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Don’t give up giving up.

Smoking remains the world’s major preventable cause of early death. Reductions in smoking behavior have a major positive impact on numerous health outcomes.

A wide range of diseases and conditions are caused by cigarette smoking, including cancers, respiratory diseases, coronary heart and other circulatory diseases, stomach and duodenal ulcers, erectile dysfunction and infertility, osteoporosis, cataracts, age-related macular degeneration and periodontitis (US Department of Health and Human Services 2004).

Following surgery, smoking contributes to lower survival rates, delayed wound healing and post-operative respiratory complications (US Department of Health and Human Services 2004). Women who smoke during pregnancy have a substantially higher risk of spontaneous abortion (miscarriage) than those who do not smoke. Smoking can also cause complications in pregnancy and labour, including ectopic pregnancy, bleeding during pregnancy, premature detachment of the placenta and premature rupture of the membranes (British Medical Association 2004).

The harmful effects from nicotine dependence are generally related to the harm caused by smoking cigarettes and therefore the primary goal should be smoking cessation.

The Five Stages of Change in Giving Up Smoking.

Giving up smoking doesn’t just happen. Individuals undergo a dynamic process when considering stopping, which Prochaska and DiClemente (1986) captured in their Stages of Change model. This model outlines the incremental process people go through as they change a particular behaviour.

Stages of Change (Prochaska & DiClimente)

Therapists/Psychologists often use this model to help facilitate change in their patients. Therapists/ psychologist must be skilled at responding to the evolving needs of the individual as they progress through the stages.

Nicotine replacement formulations, antidepressant medications and some special medications working at Nicotine receptors in brain are available. These medications have been investigated and proved to be effective. It is suggested that a gradual reduction in smoking is an optimal approach prior to smoking cessation. Each of the above medications have a role in stabilizing the chemical imbalance in the brain. These medications are recommended only for those who would like to quit smoking. Factors to consider when deciding which of the treatments to initiate include:

  1. Motivation to stop
  2. Availability of counselling
  3. Previous experience with smoking cessation aids
  4. Contraindications to use and the potential for adverse events
  5. Personal preference of smoker.

More recently in recognition of the fact that not all smokers are able or willing to stop smoking or abstain from nicotine completely, it is recommended that smokers use one or more licensed nicotine-containing products while still smoking to prevent relapse. These are also used to alleviate temporary withdrawal symptoms. Please ask our Consultant Psychiatrist for more details, availability of these medications in UAE and for any further information.

In the following section, we focus on counselling / psychological treatments for smoking cessation.

Motivational Interviewing is a technique frequently used in helping patients change addictive behaviour such as smoking. The psychologist maintains a non-confrontational stance, and elicits the patient’s own intrinsic resources to change. An effective approach is collaborative, evocative and respects individuals’ autonomy. Relapse is normalised and viewed as an opportunity to learn about long term behaviour change in the future. If individuals relapse, they need not start the cycle again; in most cases individuals begin the cycle again at the contemplation or preparation stages.

Once you have identified which stage of change you are currently at, you can use the table below to engage in activities that might help you to progress to the next stage in the cycle.

Many people find it easier to give up smoking when they do so with professional support. Research shows that nicotine replacement or medication plus psychological support is the most effective treatment in helping people maintain abstinence from smoking. If you are experiencing problems in reducing or quitting smoking and would like to contact us for professional advice and support you can book in to see us by calling our reception team on 800-LifeWorks or emailing them at

Dr. Shankar Srinivas Kuchibatla, Consultant Psychiatrist and Medical Director
Dr. Marie Thompson, Senior Clinical Psychologist
LifeWorks Holistic Counselling centre,