1. Don't smoke.2. See 1.
This is essentially what Simon Chapman and Ross MacKenzie suggest in a provocative PloS Medicine paper, The Global Research Neglect of Unassisted Smoking Cessation: Causes and Consequences.
Their point is deceptively simple: there is lots of research looking at drugs and other treatments to help people quit smoking tobacco, but little attention is paid to people who quit without any help, despite the fact that the majority (up to 75%) of quitters do just that. This is good news for the pharmaceutical industry and others who sell smoking-cessation aids, but it's not clear that it's good for public health.
As they put it,
despite the pharmaceutical industry’s efforts to promote pharmacologically mediated cessation and numerous clinical trials demonstrating the efficacy of pharmacotherapy, the most common method used by most people who have successfully topped smoking remains unassisted cessation ... Tobacco use, like other substance use, has become increasingly pathologised as a treatable condition as knowledge about the neurobiology, genetics, and pharmacology of addiction develops. Meanwhile, the massive decline in smoking that occurred before the advent of cessation treatment is often forgotten.
Their argument is not that drugs never help people to quit; nor are they saying that tobacco isn't addictive, or that there is no neurobiology of addiction. Rather, they are saying that the biology is only one aspect of the story. The importance of drugs (and other stop-smoking aids like CBT), and the difficulty of quitting, is systematically exaggerated by the medical literature...
Of the 662 papers [about "smoking cessation" published in 2007 or 2008], 511 were studies of cessation interventions. The other 118 were mainly studies of the prevalence of smoking cessation in whole or special populations. Of the intervention papers, 467 (91.4%) reported the effects of assisted cessation and 44 (8.6%) described the impact of unassisted cessation (Figure 1).... Of the papers describing cessation trends, correlates, and predictors in populations, only 13 (11%) contained any data on unassisted cessation.
Most tobacco control research is undertaken by individuals trained in positivist scientific traditions. Hierarchies of evidence give experimental evidence more importance than observational evidence; meta-analyses of randomized controlled trials are given the most weight. Cessation studies that focus on discrete proximal variables such as specific cessation interventions provide ‘‘harder’’ causal evidence than those that focus on distal, complex, and interactive influences that coalesce across a smoker’s lifetime to end in cessation.
Six out of ten of people have had at least one time in their life where they have found it difficult to cope mentally... stress (70%), anxiety (59%) and depression (55%) were the three most common difficulties encountered by the public
Three quarters of people in the UK experience depression occasionally or regularly yet only a third seek help
But we don't know whether these tens of millions of cases of untreated "mental illness" should be treated, because there is basically no research looking at what happens to such people without treatment. On the other hand, the very fact that they aren't treated, and yet manage to hold down jobs, relationships and so forth, suggests that the situation is not so bad.
Of course we must never forget that depression and anxiety can be crippling diseases, but fortunately, such cases are at least comparatively rare. By using the word "depression" to cover everything from waking-up-at-4-am-in-a-suicidal-panic-melancholia to feeling-a-bit-miserable-because-something-bad-just-happened, it's easy to forget that while clinical depression is a serious matter, feeling a bit miserable is normal and resolves without any help 99% of the time. Even though there are no published scientific studies proving this, because it's not the kind of thing scientists study.
Incidentally, this issue is a good reminder that there's no one big bad conspiracy behind everything. With smoking, Big Tobacco find themselves in direct opposition to Big Pharma, like in From Dusk Till Dawn when the psychopaths fight the vampires. With depression, the people who are quickest to decry the widespread use of antidepressants often seem to be the ones who are most keen on the idea that depression is common and under-treated, perhaps because it allows them to recommend their own favorite psychotherapy. Big Pharma hands the baton to Big Couch in the race to medicalize life.
Chapman S, & MacKenzie R (2010). The global research neglect of unassisted smoking cessation: causes and consequences. PLoS medicine, 7 (2) PMID: 20161722
32 comments:
This is the point made by Gene Heyman in his book Addiction: A Disorder of Choice
The fact that the majority of addicted smokers quit on their own has another interpretation--they would be happy to have help if it were cheap, effective, and readily available.
