Background: In view of skyrocketing number of cases leading to increased prevalence of tobacco use, especially in developing countries the interventions for smoking cessation have become an urgent need of the hour. The aim of the present study is, therefore, to know the effect of pharmacotherapy alone and pharmacotherapy with psychotherapy on tobacco cessation.

Methods: It is a prospective cohort study conducted in 75 subjects (Pharmacotherapy alone group, n= 38; pharmacotherapy with psychotherapy group n= 37). Subjects were randomly allocated into two groups. Medication was given to all the subjects with bupropion (300 mg) based on the severity of tobacco addiction while psychotherapies were individually tailored and delivered only in one group.

Results: Tobacco abstinence rates in both the groups differ markedly. The mean age of patients in the pharmacotherapy alone group and the combined group was 31.59±13.75 and 34.14±11.71 years, respectively. The mean age of starting tobacco use was 22.41±8.34 and 22.71±8.21 years in the pharmacotherapy alone group and the combined group, respectively. Overall, 22.7% (n=17) of the subjects were smoker while majority of them belonged to smokeless group (77.3%, n=58). The overall rates of continuous abstinence at 6, 8 and 12 weeks were 26.3%, 28.9% and 28.9% respectively in pharmacotherapy group, while in combined therapy group it was 47.3, 54.1, and 54.1 respectively.  In Smokeless group it was 28.1% at week 6, 8 and 12 in pharmacotherapy group and 50%, 53.8% and 53.8% respectively in combined therapy group while in smokers abstinence rate at 6, 8 and 12 weeks was 16.7%, 33.3% and 33.3% respectively in pharmacotherapy group and 45.5%, 54.5% and 54.5% in combined therapy group (p<0.05).

Conclusions: Combined therapy was found to be significantly more effective than pharmacotherapy alone in both smoker as well as smokeless tobacco user group.

Key words: Tobacco cessation, Bupropion, Combined therapy.

1. World Health Organization. Tobacco or health: a global status report. Geneva: WHO; 1997.
2. World Health Organization. WHO Report on the Global Tobacco Epidemic, 2011. Geneva: World Health Organization, 2011 [accessed 2015 Apr 7].
3. Peto R, Lopez AD, Boreham J, Thun M, Heath C Jr. Mortality from tobacco in developed countries: indirect estimation from national vital statistics. Lancet 1992; 339: 1268-78.
4. Peto R, Lopez AD, Boreham J, Thun M, Heath C Jr. Mortality from smoking in developed countries, 1950-2000: indirect estimates from national vital statistics. Oxford: Oxford University Press, 1994.
5. Fagerstrom KO. Smoking cessation treat-ment with sustained release bupropion: optimising approach to management. Drugs 2002; 60 (suppl.): 1S-70S.
6. The Tobacco Use and Dependence Clinical Practice Guidelines Panel, Staff and Consortium Representatives. A clinical practice guidelines for treating tobacco use and dependence: A US Public Health Service Report. JAMA 2000; 283: 3244-54.
7. Lancaster T, Stead L, Silagy C, Sowden A. Effectiveness of interventions to help people stop smoking: findings from the Cochrane library. BMJ 2000; 321: 355-7.
8. West R, Mcneill A, Raw M. Smoking cessation guidelines for health professi-onals: an update. Thorax 2000; 55: 987-99.
9. Russell MAH, Wilson C, Taylor C, Baker CD. Effect of general practitioners’ advice against smoking. Br Med J 1979; 2: 231-5.
10. Jorenby DE, Leischow SJ, Nides MA, Rennard, SI, Johnston, JA, Hughes, AR, et al. A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. N Engl J Med 1999; 340: 685-91.
11. Ascher JA, Cole JO, Colin JN, Feighner JP, Ferris RM, Fibiger HC, et al. Bupropion: a review of its mechanisms of antidepressant activity. J ClinPsychiatr 1995; 56: 395-401.
12. Johnston JA, Lineberry CG, Ascher JA, Davidson J, Khayrallah MA, Feighner JP, et al. A 102-center prospective study of seizure in association with bupropion. J ClinPsychiatr 1991; 52: 450-6.
13. Nerin I, Crucelaegui A, Mas A, Guillen D. Profile of smokers who seek treatment at a smoking cessation clinic. Arch Bronconeumol 2003; 39: 298-302.
14. Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO. The Fagerstrom test for nicotine dependence: a revision of the Fagerstrom Tolerance Questionnaire. Br J Addict 1991; 86: 1119-27.
15. Chabbra SK, Rajpal S, Gupta R. Pattern of smoking in Delhi and comparison of chronic respiratory morbidity among beedi and cigarette smokers. Indian J Chest Dis All Sci 2001; 43: 19-26.
16. Ahluwalia JS, Harris KJ, Catley D, Okuyemi KS, Mayo MS. Sustained-release bupropion for smoking cessation in African Americans: a randomized controlled trial. JAMA 2002; 288: 468-74.
17. Dale LC, Ebbert JO, Glover ED, et al. Bupropion SR for the Treatment of Smokeless Tobacco Use Drug Alcohol Depend 2007 September; 90(1) : 56–63.
18. Swan GE, McAfee, T, Curry SJ, Jack LM, Javitz H, Dacey S, et al. Effectivness of bupropion sustained relase for smoking cessation in a healthcare setting: a randomized trial. Arch Intern Med 2003;163:2337-44.
19. George D’Souza, Dorothy P. Rekha, PriyaSreedaran, K. Srinivasan, Prem K. Mony. Clinico-epidemiological profile of tobacco users attending a tobacco cessation clinic in a teaching hospital in Bangalore city. Lung India 2012;(29)2:137-42.
20. Jarvis, M. J. (2003). "Monitoring cigarette smoking prevalence in Britain in a timely fashion." Addiction 98(11): 1569-74.
21. Hurt RD, Sachs DP, Glover ED, Offord KP, Johnston JA, Dale LC, et al. A comparison of sustained-release bupropion and placebo for smoking cessation. N Engl J Med 1997; 337: 1195- 1202.
22. Kottke TE, Battista RN, DeFriese GH, Brekke ML. Attributes of successful smoking cessation intervention in medical practice: a meta-analysis of 39 controlled trials. JAMA 1988; 259: 2882-9.
23. Cummings SR, Coates TJ, Richard RJ, Hansen B, Zahnd EG, Vandermartin R, et al. Training physicians in counseling about smoking cessation: a randomized trial of the ‘Quit for Life’ program. Ann Intern Med 1989; 110: 640-7.
24. Strecher VJ, O’Malley MS, Villagra VG, Campbell EE, Gonzalez 11, Iron TG, et al. Can residents be trained to counsel subjects about quitting smoking?: results from a randomized trial. J Gen Intern Med 1991; 6: 9-17.
25. Tonstad S, Farsang C, Klaene G, Lewis K, Manolis A, Perruchoud AP, et al. Bupropion SR for smoking cessation in smokers with cardiovascular disease: a multicentre, randomized study. Eur Heart J 2003; 24: 946-55.
26. Aubin HJ, Lebargy F, Berlin I, Bidut-Mazel C, Chemali- Hudry J, Lagrue G. Efficacy of bupropion and predictor of successful outcomes in a sample of French smokers: a randomized placebo-controlled trial. Addiction 2004; 99:1206-18.

Abbas Mehdi

Department of Psychiatry, Institute of Medical Sciences,

Banaras Hindu University, Varanasi221005, Uttar Pradesh India