ATTUD Journal Club Postings

Could Helping Smokers Plan a Quit Attempt Be Harmful

Several experimental studies have suggested gradual cessation is, as effective but no more effective, than abrupt cessation. We completed a study in which we found that, surprisingly, smokers who wanted to quit gradually did somewhat better with abrupt than gradual. Followup studies suggested that perhaps part of the reason for this is that gradual cessation requires putting off quitting for several days or weeks and smokers may lose motivation over time. In addition, most, but not all, recent studies have found that smokers who quit spontaneously do better than those who delay quitting. Often in treatment, we ask smokers to do preparatory work prior to quitting But is it possible that by doing so, we are actually making it less likely for them to quit?

This month, Ron Borland published an experimental test of this important question (Annuals Behavioral Medicine, epub ahead of print). In the context of a quit line, he randomized smokers into several groups. One comparison he made was between those who were asked to move their quit date up ahead vs those who were not asked to do this. He found this neither helped nor hurt their chances of quitting. He also found that structured planning was helpful, but that most of the help occurs, not from addressing potential problems before quitting but rather addressing them as they occur and are relevant during the quit attempt. Consistent with this, recent studies have found “front‐loading” treatment during the first days of quitting is more effective (NTR 14:578, 2012).

So the take‐home messages for me are 1) encourage smokers to set a quit date that is as soon as possible, 2) lots of contacts prior to the quit date are probably not that helpful, and 3) lots of contact in the first few days of quitting. For example, I usually have phone contact with smokers daily for the first few days after quitting probably are. I do this, in part, because half of self‐quitters lapse within the first 3 days. Also, as Dr. Borland suggests, much more motivation to engage in relapse prevention when you are struggling not to smoke than when you are thinking about a theoretical problem that may or may not occur next week.

Any thoughts?