ATTUD Journal Club Postings

How Prevalent is Use of Face-to-Face Counseling for Smoking Cessation

Most US surveys report that about a third (36%) of smokers trying to quit seek treatment; many (32%) used medications but few (4%) smokers used counseling (Shiffman, Am J Prev Med 34:103-111, 2008). However, a new survey suggests use may be greater (Borland, Addiction 107:197-205). In a survey of 10 countries, the incidence of use of counseling in the last year among those who had tried to quit ranged from 4% in Australia to 17% in the UK.  In this survey, 12% in the US had used counseling. It is interesting to compare these results with those of other disorders. For example, like nicotine dependence, alcoholism can be treated either with medications or counseling. In the US, about one third of those with alcoholism seek treatment (like nicotine dependence) but 90% of treatment seekers use face-to-face counseling and <5% use medications. On the other hand, about half of those with depression sought treatment and among treatment seekers, two thirds used medications and one third sought counseling.

So it’s interesting to speculate on why there are such differences in seeking counseling vs medications across behavioral disorders and countries. Some of it is probably due to history; e.g. for many decades counseling was the only treatment available for alcoholism. Some of it is the manifestation of the disorder. Those with alcoholism have many more urgent psychosocial problems than smokers. On the other hand, some outcomes do not seem to make sense. Since the disease model is prominent in conceptualizing alcohol disorders, and since this is based on the notion of a genetic biological cause, one would think medications would be widely used in alcohol treatment. Also, the British have often been thought to be more reserved and private, yet use of counseling is high in the UK.
I would be interested in other thoughts about treatment seeking.