ATTUD Journal Club Postings

Is Varenicline More Effective than NRT?

In several studies of varenicline vs. placebo, the magnitude of benefit from varenicline appeared to be more than that usually obtained with NRT. Only two randomized trials have directly compared varenicline with NRT. One trial was a large (n=746), well done study (Thorax 63:717) that found varenicline was more effective than standard dose NRT (26% […]

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Do Specialists Obtain Higher Quit Rates and, If So, Why

A recent article (McDermott et al, Nicotine and Tobacco Research , advance publication) briefly reviewed four studies that found tobacco treatment specialists were associated with higher quit rates than non-specialists. Unfortunately, these were not randomized trials, but observational findings and thus the differences in specialist vs nonspecialist outcomes could be due to other factors (e.g. […]

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Efficacy of Adding Counseling to Medications for Smoking Cessation: When is Counseling Justified

A recent Cochrane review (“Behavioral Interventions as adjuncts to pharmacotherapy for smoking cessation”, Issue 12, 2012) reviewed 38 studies found individual in-person or phone counseling of at least 4 sessions were 1.3 times higher than that with medications alone (mostly NRT) with some evidence of greater quit rates with greater intensity of treatment. In comparison, […]

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Changing Treatment in Non‐Responders

A common practice in medicine is to monitor response to a treatment and, if it seems to be inadequate, to increase the intensity or add/change to a new treatment. What is the empirical evidence for such a strategy in treating smokers? Four studies have tested changing treatment in non‐responders. Two studies found no benefit. One […]

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Can we predict who will quit? Does it matter?

Vangeli et al (Addiction 106: 2110-2121, 2011) identified eight large, population based studies of smoking cessation in the real world. The surveys included both US and other countries. Six used data acquired between 2000 and 2010. These studies offer the most generalizable test of predictors of making a quit attempt or predicting success once one […]

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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 […]

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Does Promoting Insight into Addiction Help or Hinder Smoking Cessation?

Oftentimes those addicted to drugs deny they are addicted. Methods to convince them they are, indeed, addicted (many of which are confrontational) to break down “denial” are common in the treatment of non-nicotine addictions. Randomized trials of breaking down denial as a treatment are not available. In fact, others have argued that emphasizing addiction undermines […]

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Pros and Cons of Describing Addiction as a Brain Disease

A recent editorial (Gartner et al, Addiction 107:1199) discussed the pros and cons of describing addiction as a “brain disease.” It noted that advocates of this view believe it reduces stigma, increases treatment seeking, suggest treatment rather than legal interventions, and increases funding for addiction treatment and research.

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Scheduling of Counseling for Smoking Cessation

Most of you know that the incidence of relapse after trying to quit is high in the first few weeks, but you may not realize how high it is. Most studies find that, among self-quitters, half of smokers relapse in the first 2 days and two-thirds in the first week. Even with intensive treatment over […]

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Do Ex-smokers Return to Normal?

We all have been at cocktail parties and heard innumerable stories of how smokers quit. Often we will hear former smokers say they can’t believe they ever smoked and have no desire at all to return to smoking; others say they have to remain vigilant because they still have desires to smoke at times. I […]

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