"Isn't quitting cold turkey too dangerous?"

"Isn't quitting cold turkey too dangerous?"

Joined: 18 Dec 2008, 23:57

26 Oct 2006, 18:34 #1

Seven months ago the following question was emailed to me at the AskJoel board:
"Hi, I have been told before that "cold turkey" stop smoking can actually bring out medical problems in your body because it shocks it and that the weaning method was actually safer. Have you seen any research to back this up? It terrifies me that this could be true but not stopping is just as scarey....

Thank you.


John and I assembled numerous replies that I am attaching below. A new study that was just released shows just how much of a misconception many people have about this topic--apparently including a lot of cardiologists who have been giving NRT to critically ill patients. I was actually quite surprised to find out that this was a common practive now a days. It was my understanding when I worked in hospital based settings that no caridac patient would be given patches or any NRT while in Intensive Care. I don't know when this practice changed but given the known vasoconstriction risks of nicotine I am surprised that this practice has been going on now for the past five to ten years.

First, here is today's article. I will attach the original comments from the AskJoel board after this:
Nicotine patches may
boost intensive care risk
  • 19:30 25 October 2006
  • NewScientist.com news service
  • Roxanne Khamsi
Nicotine given to intensive care patients to ease their withdrawal from cigarettes may put them at a greater risk of death than going "cold turkey", researchers say.

A preliminary study of more than 200 smokers placed in intensive care suggests they are better off simply enduring withdrawal symptoms than receiving nicotine replacement therapy (NRT).

Nicotine replacement therapy has become common in hospitals' intensive care units (ICUs) in the last five to 10 years. The drug reduces withdrawal symptoms, such as headache and irritability, among smokers in these units, who are too sick to go to an area where they can smoke.

Bekele Afessa at the Mayo Clinic College of Medicine in Rochester, Minnesota, US, and colleagues expected to find that patients comforted by (NRT) fare better than smokers who do not receive it.

Heart power The team examined the intensive care records of 224 smokers, half of which received NRT, mostly via skin patches.

Surprisingly, they found that 18 of the patients on NRT died, compared with just three of the smokers that did not receive nicotine. Also, the average duration of an ICU stay for patients given nicotine was 24.4 hours, about 2 hours longer than their cold-turkey counterparts.

"We have to be aware that we may be doing some harm [by giving patients NRT]," Afessa warns.

He notes that many of the patients in the study had been admitted to the ICU because they had gone into sepsis due to an infection. Sepsis can cause the body to release myocardial depressant factor, a molecule that reduces the pumping power of the heart.

Nicotine may further weaken the hearts of these patients by causing the coronary artery feeding the heart, to narrow, he suggests. This would reduce the amount of oxygen being pumped to other organs in the body. Many of the ICU patients in the trial died of multiple organ failure.

Wake-up call Nicotine is known to cause a narrowing of the coronary artery in chronic smokers, but remains unknown whether short-term doses of the drug can have the same effect.

Experts say the results of the new study should encourage more research on how NRT affects hospital patients. "This is a wake-up call that we really need to study this," says Mark Rosen, president of the American College of Chest Physicians.

He adds, however, that a large prospective study is necessary to establish whether nicotine definitely causes an increased risk of death among patients.

Afessa presented the findings at the annual meeting of the American College of Chest Physicians (ACCP) in Salt Lake City, Utah, US, on Wednesday.
© Copyright Reed Business Information Ltd.
Source Link: http://www.newscientist.com/article/dn1 ... -risk.html

Joined: 18 Dec 2008, 23:57

26 Oct 2006, 18:35 #2

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From: Joel Sent: 2/26/2006 6:25 AM
As far as I know there has never been any credible research done that had proved that quitting cold turkey was too dangerous. I actually haven't even had the question posed to me for many years.

There was a time when I used to get the question quite frequently. In my early years of doing programs I would hear it from people who told me that they had personal physicians who would tell them that quitting was just too much of a shock to their system and not worth the risk. It was often advice given to pregnant women by their obstetricians.

