Etiology of smoking
Tobacco smoking as self-medication
Recording smoking status as a vital sign increases the frequency of brief advice to patients by physicians.
Demonstration of damage to lungs
In general, informing patients of their lung function as measured by spirometry does not increase smoking cession according to a systematic review by the U.S. Preventive Services Task Force (USPSTF). However, in a more recent randomized controlled trial, patients in the group who were informed of their 'lung age' were more likely to stop smoking. However, in this trial, "People with worse spirometric lung age were no more likely to have quit than those with normal lung age in either group".
Demonstration of damage to blood vessels
"In smokers, carotid plaque screening performed in addition to thorough smoking cessation counseling is not associated with increased rates of smoking cessation or control of cardiovascular risk factors" in a randomized controlled trial that was not large enough to exclude meaningful benefit. In this study, the relative benefit ratio of carotid plaque screening for smoking cessation was 1.1 and, the relative benefit increase was 12.7%. In populations similar to those in this study which had a rate of benefit as measured by the smoking cessation of 22.1% without treatment, the number needed to treat is 36. 
One earlier trial reported benefit. "Providing smokers with photographs demonstrating atherosclerosis on their own person was an effective adjunct to physician's advice to quit smoking" according to a randomized controlled trial.  In this study, the relative benefit ratio of carotid plaque screening for self-reported smoking cessation was 3.5 and, the relative benefit increase was 252.4%. In populations similar to those in this study which had a rate of benefit as measured by the self-reported smoking cessation of 6.3% without treatment, the number needed to treat is 6. 
Varenicline, a partial agonist at the α4β2 nicotinic acetylcholine receptor, may be more effective than bupropion and placebo; however, bupropion is a generic drug. Varenicline is probably better than the nicotine patch; however, the only study was not blinded and was industry sponsored.
(relative risk ratio)
- Spray, 2.37
- Inhaler, 2.18
- Patch, 1.88
- Gum, 1.65
Rimonabant, a selective type 1 cannabinoid (CB1) receptor antagonist, improves smoking cessation and moderate weight gain associated with smoking cessation according to a meta-analysis of randomized controlled trials by the Cochrane Collaboration. However, "there is current concern (August 2007) over rates of depression and suicidal thoughts in people taking rimonabant for weight control."
Addiction is reinforced by the fear of experiencing the adverse effects associated with the cessation of the drug. Smoking withdrawal causes cognitive deficits analogous to attention deficit hyperactivity disorder, an observation which prompted researchers to test the hypothesis that drugs that ameliorate ADHD facilitate smoking cessation. In confirmation of this hypothesis, it was shown that atomoxetine, a norepinephrine reuptake inhibitor that is approved by the FDA to treat the symptoms of ADHD, dose-dependently reversed congnitive deficits in an animal model of nicotine withdrawal. Atomoxetine is not indicated at this time as a medication to treat the ADHD-like symptoms of smoking cessation.
Combinations of medications
|Intervention group||Comparison group|
|Community volunteers with predefined medical illnesses||Triple therapy of nicotine patch, nicotine oral inhaler, and bupropion ad libitum||Nicotine patch alone||Abstinence at 26 weeks by 7 days exhaled carbon monoxide testing||35%||19%|
|Community volunteers without medical illness||Double therapy with bupropion and nicotine patch||Nicotine patch alone||Abstinence at 52 weeks by single exhaled carbon monoxide testing||Both drugs 36%
Bupropion alone 30%
Apart from these trials, the roles of competitions and incentives are not clear.
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