ATTUD Journal Club Postings

Motivation vs Skill vs Dependence in Quitting Smoking

Smokers’ perceptions about quitting are just the opposite of what science says. A recent paper (Addict Behav 53: 175-180) has replicated the conclusions of a prior review (Addiction 106:2110-2121, 2011) that commitment/motivation/willpower predict making a quit attempt but does not predict ability to remain abstinent after a quit attempt. These papers also found the opposite for dependence; i.e., dependence does not predict making a quit attempt but does predict the ability to remain abstinent. Interestingly, surveys find that the large majority of smokers (> 70%) believe motivation is both a necessary and a sufficient condition to quit smoking, and few (<35%) cite addiction as a barrier (Drug Alcohol Reviews 27:21-27, 2007). I could not find empirical data, but my impression is that also most smokers do not see stopping smoking as a skill, but rather is matter of effort; i.e., they see it more like becoming a great jogger vs becoming a great golfer.

These results have a couple of implications. First, they would suggest that once a smoker has decided to quit (e.g. made a quit date) that increasing motivation should not be helpful. In fact, most meta-analyses of motivational interviewing and contingency management find that most the effect is from interventions with smokers not ready to quit (however, this is not to say they do not work at all with dedicated quitters). Second, I think we should be discussing with smokers whether they, indeed, hold these views. When I have such discussions, I am impressed by how often smokers frame quitting as a test of character. Some even seem to value quitting on their own as more important than whether they die early from smoking. Some of this may come from knowing another smoker who has quit on his/her own and being reluctant to state they are “weaker- willed” than the other smoker. In trying to get them to give up this framing, I refer to people who clearly have character but still smoke. For democrats, I refer to President Obama who, 8 yrs later, is still using nicotine gum intermittently. For republicans, I refer to John Boehner, Matt Damon, or Matt Gibson. I also bring out the genetics of nicotine and say maybe they just have the smoking gene and that’s the reason they find it more difficult.

Would enjoy hearing how others approach this.