What must be understood about this information is was what the level of total misunderstanding there was by the physicians at the time, as well as by the entire medical and scientific community. It was at a time that there was a good chance that if a woman were to ask her physician if smoking was harmful to her baby, that the physician could have reached into his shirt pocket, pulled out a cigarette, took a few puffs while in deep contemplation and came back with the answer that smoking didn't really pose any real risk. The same kind of conversation could have been held between a man and his cardiologist or any person with almost any medical condition talking to his or her doctor. Back in the 1950's over half of the doctors in our country smoked.

What we know now about the dangers of smoking as it relates to many conditions makes it totally obvious to almost any health care professional in any field that smoking is deadly, even though in the past the lack of solid information caused the wrong advice to be standard fare.

We now have decades of experience with millions and millions of people successfully quitting smoking, the vast majority of them doing so by going cold turkey. It should be obvious to almost any one now that the dangers of quitting smoking is not what smokers need to be concerned with, it is the dangers they face if they do not quit smoking.

On a personal note, I have personally run over 4,500 people through cold turkey smoking programs for almost 30 years now. Out of those 4,500 people I only had two people who died during the two week period of the clinic. One was a younger man, probably in his thirties with severe heart disease and diabetes who was forced into the program by his wife and doctor because it was clear to both of them that he was in real danger of dying if he didn't quit smoking. Unfortunately, while the man's wife and doctor were both convinced that he was in immediate danger, the man himself didn't accept the risk for in fact, he did not quit smoking during that clinic. He was cheating throughout the program and his wife was not ever sure he had reduced his smoking at all from the first day of the program. He died on the fifth or sixth day.

The other death was from a man who was also in really bad shape, having just had major cardiac surgery, was still having ongoing problems with chronic heart failure and had a terrible prognosis coming in. His doctor had told him that he was a walking time bomb and he meant it in very literal terms. He died about ten days into the program. He had quit and had eased up in the withdrawal, was in fact very proud of the fact that he had quit and was happy with his decision to do so. I actually went to his funeral. His wife was very happy to see me there, and excitedly introduced me to a number of their family members and friends, explaining how I was the person who helped her husband to quit smoking. They were all very proud of the man and felt that he really was trying to give himself a fighting chance to live. That seemed very important to his loved ones at that time.

Other than these two cases, I have never encountered a person who had died during the quitting process, which is quite remarkable considering the state of health that many people who come to clinics are in.

Again, don't waste your energy on the fear of quitting. It is a baseless fear. If you spend time doing any real research on the effects of not quitting though, the fear that you will feel will be totally warranted for the magnitude of risk posed by smoking is tremendous. The good news is that all of the risks posed by smoking can be minimized by simply making and sticking to a personal commitment to never take another puff.


Joined: 18 Dec 2008, 23:57

26 Oct 2006, 18:35 #3

From: Joel Sent: 2/26/2006 6:29 AM
Quitting Smoking: A Fate Worse than Death?

People sitting in at smoking clinics are amazed at how resistant smokers are to giving up cigarettes. Even smokers will sit and listen to horror stories of other participants in sheer disbelief. Some smokers have had multiple heart attacks, circulatory conditions resulting in amputations, cancers, emphysema and a host of other disabling and deadly diseases. How in the world could these people have continued smoking after all that? Some of these smokers are fully aware that smoking is crippling and killing them, but continue to smoke anyway. A legitimate question asked by any sane smoker or nonsmoker is, "why?"

The answer to such a complex issue is really quite simple. The smoker often has cigarettes so tied into his lifestyle that he feels when he gives up smoking he will give up all activities associated with cigarettes. Considering these activities include almost everything he does from the time he awakes to the time he goes to sleep, life seems like it will not be worth living as an ex-smoker. The smoker is also afraid he will experience the painful withdrawal symptoms from not smoking as long as he deprives himself of cigarettes. Considering all this, quitting smoking creates a greater fear than dying from smoking.

