Aromatherapy and Quitting Smoking

Abstract

Today, the treatment approaches recommended for smoking cessation are pharmacological and behavioral therapy. Both approaches are reported to be effective alone; however, when used together, the success rate increases. Modern medicine methods, however, often have a negative image due to cost, complexity and limitations in human life. For this reason, complementary and alternative therapies are widely used in the community for the treatment of many diseases in every age group. When people are asked why they prefer complementary and alternative therapies, the most important reason seems to be to improve quality of life by providing symptom control. Other reasons include economic problems, the lack of health insurance, the improvement of quality of life, the influence of the media and the environment, a strong belief that it will help, disappointment of conventional treatment failure, the noninvasiveness of most complementary and alternative therapies, fear of medical treatments, dissatisfaction with the current health system, medicines. Avoiding side effects can be called as a desire to have more control over health decisions. Contrary to many pharmacological and behavioral treatments that investigate the effectiveness of smoking cessation, only a few studies have included complementary and alternative treatments. Complementary treatment methods such as aromatherapy are thought to be regularly included in smoking cessation programs and their use should be ensured/expanded.

Full text

Galician medical journal 2020
Vol. 27, Issue 2, E202022
DOI: 10.21802/gmj.2020.2.2
Review
Aromatherapy and Quitting Smoking
Nurten Arslan Is¸ık
Abstract
Today, the treatment approaches recommended for smoking cessation are pharmacological and behavioral
therapy. Both approaches are reported to be effective alone; however, when used together, the success rate
increases. Modern medicine methods, however, often have a negative image due to cost, complexity and
limitations in human life. For this reason, complementary and alternative therapies are widely used in the
community for the treatment of many diseases in every age group. When people are asked why they prefer
complementary and alternative therapies, the most important reason seems to be to improve quality of life
by providing symptom control. Other reasons include economic problems, the lack of health insurance, the
improvement of quality of life, the influence of the media and the environment, a strong belief that it will help,
disappointment of conventional treatment failure, the noninvasiveness of most complementary and alternative
therapies, fear of medical treatments, dissatisfaction with the current health system, medicines. Avoiding side
effects can be called as a desire to have more control over health decisions. Contrary to many pharmacological
and behavioral treatments that investigate the effectiveness of smoking cessation, only a few studies have
included complementary and alternative treatments. Complementary treatment methods such as aromatherapy
are thought to be regularly included in smoking cessation programs and their use should be ensured/expanded.
Keywords
aromatherapy; essential oil; nicotine craving
Faculty of Health, Department of Nursing, Erzincan Binali Yildirim University, Erzincan, Turkey
Corresponding author: nurtenarslanisik1@gmail.com
Copyright ©Nurten Arslan Is¸ ık, 2020
Introduction
The tobacco epidemic is one of the biggest public
health threats the world has ever faced, killing more
than 8 million people a year around the world. More
than 7 million of those deaths are the result of direct
tobacco use. According to WHO Global Report
data, as of 2012, smoking causes more deaths than
the sum of deaths caused by malaria, HIV/AIDS
and tuberculosis [1,2].
Pharmacotherapy and supportive therapy are
two effective approaches to smoking cessation. In
order to obtain a more effective result, both methods
must be applied together [
3
]. There are many phar-
macological agents with proven efficacy in smoking
cessation [
4
]. US Food and Drug Administration
(FDA) -approved medications used for smoking ces-
sation include nicotine replacement therapy (NRT),
transdermal patch, nicotine gum, nicotine nasal
spray, nicotine inhaler and lozenges [
5
], and bupro-
pion and varenicline. Nortriptyline and clonidine,
though not approved by the FDA, are clinically
effective in smoking cessation [
6
]. The first-line
medications for smoking cessation are NRT and
sustained-release (SR) bupropion. Other medica-
tions used as second-line treatment are clonidine,
nortriptyline and varenicline.
Using the necessary medicines to help you quit
smoking almost doubles your chance of quitting.
However, 50-80% of those who try to quit smoking
prefer not to use any drugs. Smokers can avoid
using drugs due to their side effects, contraindica-

