EFFECTIVENESS OF A "SIX-WEEK GROUP PROGRAM" FOR SMOKING CESSATION: A ONE YEAR FOLLOW-UP STUDY

Nicotine is included in DSM IV as an addictive substance and tobacco addiction is considered to be a chronic medical illness. According to the analysis of the Cochrane Library (http:\\www.cochrane.org) the most effective therapies for tobacco addiction are: group counselling sessions, nicotine replacement therapy (NRT) and bupropion therapy (BT). The aim of the present study was to evaluate the efficacy of the combined use of these approaches by assessing: i) the percentage of nicotine dependent subjects (NDS) who quit smoking, ii) if the Severity of Dependence Scale (SDS) was as effective as the Fageström Tolerance Questionnaire (FTQ) in detecting nicotine dependence and iii) if the intensity of smoking craving, measured by a Visual Analogic Scale (VAS), decreased during the program adopted. From January 2001 to June 2002, 72 NDS (31 males and 41 females, median age 45.8 yrs + 10.7, range 27 – 77) were recruited by our unit. After a motivational individual interview, NDS entered a six-week group program for smoking cessation, the “Five-day plan”, adopted by Mc Farland and Folkner in the fifties and modified in 1975 by Mangiaracina: a preliminary session one week in advance and, at the end of the original core of consecutive five-days, one session/week for four consecutive weeks were added. In the absence of specific medical problems, it was suggested that NDS use 150 mg tablets (twice a day) of sustained-release BT, while NRT administered with an inhaling device was recommended when FTQ score was higher than 7. NDS began BT ten days before the “quitting day” (first day of the five consecutive days). A medical staff conducted the motivational interviews of the NDS. Blood pressure, pulse and body weight were recorded and the amount of exhaled carbon monoxide (CO) determined. The level of dependence was evaluated by FTQ and SDS and the degree of nicotine craving was measured by VAS before and at the end of the five consecutive days. BT was carried out by 43 (61%) NDS; no one of the NDS decided to use NRT, while 28 (39%) NDS did not receive any pharmacological therapy. Only 14 NDS complied with the protocol of BT. NDS received two telephone calls from counsellors, at 3 and 12 months after the begin of the program, who questioned their smoking condition. Whenever possible, NDS were called in to measure exhaled CO. Our results show that at the time of the motivational interview, all NDS scored a high level of FTQ (6.1 + 1.9) as well as SDS (9.1 + 2.6) and the two scores were highly correlated (P<0.01 Pearson’s correlation index). During the five-day plan program, VAS values halved (VAS before the therapy: 53.7 + 20.8 and VAS on the fifth day of abstinence: 28.9 + 23.4; t=7.60, P<0.01). Fifty-seven (79.2%) of the NDS treated achieved a smoking cessation at the end of the program, fifty-three (73.6%) were still abstinent three months later and 46 (63.9%) a year later. In conclusion, SDS appears to be as good as FTQ in evaluating tobacco dependence, and the adopted therapy is effectively helpful for NDS. In fact, one year later almost two-thirds of the enrolled NDS were still not smoking.