If the smoker were correct in all his assumptions of what life as an ex-smoker were like, then maybe it would not be worth it to quit. But all these assumptions are wrong. There is life after smoking, and withdrawal does not last forever. Trying to convince the smoker of this, though, is quite an uphill battle. These beliefs are deeply ingrained and are conditioned from the false positive effects experienced from cigarettes.

The smoker often feels that he needs a cigarette in order to get out of bed in the morning. Typically, when he awakes he feels a slight headache, tired, irritable, depressed and disoriented. He is under the belief that all people awake feeling this way. He is fortunate though, because he has a way to stop these horrible feelings. He smokes a cigarette or two. Then he begins waking up and feels human again. Once he is awake, he feels he needs cigarettes to give him energy to make it through the day. When he is under stress and nervous, the cigarettes calm him down. Giving up this wonder drug seems ludicrous to him.

But if he quits smoking he will be pleasantly surprised to find out that he will feel better and be able to cope with life more efficiently than when he was a smoker. When he wakes up in the morning, he will feel tremendously better than when he awoke as a smoker. No longer will he drag out of bed feeling horrible. Now he will wake up feeling well rested and refreshed. In general, he will be calmer than when he smoked. Even when under stress, he normally will not experience the panic reactions he used to feel whenever his nicotine level fell below acceptable levels. The belief that cigarettes were needed for energy is one of the most deceptive of all. Almost any ex-smoker will attest that he has more strength, endurance, and energy than he ever did as a smoker. And the fear of prolonged withdrawal also had no merit, for withdrawal symptoms would peak within three days, and totally subside within two weeks.

If any smoker just gives himself the chance to really feel how nice not smoking is, he will no longer have the irrational fears which keeps him maintaining his deadly addiction. He will find life will become simpler, happier, cleaner, and most importantly healthier, than when he was a smoker. His only fear will now be in relapsing to smoking and all he has to do to prevent this is - NEVER TAKE ANOTHER PUFF!

Joined: 18 Dec 2008, 23:57

26 Oct 2006, 18:36 #4

From: Joel Sent: 2/26/2006 6:29 AM
"I have smoked for so long and so much, what is the use in quitting now?"

On the third day of a recent clinic, a woman participant in her late fifties who had been off smoking for just over 48 hours asked one of those questions that I have heard hundreds of times in past programs. "I have smoked so long and so heavily, what good will quitting smoking do for me now?" A few minutes of explaining the bargaining phase people go through when they are initially quitting smoking seemed to clarify why she was having such thoughts rationalizing why she didn't really need to quit.

A few minutes later, she told me a story about her personal family history, one that quite simply gave a better answer to her original query than I could ever have come up with. "My father was a chain smoker," she said. "He quit when he was 60 because he had a heart attack. Never smoked one after that. Even though he was a heart attack victim, after he quit smoking he felt better than he had felt in years. Much more endurance, greater vitality. He lived to the age of 95, bright and alert to the end."

On the sixth night I called her to see if she had made it through the weekend all right. "I feel so bad," she replied. "I had a terrible evening last night and I had a major problem dealing with a client at work this morning. I was just so upset from lack of sleep and frustration, I finally broke down and took a cigarette. I've been beating myself up for it ever since. I am more depressed now than I was before. Why am I beating myself up so, and what should I do now?"

I said she had two options, quit right then and face a potential full three day withdrawal or go back to full fledged smoking all over again. If she didn't make a decision, her body would automatically make the decision for her. Again she expressed the sentiment that she was beating herself up so badly and wanted me to explain why she was so upset with herself. She just couldn't believe that one cigarette could be so important to be making such a big issue.

A few minutes later, she told me the story of how her husband had once been off for three years. One day while they were in the car together, for one reason or another he bummed a cigarette from her. She raised the issue with him of what good would a cigarette be after all that time, but he convinced her it was no big deal. What right did she have to protest anyway, she thought, she was a chain smoker herself. He finally got his way. He never stopped smoking after that day. Four years later she got a call at work that her husband had collapsed at her mother-in-law's home. By the time they got to him it was too late. He had died of a sudden and totally unexpected heart attack. She has little doubt that his last four years of smoking was a major contributing factor to his sudden and premature death.

