in place of a generally accepted standard of care.4
Part 1 of this review aims to familiarize clinicians with several non-pharmacologic CAM methods their patients may be using, and the evidence, or lack thereof, to support their use.
Motivational interviewing, mindfulness training, and cognitive behavioral therapy are CAM methods commonly used in smoking cessation interventions. Hypnosis has also been employed with variable success.
Motivational Interviewing
Motivational interviewing was first developed by psychologist William Miller in the 1980s for treatment of excessive alcohol use. When used for smoking cessation, the interviewer listens to the patient’s challenges and concerns and asks questions in a way that helps individuals who smoke frame their reasons for quitting.
A Cochrane Database of Systemic Reviews including >16,000 participants with a 6-month or greater follow up, the endpoint being smoking cessation, showed a 25% success rate.5 However, a further Cochrane database review showed that it was helpful only when the individual who smoked actively wanted to quit.6
Nonetheless, motivational interviewing is an easily learned technique that can be employed in clinics by any health care provider.
Mindfulness Training
Mindfulness training can be described as learning to be comfortable with an experience rather than reacting to it. This approach can be implemented in person or via telehealth and has been found to be helpful in managing withdrawal and cravings.7It has been shown to be feasible and acceptable by patients in low socioeconomic groups and in minority communities.8
A meta-analysis of four randomized controlled trials showed that 25.2% of mindfulness training users were able to quit smoking while only 13.6% of patients receiving usual care without mindfulness training were able to quit smoking.9
Cognitive Behavioral Therapy
Like mindfulness training, cognitive behavioral therapy (CBT) can help individuals quit smoking once they commit to stopping. CBT focuses on identifying maladaptive thoughts and behavior patterns. These strategies help by increasing a person’s confidence in their ability to quit and by fostering coping skills in the face of stress and urges to smoke.10
Hypnosis
Hypnosis has been used since the 1980s, and while a large meta-analysis including 1926 patients showed insufficient evidence as a smoking cessation modality,11 in individual cases it has been reported to be effective. It is difficult to draw general conclusions since many hypnotic techniques and methods are used. So, even though evidence may not be incontrovertible, this modality is worth considering in patients interested in trying it. Both professional hypnosis and self-hypnosis are considered safe.
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 healthcare providers to encourage their patients to quit smoking using current best practices, in addition to any other modalities 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
- 1. Samet JM. Tobacco smoking: the leading cause of preventable disease worldwide. Thorac Surg Clin. 2013 May;23(2):103-12. doi: 10.1016/j.thorsurg.2013.01.009. Epub 2013 Feb 13. PMID: 23566962.
- 2. Sood A, Ebbert JO, Sood R, Stevens SR. Complementary treatments for tobacco cessation: a survey. Nicotine Tob Res. 2006 Dec;8(6):767-71. doi: 10.1080/14622200601004109. PMID: 17132524
- 3. Wieland LS, Manheimer E, Berman BM. Development and classification of an operational definition of complementary and alternative medicine for the Cochrane collaboration. Altern Ther Health Med. 2011;17(2):50-59.
- 4. National Center for Complementary and Alternative Medicine. https://files.nccih.nih.gov/s3fs-public/nccam_special_report.pdf. Accessed 2 June, 2022
- 5. Lindson-Hawley N, Thompson TP, Begh R. Motivational interviewing for smoking cessation. Cochrane Database Syst Rev. 2015 Mar 2;(3):CD006936. doi: 10.1002/14651858.CD006936.pub3. PMID: 25726920.
- 6. Lindson N, Thompson TP, Ferrey A, Lambert JD, Aveyard P. Motivational interviewing for smoking cessation. Cochrane Database Syst Rev. 2019 Jul 31;7(7):CD006936. doi: 10.1002/14651858.CD006936.pub4. Epub ahead of print. PMID: 31425622; PMCID: PMC6699669.
- 7. Smokefree.gov. “Practice Mindfulness.” https://smokefree.gov/challenges-when-quitting/stress/practice-mindfulness. Accessed 26 May, 2022.
- 8. Charlot M, D’Amico S, Luo M, Gemei A, Kathuria H, Gardiner P. Feasibility and Acceptability of Mindfulness-Based Group Visits for Smoking Cessation in Low-Socioeconomic Status and Minority Smokers with Cancer. J Altern Complement Med. 2019 Jul;25(7):762-769. doi: 10.1089/acm.2019.0016. PMID: 31314565.
- 9. Oikonomou MT, Arvanitis M, Sokolove RL. Mindfulness training for smoking cessation: A meta-analysis of randomized-controlled trials. J Health Psychol. 2017 Dec;22(14):1841-1850. doi: 10.1177/1359105316637667. Epub 2016 Apr 4. PMID: 27044630.
- 10. Vinci C. Cognitive Behavioral and Mindfulness-Based Interventions for Smoking Cessation: a Review of the Recent Literature. Curr Oncol Rep. 2020 May 16;22(6):58. doi: 10.1007/s11912-020-00915-w. PMID: 32415381; PMCID: PMC7874528.
- 11. Barnes J, McRobbie H, Dong CY, Walker N, Hartmann-Boyce J. Hypnotherapy for smoking cessation. Cochrane Database Syst Rev. 2019 Jun 14;6(6):CD001008. doi: 10.1002/14651858.CD001008.pub3. PMID: 31198991; PMCID: PMC6568235.
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
