Schaffer Online Library of Drug Policy Sign the Resolution for a Federal Commission on Drug Policy


Contents | Feedback | Search | DRCNet Home Page | Join DRCNet

DRCNet Library | Schaffer Library | Alcohol


5. Tobacco


Since it was first suggested in 1898 that smoking may result in lung cancer, many studies have examined the effect of tobacco smoke on active and passive smokers. As the social and economic costs of tobacco-related problems are enormous, medical practitioners and health workers play an important role in educating smokers of the risks and promoting the health benefit of quitting.




Tobacco smoke contains over 4000 compounds, many of which have been linked to human disease.


Complications related to pregnancy and reproduction
Degenerative disease
Traumatic and accidental




Complications related to pregnancy and reproduction


Degenerative disease

Traumatic and accidental


Most psychological and behavioural difficulties occur with the cessation of smoking and in the ambivalent phase leading up to the decision to quit. However, most withdrawal phenomena are short lived, and with continual abstinence, ex-smokers enjoy many positive psychological effects.

Common psychological presentations of nicotine withdrawal:



Ex-smokers live longer than those who continue to smoke. The extent to which life span improves depends on the length of time since quitting, number of cigarettes smoked over how many years and the health status of the ex-smoker.

However, quitting is beneficial even in the presence of disease, eg patients with chronic obstructive airways disease will have improved lung function and symptomatology. Even lung cancer patients can help avoid second cancers and terminal respiratory infections. Of course, early cessation, with the support of education from health professionals and stop smoking programmes, will have greater health benefit by preventing the development of disease rather than its progression.

Although health issues are often given as the main reason for stopping smoking, for those who have yet to develop disease these events may be far less relevant than social or financial issues, or the health of their family.

Medical practitioners and other health care workers can help by emphasising the positive benefits of quitting. Discussion of withdrawal symptoms with the patient can also help them prepare for the process of quitting. It may be worthwhile for health professionals to think about their own behaviour and attitudes to smoking and how this affects their advice to patients.



It should be emphasised that most of these are short lived when discussing them with the patient (eg symptoms usually peak about 3 days after cessation and the withdrawal, usually mild, is over within 7-10 days for most people). Discussion of withdrawal symptoms is not to discourage the uncommitted from the attempt, but rather to help the patient be better prepared for quitting, especially if it is his or her first attempt.

Psychological symptoms

Physical symptoms


Individual approaches

A good start is to document each patient's smoking history as part of general history-taking on initial presentation. When time allows, the patient can be encouraged to talk about their smoking using a non-judgemental question such as, 'How do you feel about your smoking?' A helpful model to use when assessing the smoker's readiness to quit identifies three stages:

  1. Not ready – They are likely to become defensive and resistant to simple advice to stop. Gentle encouragement of the patient to think about their habit and making it clear that you are available for further support is the most effective approach.
  2. Unsure – The advantages of continuing to smoke are still as important as the advantages of quitting. Discussion can focus on weighing up the pros and cons and any other specific concerns.
  3. Ready – They will respond positively to advice to stop and can be given more specific help on how to deal with withdrawal symptoms. Provide follow-up to encourage their efforts and deal with continuing difficulties (Mendelssohn and Richmond, 1992).

It is therefore useful to identify how ready the patient is to change in order to provide the most appropriate individual assistance. An approach that helps the patient to take control and responsibility for the problem is more likely to be successful than systematically giving advice to stop or telling the patient what to do.


Many ex-smokers relapse, especially in the setting of social events, peer pressure and alcohol. Patients should be encouraged to view these as learning experiences, and to learn from there how to avoid future relapses when they try again. Subsequent attempts are often easier for this reason.

Additional approaches

Resources available for the cessation of smoking

1. How to help smokers to quit: a guide for the health professional

An easy to use guide to give health professionals tips in counselling smokers with a brief intervention. The guide also outlines the stages a smoker goes through when quitting and illustrates how a health professional can help using The Can Quit Book.

2. The can quit book

A book for all smokers. Based on years of research and practical knowledge, it gives advice on recognising why people smoke, the health facts about smoking and an individual's health, preparing to quit and techniques to give up smoking and stay stopped.

Both resources are available from:

Victorian Smoking and Health Program (Quit)
PO Box 888Carlton South Vic. 3053
Telephone (03) 663 7777
Fax (03) 663 7761.
Note: No fee for orders in Victoria, small fee for orders interstate.

3. Smokescreen for the 1990s

The stop smoking programme for use by medical practitioners, obtained through the Prince of Wales Hospital, New South Wales.

There are two kits available:

  1. one kit for GPs
  2. self-help kit for smokers that can be displayed in the surgery.

Kits available from:

The Smokescreen Unit
Prince of Wales Hospital
High Street
Randwick NSW 203
Telephone (02) 399 4766
Fax (02) 399 2196.

4. Sick of smoking?

A manual for helping patients stop smoking, obtained through the South Australian Health Commission:

Sick of Smoking Officer

College House15 Gover Street
North Adelaide SA 5006
Telephone (08) 267 1249.

General and community approaches


Recent evidence has come to light showing the harmful effects of tobacco smoke on the health of non-smokers.

Cigarette smoke can be separated into two components, mainstream smoke which is inhaled by the active smoker, and sidestream smoke, the unfiltered smoke released from the end of a lit cigarette, which results in passive smoking in non-smokers.

The dangers of passive smoking are highlighted by the knowledge that 85% of cigarette smoke is released as sidestream smoke. Since the sidestream smoke is unfiltered it contains higher concentrations of dangerous chemicals. The effects of this harmful smoke in non-smokers can lead to increased incidence of bronchitis, pneumonia, and other chest illness in children, Sudden Infant Death Syndrome, lung cancer and lung disease. In addition, the irritants in tobacco smoke are a major concern to people with asthma and people with allergies, especially of the eyes, nose and throat.

Recent estimates suggest that annually approximately 150 deaths from lung cancer and 1000 deaths from heart disease in Australia are due to passive smoking (Holman, Armstrong, Arias et al., 1988).

Health risks of passive smoking

At work

The legal ramifications of smoking in the workplace are now becoming apparent. In Australia there have been at least 10 cases since 1980 where workers have received compensation for injuries incurred as a result of passive smoking in the workplace. As a result increasing numbers of employers are making their workplaces smoke-free.

Contents | Feedback | Search | DRCNet Home Page | Join DRCNet

DRCNet Library | Schaffer Library | Alcohol