So why was she now making such a big deal out of a cigarette? Once again, her own personal history was giving her a more powerful answer than I could ever have expressed. One cigarette, in a car a number of years earlier helped to end her husband's life. If he had known the implication that one cigarette would have had, he would never have considered the thought for more than a second. In retrospect, she had the opportunity to look back to that day and realize how a fleeting urge followed by poor judgment helped to end or shorten her husband's life.

With the kind of personal experiences she had witnessed associated with smoking, it is quite easy to see how she could be so hard on herself for what occurred earlier that day. She witnessed how smoking diminished the quality of her father's life and almost brought on a premature death. Equally important, she saw how quitting smoking vastly improved his health and general feeling of well being. She also witnessed how her husband's momentary lapse of judgment resulted in her suffering such a grave loss just a few years earlier. If he had the opportunity, he would surely have cursed the day he lit just one. She had the benefit of hindsight, which now was haunting her because she had made the same mistake that day he had made just a few years earlier. He never got the chance to quit again. She still has time to make a decision-and she was asking me what she should do now. Again, I feel her own personal experience and the immediate emotional reactions she was now experiencing were giving a more powerful answer to her question than I could. If she listened to her heart, I am sure it was telling her to - NEVER TAKE ANOTHER PUFF!


Joined: 18 Dec 2008, 23:57

26 Oct 2006, 18:36 #5

"I Can't Quit or I Won't Quit"

"I don't want to be called on during this clinic. I am quitting smoking, but I don't want to talk about it. Please don't call on me." This request was made by a lady enrolling in one of my clinics over 20 years ago. I said sure. I won't make you talk, but if you feel you would like to interject at anytime, please don't hesitate to. At that she got mad and said, "Maybe I am not making myself clear-I don't want to talk! If you make me talk I will get up and walk out of this room. If you look at me with an inquisitive look on your face, I am leaving! Am I making myself clear?" I was a little shocked by the strength of her statement but I told her I would honor her request. I hoped that during the program she would change her mind and would share her experiences with the group and me but in all honesty, I wasn't counting on it.

There were about 20 other participants in the program. Overall, it was a good group with the exception of two women who sat in back of the room and gabbed constantly. Other participants would turn around and tell the two to be quiet. They would stop talking for a few seconds and then start right up again with just as much enthusiasm as before. Sometimes, when other people were sharing sad, personal experiences, they would be laughing at some humorous story they had shared with each other, totally ignorant of the surrounding happenings.

On the third day of the clinic, a major breakthrough occurred. The two gossips were partying away as usual. There was one young woman, probably early twenties who asked if she could talk first because she had to leave. The two gossips in back still were not listening and kept up with their private conversation. The young woman who had to leave said, "I can't stay, I had a horrible tragedy in my family today, my brother was killed in an accident." Fighting back emotions she continued. "I wasn't even supposed to come tonight, I am supposed to be helping my family making funeral arrangements. But I knew I had to stop by if I was going to continue to not smoke." She had only been off two days now. But not smoking was important to her. The group felt terrible, but were so proud of her, it made what happened in their day seem so trivial. All except the two ladies in the back of the room. They actually heard none of what was happening. When they young woman was telling how close she and her brother were, the two gossips actually broke out laughing. They weren't laughing at the story, they were laughing at something totally different not even aware of what was being discussed in the room. Anyway, the young woman who lost her brother shortly after that excused herself to go back to her family. She said she would keep in touch and thanked the group for all of their support.