The fact that only a small percentage quit in a formal treatment program shouldn't be offered as evidence that solo cold turkey is the quitting scheme of choice. Or that quitting smoking is easier than all the treatment pros would have you to believe. Or, least of all, that addiction is somehow a lifestyle choice.
The fact that most smokers quit on their own is not an argument against treatment; it’s an argument for better outreach and more effective treatment.
"1. Don't smoke.
2. See 1."
Brilliant!
As somebody with bipolar disorder, I take your point about depression. The best quote I read was a recent article by Professor Lewis Wolpert in the Telegraph, who suffered from depression - "if you can describe your severe depression, you have never, in fact, experienced it".
http://www.telegraph.co.uk/health/healthnews/6943587/Prof-Lewis-Wolpert-Why-depression-is-still-a-dark-destroyer.html
It's worth remembering that unassisted quitting has a lot of failures that your statistic misses: most people have multiple failures before they succeed. This is something of a moot point; the successes succeed eventually but this may involve years of smoking impact.
A program may short-circuit this process, providing information about preparation and problems. Arming abstainers against falling off the wagon, especially in an old usage scenario is generally considered vital in drug programs. A program may also clarify the quitters' motives and build their resolve.
The unassisted quitter may build up this background of information more haphazardly over a period of years, that incorporates a number of failures.
I'm not saying yes or no to drugs or patches but my personal experience, admittedly as a light smoker, is that giving up is relatively easy but staying off is more complex. The medical aid isn't going to help you much with that. My guess is that an optimal program would assess personalities, knowledge and motives then use the assessment to recommend either a self- or externally-managed program, with or without drugs or placebo assistance.
jim & Dirk: I think Chapman and MacKenzie's point is not that assistance is useless, but that it shouldn't be the central focus of anti-tobacco campaigns.
It could be argued that since RCTs show that smoking cessation treatments are better than placebo, they should be widely used, because that will help people quit. Unassisted quitters will quit whatever you do, and assistance will help some extra people quit. Which does make a lot of sense.
But this only works if we assume that promoting mass use of smoking cessation treatments will not make it harder for people to quit unassisted. But it might do, because of the power of the placebo and expectations in shaping human behaviour. If people believe that quitting is pretty easy, and most people are able to do it with no help, that might make them better able to quit than if they've come to believe that it's this serious addiction that requires all kinds of treatments to even have a hope of beating.
Neuroskeptic: A good point for sure. But doesn't it cut the other way, too? If people are told repeatedly that quitting is easy, providing you possess even a shred of willpower or self-control, than society drives all smokers further underground, since they have long since learned how hard it is to quit, despite what anybody says. That's the way it was in the culture until about 15 years ago, when nic patches and zyban arrived to save the day for smokers who could not quit on their own.
Reminds me of the time years ago when Rush Limbaugh announced triumphantly on the air that he had quit smoking cigarettes, noting that it was "the easiest thing I ever did." Cut to a few years later, to a picture of a stogie-chomping Rush gobbling ocycodin by the long ton.
I recently came across this paper, with its account of The Whitehall Study. http://members.iinet.com.au/~ray/TSSOASb.html
P.S In case of doubt, I don't smoke. Indeed, I find cigarette smoking a repugnant habit. But, is giving up smoking going to extend life or not?
Nice post. But I was a 20+ year a pack a day smoker who loved sucking down every butt. I quit six years ago cold turkey. Why? Because I had two kids who I knew I had to put through college and launch into adulthood. So six years out, my kids are doing well in college and I am alive to pay their tuition bills. So quitting was a realization that I had a duty to my children. It was a simple as that. I didn't need any Big Pharma intervention; I just realized I had to sacrifice, like any good parent should. Wow...so I guess my will power realigned the wiring in my brain? Imagine that! Giving up an addiction without taking drugs? What are all you neurobiologists to make of me?
Dearieme - I think you've hit on the pertinent point: if we stop smoking and drinking, eat only unsaturated fats, take more exercise etc etc ad nauseam, will death be deferred indefinitely?
