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Does a combination of smoking cessation medication and behavioural support help smokers to stop?

Stead LF, Lancaster T
Published Online: 
12 December 2012

Behavioural support (such as brief advice and counselling) and medications (including varenicline, bupropion, and nicotine replacement therapies like patches or gum) help people quit smoking. Many guidelines recommend combining medication and behavioural support to help people stop smoking, but it is unclear if some combinations are more effective than others, or if the combination of medication and behavioural support works better in some settings or groups than in others.

This review includes 41 studies which compare combinations of behavioural support and medication to help smokers to stop compared to groups receiving usual care or less behavioural support. One large study found a very strong treatment effect; it had an intensive intervention which included extended availability of nicotine gum, multiple group sessions, and long term contact to help maintain abstinence or encourage additional quit attempts Because it was not typical of most treatment programmes, it was not included when we combined the results from the included studies although it shows that such intensive support can be very effective. Based on the remaining 40 studies, we found that using a combination of behavioural support and medication might typically increase the chances of a person successfully quitting smoking by 70 to 100 per cent compared to their chance of success if they just received brief advice or support. There was no clear evidence that providing more contact time increased the effect of the intervention, and there was only weak evidence that studies offering a larger number of behavioural support sessions had larger effects. However, when we only looked at studies where most people used the treatments offered, there was some evidence that intensive support was more effective.