A few minutes later I was then relating some story to the group, when all of a sudden the lady who requested anonymity arose and spoke. "Excuse me Joel," she said loudly, interrupting me in the middle of the story. "I wasn't going to say anything this whole program. The first day I told Joel not to call on me. I told him I would walk out if I had to talk. I told him I would leave if he tried to make me talk. I didn't want to burden anyone else with my problems. But today I feel I cannot keep quiet any longer. I must tell my story." The room was quiet.

"I have terminal lung cancer. I am going to die within two months. I am here to quit smoking. I want to make it clear that I am not kidding myself into thinking that if I quit I will save my life. It is too late for me. I am going to die and there is not a **** thing I can do about it. But I am going to quit smoking."

"You may wonder why I am quitting if I am going to die anyway. Well, I have my reasons. When my children were small, they always pestered me about my smoking. I told them over and over to leave me alone, that I wanted to stop but couldn't. I said it so often they stopped begging. But now my children are in their twenties and thirties, and two of them smoke. When I found out about my cancer, I begged them to stop. They replied to me, with pained expressions on their faces, that they want to stop but they can't. I know where they learned that, and I am mad at myself for it. So I am stopping to show them I was wrong. It wasn't that I couldn't stop smoking- it was that I wouldn't! I am off two days now, and I know I will not have another cigarette. I don't know if this will make anybody stop, but I had to prove to my children and to myself that I could quit smoking. And if I could quit, they could quit, anybody could quit."

"I enrolled in the clinic to pick up any tips that would make quitting a little easier and because I was real curious about how people who really were taught the dangers of smoking would react. If I knew then what I know now- well, anyway, I have sat and listened to all of you closely. I feel for each and every one of you and I pray you all make it." Even though I haven't said a word to anyone, I feel close to all of you. Your sharing has helped me. As I said, I wasn't going to talk. But today I have to. Let me tell you why." Then she turned to the two ladies in the back of the room, who actually had stayed quiet during this interlude. Suddenly she flared up, "The only reason I am speaking up now is because you two BITCHES are driving me crazy. You are partying in the back while everyone else is sharing with each other, trying to help save each other's lives. She then related what the young woman had said about her brother's death and how they were laughing at the time, totally unaware of the story. "Will you both do me a favor, just get the **** out of here! Go out and smoke, drop dead for all we care, you are learning and contributing nothing here." They sat there stunned. I had to calm the group down a little, actually quite bit, the atmosphere was quite charged with all that had happened. I kept the two ladies there, and needless to say, that was the last of the gabbing from the back of the room for the entire two-week clinic.

All the people who were there that night were successful at the end of the program. At graduation, the two ladies who had earlier talked only to each other were applauded by all, even the lady with lung cancer. All was forgiven. The girl who lost her brother also came for the graduation, also smoke free and proud. And the lady with lung cancer proudly accepted her diploma and introduced one of her children. He had stopped smoking for over a week at that time. Actually, when the lady with cancer was sharing her story with us, she had not told her family yet that she had even quit smoking. It was a few days later, when she was off a week that she told her son. He, totally amazed said to her that if she could quit smoking, he knew he could and stopped at that moment. She beamed with joy. Six weeks later she succumbed to the cancer. I found out when I called her home just to see how she was doing and got her son on the line. He thanked me for helping her quit at the end. He told me how proud she was that she had quit and how proud he was of her, and how happy she was that he had quit also. He said she never went back to smoking, and I will not either." In the end, they had both given each other a wonderful gift. He was proud her last breath was smoke free- she NEVER TOOK ANOTHER PUFF!

Epilog: I normally say you can't quit for someone else, it has to be for yourself. This incident flies in the face of this comment to some degree. The lady with lung cancer was quitting smoking to save her children from her fate, to some degree undo the lesson that she had taught years earlier. The lesson that she "could not stop." It was that at the time she "would not stop." There is a big difference between these two statements. It holds true for all smokers. The lady in this story proved years later she could quit-too late to save her life, but not to late to save her sons. Next time you hear yourself or someone else say, I cannot stop, understand it is not true. You can quit. Anyone can quit. The trick is not waiting until it is too late.

