Section 5 - Referral to Specialist Services
This section covers:
- Details of local stop smoking services
- Types of support available
- Notes
- Key points
- Key contact persons
- How to refer someone
Details of local stop smoking services
There are stop smoking services available in every local NHS health board in Scotland. These are delivered by specially trained staff who can deliver support in either groups or to individuals. They offer both face to face behavioural support and access to pharmacological support such as NRT, Zyban® or Champix® to those intending to stop smoking.
All smokers making an attempt to quit should be strongly encouraged to use these services to help them, as this increases their chances of a successful quit attempt. When you deliver brief advice you will need knowledge of the different services available within your area.
You can obtain contact details and information about the services available in your area at:
www.canstopsmoking.com/local-help
Types of support available
There are two main types of support available to aid quit attempts. These are behavioural support and pharmacological support. Most stop smoking services offer a combination of these types of support.
Click on the links below to find out more information:
Behavioural support
This normally involves the person attending a number of sessions with a specialist stop smoking advisor. Behavioural support can be delivered either individually or in groups and both usually lasts a minimum of 6 weeks. Smokers are encouraged to set a quit date and use prescribed medications such as NRT, Zyban® or Champix® when appropriate.
Within both individual and group behavioural support the specialist stop smoking advisor will:
- Check that the person is motivated to stop
- Assess a person's tobacco dependence
- Assess suitability for medication
- Measure the person's carbon monoxide levels using a carbon monoxide monitor.
Carbon monoxide monitors are commonly used in smoking cessation services to monitor the levels of carbon monoxide in a smoker's breath and also as a motivational tool for the smoker.
Pharmacological support
This includes medications that can help with stopping smoking such as nicotine replacement therapy (NRT), Zyban® and Champix®.
For further information on medications please refer back to section 3
Other forms of support available include:
- Telephone support from Smokeline (0800 84 84 84) which is a free, confidential Scottish helpline. Smokeline is staffed by trained advisors who will give advice and guidance to help those who want to stop smoking, as well as providing details of how to access local specialist services.
- Support or advice from a General Practitioner (GP)
- Community Pharmacy Schemes: where pharmacists are trained to provide both behavioural and medical stop smoking support within a local pharmacy setting.
- Specialist stop smoking services for particular groups such as young people, pregnant women or hospital patients.
You can find out more information at: www.canstopsmoking.com
Medications that can help with stopping smoking :
Nicotine Replacement Therapy :
- NRT stands for Nicotine Replacement Therapy.
- NRT provides lower doses of nicotine than that found in cigarettes, and contains none of the harmful components of tobacco.
- NRT supplies low levels of nicotine to the body, therefore easing withdrawal symptoms and helping break the habit of smoking.
- NRT products are only used after the quit date, i.e. after the person has stopped smoking. This is to prevent an overdose of nicotine.
- NRT is available on prescription.
There are seven forms of NRT :
- Patches.
- Gum.
- Inhalator.
- Nasal spray.
- Microtab (tablet)
- Lozenges.
- Mouth spray.
NRT is suitable for most people, however it is important that you encourage any individuals that have concerns or require more detailed information to speak to a pharmacist or their GP. In particular some caution is required around the use of medications with pregnant women, young people or those with heart disease or diabetes.
There are some common misconceptions and myths surrounding the use and effectiveness of NRT. Some examples of these are included in the table below
| Misconception | Fact |
|---|---|
| Nicotine is the most harmful substance in tobacco | Most tobacco-related diseases result from other chemicals in tobacco. Nicotine is highly addictive and is a stimulant drug that raises blood pressure and heart rate, however the health effects of this are minimal compared to the effects of the other substances in tobacco |
| Nicotine causes cancer, heart disease and chronic respiratory disease. | These diseases are caused by other harmful substances in tobacco, not nicotine itself. |
| NRT products are as addictive as tobacco. | The amount of nicotine delivered by NRT is less than that delivered by smoking cigarettes and it is released into the blood stream at a much slower rate. The addictive effect of nicotine is therefore tempered in NRT products. |
| Nicotine in any form is hazardous to health | Nicotine in NRT is cleaner than that found in tobacco and therefore contains none of the toxins found in cigarettes. The nicotine from NRT products can still raise blood pressure and heart rate, however the risks of using nicotine in NRT products are minimal compared to the risks of continuing to smoke cigarettes which contain many other hazardous chemicals as well as nicotine. |
It is important that you have an awareness of these myths so that you can provide individuals with the accurate factual information to assist them with deciding whether they wish to use such medications.
Other types of medications (non-nicotine based) used to help people to stop smoking include:
- Zyban is the trade name for a drug called bupropion which affects the chemical messages in the brain involved in addiction and withdrawal. It can therefore ease cravings and withdrawal symptoms in someone stopping smoking. Treatment normally starts a week before a quit date while the individual is still smoking. It is a prescription-only medicine that comes in a tablet form. Zyban is not prescribed to people under the age of 18 years or to women who are pregnant or breastfeeding.
- Champix is the trade name for a drug called varenicline which is a non-nicotine based medication in a tablet form. It can also help to reduce the cravings and withdrawal symptoms associated with stopping smoking. Champix works on the brain by making smoking less satisfying and less pleasurable than before. It is a prescription-only medicine that comes in a tablet form and is taken 1 -2 weeks before a person quits. Champix is not prescribed to people under the age of 18 years or to women who are pregnant or breastfeeding.
- Both Zyban and Champix are prescription-only medicines. If an individual expresses an interest in using these medications and prescribing is not part of your job role then you should suggest that they speak to their local smoking cessation service or a GP. Specialist services will work with individuals to establish the most appropriate form of pharmacological support and will ensure that the individual receives it on prescription.
- Some alternative treatments for stopping smoking include hypnotherapy, acupuncture and laser therapy. There is insufficient evidence relating to the effectiveness of these treatments and this should be explained to the individual during brief advice. reference 1
Note
It is NOT the role of someone delivering brief advice to provide these types of support to someone who wants to stop smoking.
Instead you should refer the individual to a local stop smoking service . These services are delivered by specially trained staff who follow clear protocols in delivering such support.
Key points
- People who want to stop smoking are at least 4 times more likely to quit when combining support from stop smoking services with the use of medications such as NRT, Zyban® or Champix®.
- Smokers making an attempt to quit should therefore be strongly encouraged to use specialist stop smoking services for help and support.
Key contact persons
Within all health boards there are stop smoking services that are available free on the NHS.
Each area will also have a person responsible for the stop smoking services in the area. This person is normally called a smoking cessation co-ordinator.
How to refer someone
Most stop smoking services will take self-referrals where an individual interested in stopping smoking can phone a local service and speak to someone directly about accessing support.
Stop smoking services will also take referrals from a variety of health professionals
The procedure for making referrals on behalf of an individual will vary in different health board areas.
You can now proceed to section 6