Aromatherapy and Quitting Smoking — 2/6
tions based on personal health histories, pharma-
cotherapy costs, and desires for a chemical-free
quitting experience. Therefore, the limited success
of current smoking cessation treatments encourages
research towards new treatment strategies.
Over the past decade, interest in the use of tradi-
tional and complementary medicine to quit smoking
has increased worldwide [
7
]. In a study, a signifi-
cant percentage (27%) of smokers showed that they
used traditional and complementary medicine in
addition to pharmacological treatment. In addition,
67% of smokers who wanted to receive treatment
reported they wanted to use traditional and com-
plementary medicine practices such as yoga, med-
itation or massage to help reduce stress and quit
smoking [
8
]. Practices such as yoga, meditation,
and acupuncture can help the smoking cessation
process and become an alternative drug-free treat-
ment option, while aromatherapy has become one
of the methods used in recent years as essential
oils are cheaper and easily accessible by the per-
son [9,10,11,12].
1. Work and Mechanism of
Aromatherapy
The National Association for Holistic Aromather-
apy (NAHA) defines aromatherapy as essential oils
derived from the extracts of plants to improve and
balance body, soul and mental health. The focus of
aromatherapy is symptom control [
13
]. The appli-
cation of aromatherapy in the right way is important
to get the right effect. Essential oils can be applied
in four different ways: oral, internal, topical and
inhalation [
14
]. The aromatherapy effect is thought
to occur via the scent tractus olfactorius through the
limbic system and the connections extending to the
hypothalamus. The only sensation that goes directly
to the cerebral cortex is the sense of smell, while
other senses are relayed through the thalamus [15].
In the human olfactory system, the odorant re-
ceptors are localized on olfactory sensory neurons.
During inhalation, odor molecules travel through
the nose and affect the brain through a variety of
receptor sites, one of which is the limbic system.
The limbic system is directly connected to those
Figure 1.
Absorption of essential oils through the
nose.
parts of the brain that control heart rate, blood pres-
sure, breathing, memory, stress levels, and hormone
balance (Fig. 1) [16].
The two most important parts that process flavor
in the limbic system are amygdala and hippocam-
pus [
17
]. The amygdala is thought to affect be-
haviors such as fear and aggression. For example,
lavender is known to reduce the effect of external
emotional stimuli by increasing the diazepam-like
effect by increasing inhibitory neurons in the amyg-
dala containing gamma-aminobutyric acid [
13
,
17
].
The hippocampus is where the smell memory is
triggered [
13
]. A person who has received food that
he/she did not like before may feel his/her stomach
blurred even by smelling the same food for the sec-
ond time [
18
]. The limbic system takes most emo-
tional inputs and delivers them to the voluntary and
involuntary motor centers. Gatti and Cajola (1923)
stated that odors affect the central nervous system
or reflex system and affect respiration, pulse and
blood pressure [13].
Odor receptors adapt about 50% in the first sec-
onds after their stimulation. Subsequent adapta-
tion is much slower. The central nervous system
is thought to develop an increasingly severe feed-

