Dr Robert London

Commentary – Smoking cessation and psychiatry

Proving that cigarette smoking leads to negative health consequences has taken many years. It was President John F. Kennedy who in 1962 created a blue ribbon panel to study the ef­fects of smoking and lung cancer, as well as other cancers and cardiovas­cular disease. Starting with the semi­-nal 1964 report, numerous surgeons general have made strong cases for these links. The downward trend of cigarette smoking among physicians suggests that we have heeded these warnings.

In the late 1940s, 60% of physicians smoked cigarettes. By the time the surgeon general issued the 1964 re­port on the health benefits of smok­ing cessation, 30% of physicians smoked. The prevalence of smoking among physicians continued to de­cline in the 1960s. In the early 1980s, surveys showed that 5%-10% of physicians smoked cigarettes. By 2006-2007, the prevalence of physi­cians who smoked cigarettes had de­clined to 2% (Nicotine Tob. Res. 2010;12:1167-71).

Smoking never appealed to me, and I never started. However, early in my career, I grew concerned about smoking as a public health issue. When I told my father, an eye sur­geon (who also did not smoke), that I wanted to pursue psychiatry, he en­couraged me to learn an aspect of the specialty that few others knew and to develop that area as a subspe­cialty. That proved to be great advice. After all, I was underwhelmed by the absolute unsubstantiated dogma that dominated traditional talk therapies in psychiatric training at the time.

Soon after my residency, I started learning about hypnosis, behavior modification, and the emerging disci­pline of cognitive-behavioral therapy. I spent several years learning and working with the late Dr. Herbert Spiegel, a superb psychiatrist and na­tionally known expert in hypnosis. Dr. Spiegel and his son, Dr. David Spiegel, wrote the classic book Trance and Treatment: Clinical Uses of Hypnosis, 2nd edition (Washing­ton: American Psychiatric Associa­tion, 2003). From there, I started a short-term psychotherapy program in the mid-1970s at NYU Langone Medical Center/Bellevue – first using hypnosis in the treatment of smok­ing cessation. I continue to use this strategy today.

Although I have modified my ap­proach to smoking cessation from the original Spiegel technique, after almost 4 decades of using hypnosis for smoking cessation, I still find the Hypnotic Induction Profile (HIP), as developed by the Spiegels, to be the easiest way to measure hypnotizabili­ty. This technique involves teaching the patient self-hypnosis within a 5- to 10-minute period after taking his health and smok­ing history.

Besides aiming to help motivat­ed people stop the life-threaten­ing and addictive smoking habit, the use of hyp­nosis in treating smoking cessa­tion empowers the patient to take control of the ad­diction and habituation that smoking creates. Instructing the individual in what can be a lifelong process in the use of hypnosis regularly on his own reinforces the original treatment pro­gram and makes this approach suc­cessful. This is comparable to following a diet-exercise plan.

Another great advantage of using medical hypnosis for smoking cessa­tion is that doing so eliminates the use of powerful medications, includ­ing patches, and even needles (as in acupuncture). Such medications have potential side effects.

During the first 10 years of my smoking cessation work, follow-up phone calls were used to determine success. My team and I discovered a success rate of about 30% with re­sponders over a 6-month period.

Today, we understand that smok­ing affects almost every organ system and is the No. 1 cause of preventable disease and death worldwide.

In the current political environ­ment – in which the emphasis on austerity is leading to enormous cut­backs in health care funding and re­strictions by insurers at all levels of care – it would seem that recognizing cigarette smoking as the leading pre­ventable cause of death and disease would be addressed and controlled in a logical way. In fact, if a food or bev­erage had a fraction of the toxins found in cigarettes, they would be taken off the market. This is how we handle medications that show the slightest bit of danger. Why the dou­ble standard for cigarettes?

In addition, electronic cigarettes, or e-cigarettes, are rising in popularity. These products deliver nicotine with secondhand vapor, and the science hasn’t been done on the implications