ATTUD Journal Club Postings

Tobacco Treatment Specialists Are Needed

In prior blogs on 11/2/04, 1/31/13 and 12/21/15 (see ATTUD website) I presented evidence on whether TTSs achieve quit rates greater than brief advice or quitlines. One important study that I missed should be added to those reviews (Kotz et al, Addiction 109:491, 2013). This study used a survey of UK smokers. It is important for two reasons.The UK is the only country with lots of TTSs. And this study examined many more confounders (e.g. that those seen by TTSs are more dependent) than prior studies. Contrary to my prior meta-analysis (Nicotine Tob Res 13; 512-22, 2001), in the unadjusted studies, those that used NRT with our without brief advice did not have a higher quit rate and those that used NRT plus saw a TTS had a 36% higher quit rate. But in the adjusted analyses – where the fact that those who saw TTSs were more addicted and other factors were taken into account – OTC NRT alone again did not increase quit rates, OTC NRT plus brief advice produced a 60% greater quit rate, and NRT plus seeing a TTS tripled the quit rate.

So the take home message is that If anyone says the effectiveness of TTS counseling is small, there is good data against that. In fact, there are few behavioral treatments of any psychological problems that increase outcomes as much as TTS counseling.