Cold Turkey More Effective Than Smoking Aids
Written by Javier Armstrong
- The Guardian | University of California, San Diego
UCSD School of Medicine researchers studying tobacco addiction found that the range of pharmaceutical and anti-smoking aids available in the last decade has not increased the number of successful quitters. Their results will be published in the Annual Review of Public Health.
The study, led by professor of family and preventive medicine John P. Pierce, reviewed studies of tobacco addiction conducted within the last 20 years.
Researchers analyzed the effectiveness of pharmaceutical drugs, as well as nicotine gum and the patch, but found none of these aids have been significantly successful.
“We looked at smokers that had quit before 35, before 50 and before 65,” Pierce said. “If you quit before 35, we think you can avoid as high as 90 percent of the consequences of smoking. If you quit before 50, you can avoid at least half of them, and if you quit before 65 you can avoid at least a quarter.”
According to the paper, increasing numbers of smokers successfully quit at different ages during the 20-year period analyzed. The number of people who quit before 35 was higher every year, but the numbers leveled off in the late 1990s, suggesting the number of successful quitters had plateaued.
The researchers noticed this trend within all three age groups, indicating that fewer people were successfully quitting.
“It isn’t that the drugs don’t work,” Pierce said. “It’s that people think they don’t have to try that hard anymore.”
Pierce said that there is evidence that pharmaceutical drugs such as the patch are successful in clinical trials, but the results are not showing up in the general population. He said that the data does not show there have been more quitters even though researchers are seeing more and more people using these products.
“Marketing says put on a patch and you’ll quit, but it’s a nicotine addiction — you can’t cure a nicotine addiction with nicotine,” Pierce said. “What you can do is dull the withdrawal symptoms while you do something else about it.
Pierce said his research showed that the most successful group of quitters are those who quit without any assistance.
“You must incorporate behavior change,” Pierce said. “You must build up the motivation — this is one of the hardest things you will ever do and then really go for it. Unless you’re doing that, the nicotine patch is probably not going to help you.” Pierce said that an increase in people who attempt to quit has not translated to higher success stories. The increased availability of quitting aids has not shown to be effective, according to Pierce.
“The policy at the moment says get a drug,” Pierce said. “Yet the results we found show that 60 percent of successful quitters do it on their own.” Pierce said the current policy is not beneficial because it discourages people from quitting on their own. “There will be a lot of discussion on this topic, at the next World Conference on Tobacco or Health,” Pierce said.
Last modified on Sunday February 05, 2012 - 3:59PM
UC San Diego Researchers Review Cessation Studies and Call for Change in Policy
John Pierce, PhD
Smoking is a major public health issue and quitting is the single most important thing smokers can do to improve their health. In the 2012 edition of the prestigious Annual Review of Public Health,
researchers at the University of California, San Diego School of Medicine have reviewed the landscape of smoking cessation over the past 20 years. During this time period, there have been improvements in pharmaceutical medications to aid cessation, and free telephone cessation coaching has become available in every state. However, recent trends in smoking cessation are troubling to tobacco control researchers.
“For the past decade, attempts to quit smoking have increased, but the proportion of people who become successful quitters has gone down” said John P. Pierce, PhD, professor of Family and Preventive Medicine and director of Population Sciences at UC San Diego Moores Cancer Center. “Widespread dissemination of cessation services has not led to an increase in the probability that a quit attempt will be successful."
The problem does not appear to be with the cessation services themselves. “Randomized trials continue to demonstrate that innovations in cessation assistance, such as the new text-to-quit service, increase success rates among smokers motivated to be part of clinical studies,” said Sharon Cummins, PhD, director of Evaluation with the California Smokers Helpline and a co-author on the study. “Indeed, one study showed that heavier smokers are much more likely to quit successfully when a doctor actively monitors the quit attempt, pharmaceutical aids are used, and the smoker receives multiple coaching calls from a quitline service”.
However, recent evidence suggests that part of the problem may lie in how cessation aids are marketed by pharmaceutical companies: many such ads suggest that quitting smoking may be as simple as putting on a patch. It appears that younger smokers in particular are now more likely to underestimate the amount of work needed in order to quit smoking successfully.
Traditionally, the majority of smokers who quit successfully have done so without assistance, and recent data suggests that this has not changed. However, current national policy discourages unassisted quitting, advising clinicians to make sure smokers who want to quit do so with pharmaceutical assistance. This policy may undermine smokers’ belief in their ability to quit on their own.
The number of people who quit smoking successfully has stalled in the United States at every age. (graph)
Pierce and colleagues noted that some of the earliest texts in psychology – written more than 100 years ago – include chapters on breaking habits such as smoking. In 1890, William James laid out a series of maxims that were widely recognized then and that still hold true today: smokers need to make a strong resolution to change; they need to act quickly on that resolution; they will be more successful if they make a personal commitment to another to be successful; and finally, it is important to understand the danger of having even a single cigarette during a quit attempt.
The researchers suggest that policy makers join those in academia for a serious review of tobacco cessation policy.
In addition to Pierce, the UC San Diego Moores Cancer Center research team included Sharon E. Cummins, PhD, Martha M. White, Aimee Humphrey and Karen Messer, PhD.
Funding support for this study was provided by the Tobacco-Related Disease Research Program (TRDRP).
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