To conquer smoking, I tried electronic cigarettes from http://greensmoke.com/megaraps and they worked well for me; it depends on what is more fitting and convenient for a person to try out. You could try acupuncture or a few sessions on smoking, or even a simple life realization could change you
I don't think that there is any question that smoking is detrimental to health. But what about the millions of people who are addicted to smoking? Should they be sentenced to an excruciating, lingering death?
In a recent press release, Dr. Elizabeth Whelan (President of the American Council on Science and Health), exposed the FDA, calling their statement "distorted, incomplete and misleading" in reference to a press conference that the FDA held to scare Americans away from electronic cigarettes. Federal and state agencies collect 26 BILLION dollars per year on tobacco taxes, and ZERO on e-cigarettes.
Basically, the FDA is strongly advising us to "Stay away from these new electronic cigarettes. Stick to the good old (tax revenue producing) tobacco cigarettes. You know, the ones that cause nearly half a million deaths each year in the US alone"
The FDA has violated its own rules of presenting policies based upon sound science. In essence the FDA is telling us we don't care whether Americans live or die. We want our tax revenues!
Tobacco cigarettes are deadly, not only due to the presence of toxins and carcinogens, but because smokers inhale huge amounts of smoke (products of combustion). The result? Millions of people die from heart disease, lung disease, cancer etc.
Smokers 'need' nicotine. By getting the nicotine without the smoke, e-cig users enjoy an enormous health benefit over tobacco smokers.
The FDA has approved other nicotine delivery systems (gums and patches) but they have been dismal failures, with a success rate of under 15%. So by only approving products that don't work, the FDA has condemned millions of smokers to a lingering death. We desperately need other alternatives. Dr. Whelan commented, "Cigarette smoking remains the leading cause of preventable disease and death in the United States today. Any alternative acceptable to addicted smokers should be taken seriously. Instead of condemning the e-cigarette, the FDA should be sponsoring studies to evaluate its safety and efficacy, leaving it on the market in the interim."
I quit smoking and suffered for two and a half years. The cravings didn't go away. Not only that, but I really missed the enjoyment of smoking. Then I found electronic cigarettes (e-cigs). But wait … it’s not that simple. Most e-cigs are a complete waste of money. Here’s what I’ve done, so that you don’t need to take the hard road.
I found the best one. This one really works. I recorded a “Getting Started” video. I arranged for you to get a discount.
If you know someone who smokes, you can do them a big favour.
Go to http://www.get-e-cigs.com/
Neuroskeptic, you've certainly set the cat amongst the pigeons! It beggars belief that so many people are conned into thinking that they need medical or drug help for what is essentially a life choice.
Whether they are too fat or want to stop smoking, they buy into the advertising every time. My old man had a heart attack and was told that if he had just one more cigarette he was toast. Boom, right there and then he quit, cold turkey. He did start chewing gum like there was no tomorrow, but it was normal chewing gum not high priced stop smoking, nicotine gum.
I've also stopped smoking for health reasons and at 42 am feeling a lot better for it. No it's not easy but nothing worthwhile is. I think people need to stop looking for the easy option and just knuckle down and do what needs to be done.
Always amusing to hear a successful quitter berating those who have a tougher time and might even need some structured medical assistance.
Some people say quitting cigarettes was more difficult for them than heroin. So I guess people don't need treatment to quit smack, either.
One question--did your "knuckling down" on cigarettes involve hypnosis, as the link to your nom de plume implies? Why doesn't that qualify as "treatment"?
That reasoning just seems shaky to me. Would recovery rates/outcomes from diabetes be better if we started telling diabetes patients not to worry, their disease really isn't as serious as all that, and that they will probably be able to deal with it on their own, without medical intervention?
This could be helpful “Ever thought about finding a support group? There should be some somewhere,even if it's only through the internet.Maybe seeing a doc might be in order(one who specializes in withdrawl). Physical activity helps(sounds dumb but it does). Always remember there's as bunch more people in the same boat as you. You will survive this. It won't be fun but you can do it.”
