Smoking-Cessation Treatment

The article “Psychiatrists Should Be Armed in War Against Smoking” in the October 2 issue agreed and contrasted with my quarter-century experience in smoking cessation in my general psychiatric practice.

The advice that “psychiatrists should be armed” is unneeded. We psychiatrists have the weapons in our therapeutic ammo box: treating each smoker patient individually, obtaining a full smoking history (one hour in our office), utilizing any of the vast medications available to us (well beyond Wellbutrin and Chantix), accepting that nicotine is the addictive drug that far overrides well-meaning motivational lectures, calculating the amount of nicotine substitution beyond just the number of cigarettes smoked per day but researching the amount of nicotine in each cigarette (from brand to brand it can vary by a factor of 15), employing approved techniques such as cognitive therapy, hypnotherapy, and biofeedback—in other words, treating each smoker as an individual requiring unique combinations of therapies—much in the same way that physicians treat patients with hypertension, colitis, or anxiety—and not using one program for all as suggested by many smoking-cessation guides.

Whether patients are mentally ill or not, they have a need for knowledgeable and effective therapies by psychiatrists.

ELLIOT WINEBURG, M.D. New York, N.Y.