Heavy smokers most likely to turn to treatment

Jan 9 2008

Smokers who seek out treatment to give up the habit are less successful at quitting than smokers who try to snuff the habit without help, according to a new study.

But hold on, say the researchers - do not assume that quitting aids do not work.

Health experts say cessation treatment does help smokers quit. Moreover, a growing body of evidence is proving the effectiveness of different approaches including talk therapy, over-the-counter nicotine-replacement products and prescription medication.

The new study culled data from a government survey of more than 29,000 U.S. smokers. But lead study author Saul Shiffman said comparing the quitting success of smokers who try treatment to the quitting success of smokers who go it alone is like comparing “apples to hippopotamuses.”

Cigarette users who turn to treatment are typically more nicotine dependent - likely hardcore smokers - than cigarette users who try to quit on their own, Shiffman said.

Smoking is a tenacious, complex habit that can grip smokers with both a physical and psychological hold.

“The people who choose to participate in treatment, people who've made the decision to pay for a medication, for example, are some of the toughest cases. They are the smokers who are most vulnerable to failure,” said Shiffman, an addictive behavior researcher at University of Pittsburgh.

“Think of it from the smoker's point of view. Who would go to the trouble to get treatment? It's the people who've realized they can't quit easily on their own, those who've decided they need all the help they can get. That's exactly the kind of person who's likely to have a difficult time quitting,” he said.

The study appears in the February issue of the American Journal of Preventive Medicine.

The study found that smokers who seek out treatment - whether the help is talk therapy or medication - are more likely to fail but Shiffman said his research suggests that being on treatment is a marker for smokers who are most in need.

About 44 percent of the surveyed smokers reported they had seriously tried to give up cigarettes in the preceding year. Of the smokers who tried to quit, about 64 percent attempted to do so without the help of cessation treatment.

“The big practical point is we don't have nearly enough people seeking out treatment. Quitting smoking is essential to health and it's almost scandalous that so many people aren't getting available, effective help to quit,” said Shiffman, senior scientific advisor for Pinney Associates, a health consulting firm whose clients include pharmaceutical manufacturers and marketers. About 36 percent of the smokers who tried to quit said they used some kind of cessation treatment, either behavioral or pharmacological help.

“You have to remember that 15 years ago that number was virtually zero. It's not out of the ballpark of what we see with other behavior problems like alcoholism,” said health researcher John Hughes. Too few smokers seek out treatment, Hughes said, but he added that the percentage is in line with other problems where people feel reluctant to ask for help.

“All smokers know a lot of people who've quit without treatment. A lot of people see treatment as a crutch — or a moral inadequacy. People just don't think they ought to need help. They don't see it like a golf lesson that would help them improve their skills. They see golf as something intricate and complicated; they see quitting as a simple thing,” said Hughes, a professor of psychiatry at the University of Vermont and Fletcher-Allen Healthcare.

“How can we convince people that it's OK to try by yourself but after the first few times, get some help? Quitting is just too important to not overcome the psychological barriers to seeking out treatment,” Hughes said.