Joined: 18 Dec 2008, 23:57

26 Oct 2006, 18:37 #6

From: Joel Sent: 2/26/2006 6:59 AM
From the string Conventional quitting wisdom at Freedom from Tobacco

Every now and then I see a post that has the line line, "I've heard that...," or "I've seen somewhere...", or "I've read at another site...," or even "My doctor says...,"and then goes on to tell of some of conventional wisdom or folk tale for all to read and maybe get the impression that there is some validity to the specific quitting advice claim. This kind of post is likely standard fare at many other Internet Support Sites but we are not set up to be a standard Internet Support Site. We are set up to be an educational forum that also happens to offer support. We really make a concerted effort at Freedom to make sure that all of the concepts presented have some real value and validity.

It is one thing for a person to write that they have heard or read something and want to know if it is valid, but to just write out the comment as advice or as a fact because they have heard it that it must be true can pose a problem. This string talks about how important it is for people who post here to be cautious on what they pass out as advice that is picked up elsewhere.

I'm not saying that there isn't some good advice out there, but it is best to clear ideas though our managers first before putting it out as some sort of factual statement. At a minimum, if you heard something elsewhere that you may think is of value, post the idea as a question so as to make it clear that you are just trying to do some fact finding and not trying to give the impression that you are stating a known and valid fact that may impact people reading here at Freedom.

Joined: 18 Dec 2008, 23:57

26 Oct 2006, 18:37 #7

From: Joel Sent: 2/26/2006 7:02 AM
As long as we are addressing fear issues and quitting:

Fear of Success.

The fear of success may keep more people from starting a quit than the fear of failure. The reason people are so afraid of success is that they are often working with a false perception of what life will be without smoking. No matter how how many people tell them what life can be like without smoking, the perception an active smoker has is going to persist until the person quits smoking and sees for him or herself that life really does go on without smoking.

In clinic settings I always explain to the participants that the real goal of the clinic is to help the participants to get off for two weeks. Two weeks-that's it. In two weeks each clinic graduate will start to get a true sense of what it is like not to smoke. If the person decides that he or she hates not smoking, that life is unbearable, that he or she can no longer work, no longer carry on normal rational thoughts, no longer maintain a normal family existence, no longer have any fun or no longer able to meet life's ongoing demands-he or she will be fully capable of just going back to smoking. A person should never be afraid to quit because of the feeling that if he or she quits, he or she will not be able to get him or herself back to smoking again if the so chooses. The choice should always be based on whether the person wants to go back to full-fledged smoking or smoke nothing-but the choice for full fledged smoking exists for all ex-smokers.

On the other hand, if in the two weeks the person decides that he or she likes not smoking-maybe not smoking isn't perfect-but he or she is starting to get a flavor of where life is heading, how he or she is starting to face up to life demands and handling them reasonably well, maybe even a little better than he or she was just a few weeks earlier while still an active smoker, he or she has the choice of staying smoke free for another day.

People giving themselves the opportunity to see what not smoking is really like will overcome all these fears and generally truly appreciate the gift that they give themselves by being nicotine free. There are very few people who have ever left a clinic graduation went out and bought a carton or a case because they gave it the two weeks and decide that they really now want to become a full-fledged smoker again. Yes some people will throw away their quits days or weeks later, but it is not because they choose to relapse and are making a conscious decision to smoke until it kills them-it is because they get complacent and start to believe that they can somehow now control their quantity or duration of smoking. They almost inevitably regret this mistake and many will end up paying for it with their lives.

For as scary as quitting may be up front, the reality of what smoking can lead if understood is terrifying. A drag on a cigarette can end up costing a person tens of thousands of dollars, his or her independence, health and life. The reality of smoking does not improve with time, the fears intensify as symptoms develop and life gets a little more limited and the control nicotine exerts gets stronger and stronger.

You must quit smoking to see what life is really like as an ex-smoker and to some degree really recognize what life was like as a smoker. The longer you go without smoking and the more you understand, the less scary life will be and the more resolute you will continue to be to never take another puff!


