ATTUD Journal Club Postings

Natural History of Quit Attempts

I have tried not to use this blog to promote my own research, but thought I would violate that rule to show you some interesting findings. We recently completed a study having smokers who plan to quit sometime in the next 3 months call in each night to report on smoking for 3 months (NTR 16:1190‐1198, 2014). We provided no treatment.

Below are results from some randomly selected participants. Each column represents a day of the study and each row represents a single patient. The legend defines black, grey pixels and the “I” (the white pixel represent days that no change attempts going on). So for example, in just the first half of the study, subject number 204040 reduced smoking by > 50% on day 1, then did not try to change for 5 days, reduced for one day, did not change for 4 days, reduced for one day, intended to quit the next day but did not, did not change for four days, tried to quit and was not abstinent and reduced instead, did not change for 4 days, reduced for 3 days, did not change for one day, quit for 3 days, etc.

So the take home message, is three fold a) lots of reduction going on when people try to quit and most of it not due to failed quit attempts, b) lots of intentions to quit followed by either no attempt or inability even to reduce, and c) most importantly, the simplistic model of most interventions and research focusing on a single quit attempt does not map on to reality. In reality, quitting is messy, with lots of false starts, and short failed attempts. So, to me, this reinforces a model that does not focus on a given attempt, but rather focuses on a process of quitting. In the later, it may be best to say “I hope you quit and will help you out, but you and I know that there is a good chance you will not be successful. If you fail, please come back and see me and we can work on why you quit and see if we can change your treatment to address this. It may take us several attempts, but if you and I work together over the next several months, I think we can increase the chances of your success.” I often think one of the best markers of a good TTS is one whose smokers come back to see them when they fail. Although we do not have a direct test of my notion, I would point out that the studies with the largest quit rates in the smoking literature (the MRFIT, Lung Health and Sharon Hall’s extended treatment studies) came from studies in which therapists proactively interacted with smokers on multiple occasions after an initial failure to quit.

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