JesseOfMarionHotel

Wikipedia article Smoking Cessation (Rev. 5 Nov 09)

The entire article should be completely rewritten. No offense to its current author, but a good encyclopedia piece on a subject so complex cannot be easy to write. A health article of this importance, also part of Wikiproject Medicine, should be written by an M.D. if possible, though a resourceful layperson willing to spend considerable time researching might do it. The existing article contains a few references. The Merck Manual, 16th ed. (Merck & Co. 2002) is an excellent source, but omits newer treatments like Chantix.

The introductory section is abysmal. I propose it read as follows:

Smoking cessation is usually understood to mean the process by which a habitual tobacco smoker achieves durable abstinence. That quitting can be exceedingly difficult has been known for many years, to smokers especially, but also to their physicians and therapists as well as to the general public. Smokers often find themselves unable to quit despite having great reason and motivation to do so. Fear of enduring the nicotine withdrawal involved in traditional "cold-turkey" methods for quitting long deterred prospective ex-smokers. After the 1964 U.S. Surgeon General's Report dramatically underlined the health dangers of smoking, cigarette packages began to carry a warning label, and soon smokers, health care professionals, and pharmaceutical firms became interested in devising systematic treatment modalities, including new drugs, aimed at helping smokers succeed in giving their habits up. The first new drug was nicotine itself, the active ingredient in tobacco, but delivered by routes other than smoking, and in steadily decreasing doses in hope of weaning the smoker off and easing unpleasant withdrawal symptoms. Doctors and therapists discussed smoking cessation with their patients. Organizations such as the American Lung Association offered classes. Hypnotists plied their trade. Today smokers attempting to quit join support groups, nicotine replacement therapy is available without a prescription, and a panoply of new medicines has been deployed to the battle, arguably with some results: it is estimated that roughly half of all persons who have ever smoked no longer do.^{[needs citation]}

People are initiated into smoking mainly in youth under peer influences, subsequently coming to enjoy the effects produced by nicotine, then to become addicted to, that is chemically and psychologically dependent on, this substance. This article will not discuss initiation, which is amply covered elsewhere.^{[needs citation]} But after smoking perhaps many years, a smoker may begin to worry over the risks and costs of continuing to smoke, thus building toward a desire to do something about the newly perceived problem. How this mental process works is a subject of current research, not in any way a settled issue. Smoking-cessation experts generally agree that motivation is a necessary precondition to successful quitting.^{[needs citation]} This article addresses nicotine as a drug, presents an example model of mental processes underlying personal change, catalogs and assesses the most common approaches to quitting, then finally looks at relevant public policy.

OUTLINE

Introduction (above)

 I. Nicotine as a drug
    A. Effects of nicotine
    B. Nicotine addiction
    C. Nicotine withdrawal
II. Stages of Change model
    A. Pre-contemplation
    B. Contemplation
    C. Preparation
    D. Action
    E. Maintenance

III. Methods for quitting

    A. "Cold turkey"
        1. description of method
        2. assessment of effectiveness
    B. Counseling and psychotherapy
        1. description...
        2. assessment...
    C. Group therapy, classes, and support groups
    D. Medications
    E. New-age methods (e.g. hypnosis)
    F. Combinations of methods
IV. Public policy and smoking cessation
    A. Brief history
    B. Current initiatives
    C. Assessment of effectiveness

Conclusion JesseOfMarionHotel (talk) 00:23, 7 November 2009 (UTC)

I support sections III and IV, but I think I and II belong in the Nicotine article. You have my respect for tackling this project. I see the same issues you see with the article, but I lack the ambition or experience to conduct such a rewrite. Alan.ca (talk) 07:30, 21 November 2009 (UTC)