‘Punishment smoking’: the simple prescription from a Brazilian doctor that leads more people to quit smoking


Want to quit smoking? You don’t have to give up this habit overnight. However, every time you light a cigarette, do it standing up, in a secluded spot, with no one around, and smoke while looking at a smooth wall.

This is one of the main guidelines that cardiologist Jaqueline Scholz gives to smokers who come to the office and wish to quit.

The doctor is a professor at the USP School of Medicine (University of São Paulo) and directs the Tobacco Treatment Program at the Instituto do Coração (InCor), also in São Paulo, one of the main and most successful outpatient clinics to support smokers in the Brazil.

Scholz reports that the idea of ​​creating the technique, called “punishment smoking”, was born in 2015, during a conversation with a patient.

“He looked at my face and said, ‘Doctor, you made me spend money on medicine and said I would lose the pleasure of smoking, but that didn’t happen,'” he recalls.

“That’s when I got the idea: I got up from my chair, looked to the side and replied, ‘I want to see you enjoy smoking standing up, looking only at a wall’.”

The simple recipe was the subject of a scientific article published last year, which the specialist wrote in partnership with colleagues from USP and Unifesp (Federal University of São Paulo), as well as a representative of the Preventive Cardiology Department of the Oslo University Hospital, in Norway.

The study compared a group of patients who underwent standard smoking cessation treatment (medicines and counseling in the office) and another group who, in addition to conventional therapies, were instructed to smoke as a punishment.

The results show that 12 months after the start of follow-up, 34% of participants in the first group (standard care) had completely given up smoking. Among those who early in the process adopted the extra intervention (time-out smoking), that number stood at 65% — an increase of 31 percentage points in the success rate.

But why would the technique be working? And how can it complement the other therapeutic resources already available, such as medication and counseling, to help people who want to quit smoking?

how to appease the pleasure

Scholz points out that conventional smoking cessation treatment is based on a drug called varenicline. Generally speaking, this drug binds to nicotine receptors located on brain cells. With this, he manages to reduce that feeling of abstinence that the person feels when he stops smoking.

Nicotine, it is worth remembering, is one of the main substances found in tobacco. It is related to feelings of pleasure and well-being, but it causes a very strong dependence (hence the cigarette addiction is something so difficult to give up).

By binding to such nicotine receptors in the brain, varenicline also reduces that feeling of reward that cigarettes bring. The result of this is that the pleasure of smoking diminishes or eventually disappears.

In patients who do not respond as well to varenicline, it is possible to associate other pharmaceutical resources, such as antidepressants and nicotine patches.

Along with medications, smoking cessation treatment also includes medical follow-up, counseling sessions and those basic guidelines on when and how to quit smoking.

Limitations and opportunities

Although this line of established treatments works well for a portion of patients, we cannot ignore the fact that a portion of those who want to give up their addiction do not respond well.

Even with all the changes in brain receptors and behaviors, cigarettes still end up being an important source of pleasure for them.

“We know that the pleasure of smoking has an association with hedonic memories. [relacionadas ao prazer]and there are no drugs that work in these aspects”, says Scholz. “For them, the cigarette represents the repetition of a pleasant and pleasant experience, even if the nicotine receptors are blocked”, he adds.

In other words, smoking continues to be linked to a number of other good things in that individual’s life — such as a break from work, talking with friends, coffee, moments before or after meals.

And that’s exactly where the idea of ​​punishment smoking comes in: when consuming the cigarette standing up, with no one around and looking at a wall, the person loses all the pleasurable stimuli that were linked to the habit of lighting and inhaling the burning substances. of tobacco.

This, with medication and monitoring, can further reduce the pleasures related to smoking.

promising results

To evaluate the punishment smoking technique, Scholz assembled a team of healthcare professionals and analyzed data from patients who had been through the clinic between 2011 and 2018.

The first group, composed of 324 smokers, received standard treatment that, in addition to medication, included the strategy of defining a date on which smoking would be completely abandoned.

The second, which included 281 patients, took varenicline and the other drugs, but was not instructed to quit suddenly: they could smoke as much as they wanted, as long as they respected those basic rules of the technique (standing, isolated, looking at a wall ).

At the end of three months, 45% of the participants in group 1 had stopped smoking, compared to 75% in group 2.

Almost a year after the start of follow-up, this rate was at 34% and 65%, respectively.

Another study conducted by the group, which has not yet been published, also showed that the technique would help reduce the number of cigarettes a person consumes a day. Although these investigations show that the technique is promising, to prove its effectiveness it is still necessary to submit it to more rigorous research, such as randomized and controlled trials.

“When I talk about punishment smoking, a lot of patients stop and think, ‘Gee, doesn’t that make sense?'” Scholz reports. “In a way, we give autonomy to the patient and do not determine that he is prohibited from smoking, which can almost represent a death sentence for some”, he believes.

Finally, the doctor points out that many people do not even know that smoking is a chronic disease and have a scientifically validated treatment protocol.

“Many think that quitting smoking only involves willpower, and that’s not the case”, he explains. “Of course motivation is important, but we have other resources,” she adds. “And the person does not need to wait for the cigarette to cause a health problem to seek help”, concludes the cardiologist.

The WHO (World Health Organization) estimates that tobacco causes more than 8 million deaths every year.

The use of this substance contributes to the development of more than 15 different types of cancer, in addition to being related to heart attack, stroke, chronic obstructive pulmonary disease (COPD), tuberculosis, respiratory infections, stomach and intestinal ulcers. , sexual impotence, infertility and cataracts.

The Inca (National Cancer Institute) estimates that 443 Brazilians die every day because of smoking. Every year, 161,000 cigarette-related deaths could be avoided in the country.

BAT Brasil stated in a note that “Anvisa, by keeping the issue on the regulatory agenda, will continue to evaluate the scientific evidence that substantiated the decision of about 80 countries that have already regulated these products. In addition, Anvisa’s board expressed its great concern with the illegal market for electronic cigarettes in Brazil, which continues to grow, supplied by smuggled products and without any sanitary control.”

The company also says that “adequate regulation would guarantee millions of adult consumers of electronic cigarettes in Brazil access to the legal product, with known composition and origin, quality parameters, inspection and sanitary monitoring.”

This text was originally published here.

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