The vast majority of smokers who quit succeed in doing so by themselves. This raises an interesting dilemma for planned treatments both drug-based and behavioral. It also exposes a more general issue of supposed help givers doing the opposite.
In an earlier post, I pointed out that of the planned, or assisted, approaches to smoking cessation, aversion therapy is by far the most affective even though it is almost unknown and very rarely practiced. (In aversion therapy, the client learns to associate smoking with feeling nauseous). A reader recently informed me that the one major treatment center using this approach has gone out of business.
I neglected to point out that people quitting by themselves are more successful than any program. Indeed an Australian study of patients at 1,000 family practices found that cold turkey accounted for 88 percent of all successful long-term quitters and that it was twice as effective as pharmacology (1). Similar results were produced in U.S. studies. Such findings expose problems with quitting programs – including counseling.
A motivation riddle
Tobacco consumption is a powerful addiction because nicotine stimulates specialized neural receptors in the brain, just as all other highly addictive substances do. Most quitters fail in their initial attempt because their cravings are just too strong. That is the sad tragedy of chemical addictions – particularly if they are associated with the appalling health toll of smoking that subtracts literally decades of healthy life from heavy users.
Confronted with the fact of a seemingly unbreakable addiction, and being aware of the health costs, a smoker may feel compelled to join some kind of quitting program. Most psychotherapists would congratulate the smoker on having made progress by (a) recognizing the severity of the problem and (b) seeking help.
The data on quitting rates suggest that smokers are not doing themselves any good by signing up. In the case of programs that use nicotine replacement devices, they may be doing themselves harm. Such devices keep the nicotine addiction alive, albeit with a much safer route of administration. Needless to say, a person who remains nicotine dependent is more likely to return to smoking than one who has broken the chemical dependence by going cold turkey. Even if they no longer smoke, they find themselves addicted to nicotine as President Obama seems to be (1). The news on psychotherapy is not much better.
Relevance for psychotherapy
The bottom line is that of every ten people successfully quitting, 9 did so by themselves whether by slowly reducing the amount smoked or going cold turkey and only one used drug therapy and/or counseling. While the combination of pharmacology and counseling is more effective than pharmacology alone, it is not clear that this combination is more effective than self-quitting.
The vast majority of smokers want to quit and have tried but failed. This makes them a lucrative market for pharmacology and counseling, both of which are worse than quitting alone. Unfortunately, the only really effective organized method – aversion therapy – is no longer available.
Self-quitting may be the best approach. Yet it has not worked for most of the people who tried it. About four-fifths of smokers have tried to quit by themselves without success (2).
Breaking an addiction is tough and may require several efforts. Advice on how to be successful in cold turkey quitting is provided at: WhyQuit.com.
1. Cold turkey trounces pharmacology in GlaxoSmithKline study.
2. Cold turkey still #1 quit smoking method. http://whyquit.com/pr/053110.html