This could be helpful “Ever thought about finding a support group? There should be some somewhere,even if it's only through the internet.Maybe seeing a doc might be in order(one who specializes in withdrawl). Physical activity helps(sounds dumb but it does). Always remember there's as bunch more people in the same boat as you. You will survive this. It won't be fun but you can do it.”
Electronic cigarettes have proved to be quite effective. At least in cutting down the number of cigarettes you smoke per day.
Neuroskeptic: You article reminded me of the debates I have with my fiance regarding the efficacy / usefulness of Neuro-linguistic programming.
Also, I am reminded that my grand-parents all smoked and EVERY single one of them told me that they quit "cold turkey" when asked. I was surprised.. Why, because even as a non-smoking youth 20 years ago I somehow got it drilled into my head that quitting is really hard and therefore I should never start.
Fast forward, and I did eventually start smoking socially anyway, yet never really got addicted!
And since we got on the subject of e-cigs somehow, I also wanted to say that I switched to e-cigs completely shortly before I started my blog on the subject.
-Sparky
Smoking thrills but kills!
If a person is unable to reduce his/her weight timely, he might suffer from severe consequences in late age.
useful tips for all smokers! Thanks
You know it is very sad. The best way to quit smoking is by using electronic cigarettes. But big tobacco companies in cahoots with the government are trying to block their sale. The argument put forward is that e-cigs have some poisonous substances in them! What about the over 4000 carcinogens and toxins in cigarettes !!!!!!
The sooner, the better. Don't wait for the pain to occur. You'll be in trouble sooner if you still continue your habit.
"1. Don't smoke.
2. See 1." - True.
@Frugal Dougal "if you can describe your severe depression, you have never, in fact, experienced it." - This is absolutely correct! At least, for me. and my buddy from Easley.
To quit smoking is really just a matter of life decision. Who says you cannot quit when there are plenty of alternatives to smoking. I think people only decide to stop when they see the bad effects of the habit. One person may start to feel different psychological stress when he/she begins to perceive the consequences (e.g. discoloration, gum disease, tooth loss, etc.) and seeks help from a dentist.
Bottom line: No matter what kind of sickness you have due to smoking, the first thing that any professional doctor would tell you is, "Quit smoking."
You know it is very sad. The best way to quit smoking is by using electronic cigarettes. But big tobacco companies in cahoots with the government are trying to block their sale. The argument put forward is that e-cigs have some poisonous substances in them! What about the over 4000 carcinogens and toxins in cigarettes !!!!!!
I am a smoker. after reading this article, I tried hard to get out of this health problem.
thank you for your article about smoking is not healthy.
The first lines are very amusing.
1. Don't smoke.
2. See 1.
Haha! Well anyway, there are still ways to quit. There are some people who tried alternatives like e-cigarettes or vaporizers. Or maybe when they realize that it's taking a toll on their teeth, or their overall physical health, then maybe it's enough to stop them. Don't wait for that to happen. =(
I wouldn't believe it myself, but smokeless cigarettes cured me. I am fortunate as COPD is been scaring the bejeezes out of me.
Smoking is awful. As many commenters already mentioned, luckily there's a way out - electronic cigarettes :)
It amazes me that some people can quit cold turkey yet others can't quit no matter what they try. My grandmother quit cold turkey after my uncle got sick. She quit cold turkey because she thought it would help him get better. He did get better but I highly doubt it was because she quit. On the other hand my mother who watched my grandfather die of lung cancer can't seem to quit. She has tried everything from cold turkey to the patch. Nothing has worked for her. She did start using e cigs last year after I forced them on her and it has helped her cut down on the amount of cigarettes she smokes.
FDA is always trying to get their hands on something....
Trust me I know. So stay away from traditional cigarettes. You will be better off.
This blog is just great! I have been meaning to stop smoking for a long time now and I find it very hard during the first stages. Of course it is never easy on giving up smoking habits. Some people entirely give on quitting but I know that I am determined. Just take a look at your health and see the risks involved when smoking and you’ll understand.
more information on how to stop smoking here
I liked the first part that was about how to quit smoking. Another alternative that I have found useful is disposable e cigarette it has really helped my cravings!
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