ATTUD Journal Club Postings

Extended Counseling Improves Quit Rates: Empirical Support for What We Do

In prior blogs I have reported the results of Sharon Hall’s and others’ studies of keeping treatment ongoing after the first few weeks. In the past Sharon and others have examined extending both medication and counseling but I want to focus on the latter. Two prior randomized trials have examined extending counseling with a cognitive-behavorial therapy (CBT) focus. One found a nonsignificant trend that extended treatment lead to higher quit rates. The other, by Dr Hall, more clearly showed extended CBT to be more effective. In a third, just published study, she again found more CBT improved quit rates (Am J Pub Hlth, 2011). The treatment was eleven individual, outpatient cognitive-behavioral treatment sessions lasting about 20-30 min between weeks 12 and 52. Even 2 yrs after the quit date, she found highest quit rates in the two CBT conditions (48% and 38%) compared to medications alone and brief advice (28-36%). Her publication outlines all the treatment components she used. Unfortunately, we do not know how much of the effect was due to keeping those abstinent abstinent vs helping those who relapse to quit again. Nevertheless, the study is clear scientific evidence that the more intense and longer duration treatment that many of us provide produces more abstinence than no treatment or minimal treatment. Interestingly, there are few areas of psychotherapy that can document “more is better” and thus many are suspect when a profession claims more intensive treatment is indicated. I think we should cite this article when others question the need for our more intensive services.