Aromatherapy and Quitting Smoking — 3/6
back inhibition to suppress the transmission of odor
signals in the olfactory bulb after the onset of odor
warning [
19
]. When aromatic plants are applied by
inhalation, molecules reach the nose and the limbic
system in the brain. The limbic system is the inner-
most complex set of the brain structures under the
cerebral cortex. Among these regions, the amyg-
dala and hippocampus are very important in the
aroma process. The amygdala regulates the emo-
tional response. The fragrance memory is located
in the hippocampus and the chemicals of relaxing
aromas that have been already learnt are located
in this area. After the smell is transmitted to this
area, it is perceived as a pleasant or unpleasant one
according to previous experience [19,20].
2. Effect of Aromatherapy on
Smoking
In studies investigating the effect of aromatherapy
on smoking, lavender, bergamot, black pepper, an-
gelica and ylang-ylang oil were usually used; how-
ever, the most preferred essential oils were black
pepper and angelica oil. [21,22,23,24].
Sayette M. and Parrott D. ( (1999) investigated
the idea that an olfactory stimulus might reduce
craving for nicotine. They found that both nega-
tive and positive aromas reduced cravings against a
non-odoriferous control in nicotine addiction [
25
].
DaCosta R. (1999) explored the inhalation of essen-
tial oil as a means to reduce the craving for nicotine
withdrawal. Lavender, Helicrysum italicum, and
Angelica archangelica were tested. Angelica oil
was found to be the most helpful, with subjects able
to wait before having a cigarette [26].
Rose J. and Behm F. (1994) found that the va-
por of black pepper essential oil, when inhaled,
partially reproduced the respiratory tract sensations
experienced when smoking, therefore reducing the
craving for cigarette [27].
Newsham G. (2001) explored the effect of aro-
matherapy as an adjunct to auricular acupuncture
for drug detoxification. Twenty drops of lavender
were placed in the nebulizer. However, the results
showed no difference in the cravings [28].
Caldwell N. (2001) explored the effects of ylang-
ylang in a small controlled study of 10 women suf-
fering from cravings following withdrawal of sub-
stance abuse. One group was given ylang-ylang
essential and the other one (the control group) re-
ceived plain almond oil to inhale. The results showed
that the number of cravings in the essential oil group
decreased more than in the control group [29].
Cordell B. and Buckle J. (2013) explored the
effect of two inhaled essential oils (black pepper or
angelica) on the nicotine habits. One group received
angelica and one group received black pepper. Both
groups inhaled the essential oil for 2 minutes when
they felt the urge to smoke or use tobacco (nicotine
products). They found angelica and black pepper
were both effective in reducing nicotine craving
and increasing the time before the next nicotine
use. Black pepper was more successful in reducing
cravings, and angelica produced greater effects in
time delay to next use [30].
3. Healthcare Professional
Responsibilities in Aromatherapy
Practice
In aromatherapy applications, there are many im-
portant points healthcare professionals should pay
attention to. They include the correct method of
application, the choice of the appropriate oil, the
determination of the frequency and duration of a
session, the observation of changes in the patient
and the disclosure of the results, the direction of
the individuals to the right practices and the provi-
sion of effective consultancy services [
31
]. Essen-
tial oils used in research should have a certificate
of analysis and be purchased from reliable com-
panies. Written consent should be obtained from
the patients before the application. The patient’s
diagnosis, the presence of symptoms such as pain,
depression, fatigue, the degree of inflammation, the
wound healing process, the properties of essential
oils, the patient’s preference, experience and intu-
ition should be taken into account when selecting
essential oils [
32
,
33
]. It is very important not to
expose the oil used during application to sunlight
and to prevent contact with the eyes. Some oils
can cause sensitivity due to allergies, smudging of

Aromatherapy and Quitting Smoking — 4/6
the skin or odors. Allergy testing should be done
before using oils. They should be diluted while be-
ing massaged and used in a safe and correct dosage
range. Special care should be taken when using
essential oils in elderly patients, those with asthma
and epilepsy. Long-term daily use of oils can cause
undesirable effects on the liver and kidneys. There-
fore, it is needed to avoid aromatherapy sessions
for a certain time to restore the body. A maximum
of five oils should be used in the oil mixture. The
use of excess oils makes it difficult to control unde-
sirable effects. As essential oils are volatile, the cap
should be closed tightly after application and they
should stored under appropriate conditions [
33
,
34
].
Conflict of Interest
The authors stated no conflict of interest.
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Received: 2020-03-02
Revised: 2020-04-28
Accepted: 2020-05-12