Behavioural support programmes for smoking cessation - Needs and opportunities

Dependence on cigarettes involves a learned association between smoking beh aviour and both brain reward circuitry and the relief of nicotine withdrawa l symptoms. This process is overlaid by conditioning, beliefs and motives, which contribute towards keeping people smoking even when they want to stop . Nicotine replacement therapy (NRT), used to combat the craving and discom fort caused by nicotine withdrawal, goes a significant way towards helping smokers to recover from their dependence, but it is only part of the quitti ng process. Behavioural support programmes can be an effective aid to maint aining willpower and motivation. These programmes can range from intensive, face-to-face counselling and telephone counselling to self-help printed ma terials and videos. Low levels of access to, and demand for, intensive meth ods limit their reach, while generic self-help materials appear to have a s mall but significant impact in the absence of other interventions. There is some evidence that tailored support materials may be more effective than g eneric materials. The Committed Quitters(TM) programme offered by SmithKlin e Beecham is a set of highly tailored materials designed to supplement thei r NRT products. Evidence from clinical trials to date is encouraging and op ens up the possibility of a new era in terms of getting cost-effective beha vioural support to smokers on a large international scale.