ATTUD Journal Club Postings

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 half relapse in the first week. Given this, front-loading treatment during the first week has been advocated. A recent randomized trial compared front loaded counseling of four sessions in the first week (on quit day and then 2, 4 and 7 days afterwards) and two in the second week to a more traditional weekly counseling (Garvey et al, Nicotine and Tobacco Research, in press – available on PubMed/Medline). Overall, both groups received the same number of counseling sessions. The front-loaded group were more likely to be abstinent using a rigorous outcome measure (12% vs 6%).

Recently, I tried proactive daily phone calls in the first week (at a scheduled time of day). I thought that if doctors go and see patients daily in the hospital to adjust meds, etc, then, given the importance of smoking cessation, a 15 minute phone call daily is justified. Although my sample is small, the smokers seemed to interpret these calls to mean that I thought smoking cessation was very important and that I was invested in their becoming abstinent. Consistent with this, the Garvey found social support was a major mechanism for why front-loaded works better. But they also stated knowing I was going to call and fearing embarrassment at reporting smoking was a factor. I, myself, thought a major asset was help dealing with lapses before they become relapses. I am more and more thinking we should put as much effort into this as into preventing the first lapse.