Complementary Therapies for Smoking Cessation – A Useful Tool or Merely a Smoke Screen?

Complementary Therapies for Smoking Cessation – A Useful Tool or Merely a Smoke Screen?

Ampikaipakan Sundari, Steel Nicholas, Wilson Andrew
Citation: European Respiratory Disease 2009;5(1):41-44
Published: August 2009
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Abstract
Patients often wish to try complementary therapies to help with smoking cessation; however, many healthcare professionals feel the evidence for them is largely anecdotal. We have performed a PUBMED and Cochrane database review of the evidence for acupuncture and hypnotherapy as smoking cessation treatments. Fourteen articles were identified for acupuncture (including one Cochrane review) and 11 articles for hypnotherapy (including one Cochrane review). There was no good evidence for acupuncture. There was an apparent shortterm benefit seen in a meta-analysis. However, differing methodologies and a reliance on a single positive study, which has not been replicated, made drawing a positive conclusion untenable. There was also little evidence for the role of hypnotherapy. However, a metaanalysis of 24 studies looking at the data for males and females separately indicated that men may derive a small benefit. We conclude that there is currently insufficient evidence to use either acupuncture or hypnotherapy as smoking cessation treatment, but that there is a real need for better clinical studies.

Keywords
Smoking cessation, acupuncture, acupressure, hypnotherapy, hypnosis

Disclosure: The authors have no conflicts of interest to declare.
Received: 5 December 2008 Accepted: 2 June 2009
Correspondence: Sundari Ampikaipakan, Respiratory Medicine Department, University of East Anglia, Norwich NR4 7TJ, UK. E: sundariampi@googlemail.com

There are more than one billion smokers in the world. The World Health Organization (WHO) attributes 5.4 million deaths per year to tobacco use and it is anticipated that by 2030 there will be more than 8 million deaths per year. Smoking is the leading preventable cause of death in the world.1 Hence, never has there been a greater need for smoking cessation interventions.

Smoking cessation strategies largely involve pharmacological interventions and behavioural therapy, which includes physician advice, individual/group counselling and telephone counselling. These interventions have a clear evidence base and have been proved to work.3–6 Nicotine replacement therapy (NRT) and bupropion are proved to reduce withdrawal symptoms, in addition to the counselling and behavioural therapies that form an integral part of the smoking cessation pathway that is widely used.2

Among the simplest of behavioural interventions, brief direct physician advice to quit smoking is effective. Assuming an unassisted quit rate of 2–3%, brief advice intervention from a physician can increase this rate by 1–3% according to a meta-analysis of 28 trials involving 28,000 participants by Stead et al.3
In itself, NRT increases the chance of stopping smoking by approximately 50–70% regardless of the setting.4 In real terms, this equates to a incremental quit rate of 5%, which increases to 12% with additional intensive behavioural support.3 This applies to smokers who are motivated to quit and have a high level of nicotine dependence. There is little evidence for NRT in those smoking fewer than 10–15 cigarettes per day. Current evidence suggests that combination therapy using NRT with another agent leads to better sustained quit rates than monotherapy alone.5 Combining NRT with counselling has shown an increased sustained abstinence rate at 12 months.6 However, anecdotal evidence has long suggested that there may be a role for complementary therapies in smoking cessation. Acupuncture and hypnotherapy are two modalities that have been mooted as useful adjuncts to conventional smoking cessation therapies, but the evidence remains controversial. Evidence for the effectiveness of both of these complementary modalities will be reviewed in this article.

Methods
A review of the literature employing a search using PubMed and the Cochrane database was undertaken. The free text or keywords used were smoking cessation and hypnosis, hypnotherapy or acupuncture or acupressure. The rationale for including or excluding articles in this review is provided in Figures 1 and 2. In particular, data published since the two most recent large meta-analyses and data within the two large Cochrane meta-analyses have been considered in detail.

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