New Study Shows that Spontaneous Quit Attempts are More Successful than Planned Attempts; Focus on Pharmacotherapy May be Misguided

A new study published in the British Medical Journal reports that spontaneous quit attempts are more successful than planned quit attempts, a finding which casts doubt on the current preoccupation with pharmacotherapy as the mainstay of the national smoking cessation strategy.

As I explained in the HealthDay article about the study: "Planned quit attempts are implemented gradually and thus the level of motivation is probably rather low. But these unplanned, sudden attempts probably reflect some sentinel event or great tension that precipitates a very high level of motivation to quit. And thus these attempts are more successful."

According to the article: "Study authors Robert West and Taj Sohal liken the unplanned quit attempt to what mathematicians call "catastrophe theory." The idea is simply this: As tensions build up, even small triggers can lead to sudden and dramatic shifts in action. In nature, such forces might lead to, say, an avalanche. In much the same way, a smoker becomes disgusted with his habit, creating tension that, eventually, triggers a split decision to kick the habit."

The Rest of the Story

These findings cast doubt on the national smoking cessation strategy that was developed by an expert panel which consisted of several members with severe conflicts of interest by virtue of their financial ties to pharmaceutical companies. The chair of the panel - Dr. Michael Fiore - served as a consultant for, gave lectures sponsored by, or conducted research sponsored by Ciba-Geigy, SmithKline Beecham, Lederle Laboratories, McNeil Consumer Products, Elan Pharmaceutical, Pharmacia, and Glaxo Wellcome.

In return for these financial contributions to the expert panelists, the panel produced a smoking cessation guideline that was heavily focused on the use of planned quit attempts using pharmacotherapy. The findings of this new study suggest that the approach adopted by the expert panel may be far less effective than a strategy that is based on triggering spontaneous quit attempts.

However, the use of a "triggering" strategy would downplay the use of pharmacotherapy. Thus, it would not receive as much consideration by a panel that is heavily influenced by pharmaceutical company conflicts of interest.

I have to note that the spontaneous quitting approach accords with my experience as a physician and a smoking cessation counselor. The overwhelming majority of patients and clients who I have seen quit successfully for the long-term have done so in response to a dramatic, often life-altering event or realization, and the quit attempt was unplanned and unaccompanied by any use of pharmaceuticals.