ATTUD Journal Club Postings

Results of Recent Cochrane Review on Efficacy of Different Tobacco Dependence Treatments

The Tobacco Addiction Group of Cochrane (of which I am a member) published six new or revised meta-analyses of treatments for tobacco dependence. I am a big fan of the Cohrane reviews because they are all done using the same methods, usually locate all the available trials, and use rigorous methods. An updated review of […]

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Do We Need Tobacco Treatment Specialists?

In the past blogs I have reviewed the evidence whether treatment from a trained TTS produces higher quit rates than from a less-intensive non-TTS therapy. The Cochrane review of this question examined 5 RCTs and stated “We failed to detect a greater effect of intensive counselling compared to brief counselling (5 trials, RR 0.96, 95% […]

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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 […]

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Does Tobacco Treatment Decrease the Prevalence of Smoking? And Who Cares?

Several studies have found that the prevalence of smoking, of quit attempts or of long-term abstinence has not increased with the availability of smoking cessation medications. The most recent of these (Zhu, Tobacco Control, Epub ahead of print) concluded that the availability of varenicline did not change the population cessation rate. In that study 11% […]

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Striking While the Iron is Hot Revisited

In prior blogs, I have reviewed the retrospective studies suggesting that smokers who quit spontaneously do not have worse outcomes and often have better outcomes than those who delay and plan their quit attempt. These findings challenge the common practice of asking smokers to delay quitting in order to engage in several preparatory activities (e.g. […]

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The 5 A’s and Its Cousins

The most recent USPHS 5 A’s algorithm recommends clinicians ask and advice smokers to stop (2008 USHPS National Guidelines; Baker, Addiction 110:388‐9, 2015). If they are willing to quit, the algorithm recommends providing medication and counseling treatments. If they are unwilling to stop, it recommends a brief motivational advice protocol called the 5R’s. Since then […]

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Another New Behavioral Treatment for Tobacco Dependence

For many years there was a dearth of research on new behavioral treatments for tobacco dependence, but recently we have had several; e.g., Mindfulness therapy (MT), Acceptance/Commitment Therapy (ACT), Behavioral Activation Therapy (BAT) , Positive Psychotherapy(PP) and Contingency Management (CM). One other possible new treatment that has yet to be formally tested is manipulating behavioral […]

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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 […]

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Natural History of Quit Attempts

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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 […]

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Have we failed to detect some withdrawal symptoms?

Thirty years ago, a list of signs and symptoms of tobacco withdrawal were derived from experimental studies. Amazingly, since then not a single new symptom has been included in the DSM or most other definitions of withdrawal. How likely is it that the scientists got it exactly right back then? In fact, several new symptoms […]

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