Have you ever known someone who has quit smoking without the benefit of formal programs, self-help groups, or nicotine replacement therapy (NRT) (patches, pills, gum, etc.)? According to the American Heart Association, nicotine is one of the most addictive of all substances, weaving itself into virtually every facet of a smoker’s life. From an article by The National Institute on Drug Abuse:
“Research has shown how nicotine acts on the brain to produce a number of effects. Of primary importance to its addictive nature are findings that nicotine activates reward pathways — the brain circuitry that regulates feelings of pleasure…nicotine increases levels of dopamine in the reward circuits. This reaction is similar to that seen with other drugs of abuse… For many tobacco users, long-term brain changes induced by continued nicotine exposure result in addiction.” [i]
So, nicotine works the same way, and to the same extent as other drugs of abuse. We will look further into the addiction mechanism in the next chapter, but I’m sure that anyone who has ever tried to quit smoking understands how addictive it can be.
In 1986, the American Cancer Society reported that: “Over 90% of the estimated 37 million people who have stopped smoking in this country since the Surgeon General’s first report linking smoking to cancer have done so unaided.” [ii]
An article in the August 2007 edition of the American Journal of Public Health indicated that over 75% of those who successfully quit for 7 to 24 months did so without any help, as opposed to 12.5% who used NRT (patch or gum).[iii] A study in the February 2008 issue of the American Journal of Preventive Medicine indicated that almost 65% of quitters used no help, while around 30% used medication, and 9% used behavioral treatment.[iv]
The following appeared in PLoS Medicine, an open access, peer-reviewed medical journal in February of 2010:
“As with problem drinking, gambling, and narcotics use, population studies show consistently that a large majority of smokers who permanently stop smoking do so without any form of assistance…[T]he most common method used by most people who have successfully stopped smoking remains unassisted cessation…Up to three-quarters of ex-smokers have quit without assistance (’cold turkey’ or cut down then quit) and unaided cessation is by far the most common method used by most successful ex-smokers.” [v]
The evidence reveals that unassisted quit attempts have a much greater chance of success than those using the help of NRT’s, hypnosis, or any other method. In spite of that, the pharmaceutical industry continues to fund advertising campaigns aimed at convincing the general public, and physicians, that quitting “cold turkey,” without help, is a waste of time, and doomed to failure.
Because most assisted cessation attempts end in relapse, such “failure” risks could be interpreted by smokers as ‘I tried and failed using a method that my doctor said had the best success rate. Trying to quit unaided — which I never hear recommended — would be a waste of time.’ One review stated: “Such reasoning might well disempower smokers and inhibit quit attempts through anticipatory, self-defeating fatalism.” [vi] In other words, if the pills and patches don’t work for them, they will probably just give up.
The evidence clearly shows that empowering people with the belief they can quit smoking on their own is much more effective than feeding them the nonsense that they’re powerless.
[ii] Chapman S, MacKenzie R (2010) The Global Research Neglect of Unassisted Smoking Cessation: Causes and Consequences. PLoS Med 7(2): e1000216. doi:10.1371/journal.pmed.1000216
[v] Chapman S, MacKenzie R (2010) The Global Research Neglect of Unassisted Smoking Cessation: Causes and Consequences. PLoS Med 7(2): e1000216. doi:10.1371/journal.pmed.1000216
[vi] Gillies V, Willig C (1997) You get the nicotine and that in your blood: constructions of addiction and control in women’s accounts of cigarette smoking. J Community Appl Soc Psychol 7:285-301