Joined: 18 Dec 2008, 23:57

26 Oct 2006, 18:37 #8

The Use of Scare Tactics

Scare tactics have a bad reputation because of how they were used or more misused in the past. When you exaggerate the risks of anything, and a person finds out the real facts, it makes the whole message appear to be an exaggeration, if not an outright lie. Saying a dangerous substance does something that it does not do makes the listener disregard what the substance really does.

By this definition, quit smoking materials needs no scare tactics materials developed. The truth is scary as ****. Smoking kills! Smoking causes more preventable deaths than anything else does in America, and the rest of the world is catching up. To illustrate the relative risk of dying from smoking as compared to the risk of dying from other factors, for every thousand 20 year olds that smoke today and don't quit, 6 will die from being murdered, 12 will die from accidents, 500 will die from smoking! This is scary stuff.

But is this a scare tactic? No, it is a fact. Is giving the message to the masses a scare tactic? No it is education. We need education. We need education to prevent the next generation being where smokers are now, we need education getting those of you who are now smoking to break the grip nicotine now holds on them. We need continued education to keep reminding those who have controlled it up to this point to remember, they are a puff away from being a smoker again.

Is that concept scary to you? It better be. You have all got to be terrified of the grip cigarettes can pose on you once again if given the opportunity. Don't ever give them that chance again. Cigarettes are an unrepentant serial killer. Open your door to them and they will slowly poison you until they accomplish their ultimate goal, they will kill you. Scary stuff-you bet. There is only one way to stop this killer-it is simply knowing to never take another puff!


Joined: 18 Dec 2008, 23:57

26 Oct 2006, 18:38 #9

From: John Sent: 2/26/2006 9:05 AM
Lana, I'm confident that every quitter survery you'll find asserts that almost all successful long-term quitters quit smoking could turkey (80 to 90%). Again in 2006 almost all successful long-term quitters will again be cold turkey quitters. Contrary to being dangerous, a Jaunary, 2006 study published in the British Medical Journal asserts that your odds of success are 260% greater for those quitting without any planning. Clearly any form of weaning program involves advance planning. John

"Catastrophic" pathways to smoking cessation: findings from national survey.

British Medical Journal (BMJ) 2006 Feb 25;332(7539):458-60. Epub 2006 Jan 27.

West R - University College London, London WC1E 6BT. [url=mailto:robert.west@ucl.ac.uk]robert.west@ucl.ac.uk[/url]

OBJECTIVE: To assess the extent to which the prevailing model of smoking cessation (that smokers typically prepare their attempts to stop smoking in advance and that doing so increases their chances of success) is correct.

DESIGN: Cross sectional household survey.

SETTING: England.

PARTICIPANTS: 918 smokers who reported having made at least one quit attempt and 996 ex-smokers aged 16 and over.

MAIN OUTCOME MEASURES: Whether the most recent quit attempt was planned in advance and whether quit attempts made at least six months before resulted in at least six months' abstinence.

RESULTS: 48.6% of smokers reported that their most recent quit attempt was put into effect immediately the decision to quit was made. Unplanned quit attempts were more likely to succeed for at least six months: among respondents who had made a quit attempt between six months and five years previously the odds of success were 2.6 times higher (95% confidence interval 1.9 to 3.6) in unplanned attempts than in planned attempts; in quit attempts made 6-12 months previously the corresponding figure was 2.5 (1.4 to 4.7). The differences remained after controlling for age, sex, and socioeconomic group.

CONCLUSIONS: A model of the process of change based on "catastrophe theory" is proposed, in which smokers have varying levels of motivational "tension" to stop and then "triggers" in the environment result in a switch in motivational state. If that switch involves immediate renunciation of cigarettes, this can signal a more complete transformation than if it involves a plan to quit at some future point.

PMID: 16443610 [PubMed - in process]

Online Source Link:

Joined: 18 Dec 2008, 23:57

22 May 2007, 04:17 #10

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