Survey Questions Quit
Smoking Experts' "Expertness"
Imagine experts advising smokers that the "key" to successful quitting is to not quit smoking now, or today, but to pick some future date and then begin to plan around it. What if such advice wasn't just wrong but had actually deprived untold millions of quitters of dramatically greater odds of success?
A new quitter survey reports that roughly half of all smokers attempt quitting without any planning whatsoever. Those conducting the survey were surprised to learn that the unplanned attempts to quit smoking were 2.6 times more successful in lasting at least six months than attempts planned in advance.
Published in the online version of the January 27, 2006 issue of the British Medical Journal, the study's primary author, Robert West, a London psychology professor, has been widely quoted as saying, "Contrary to what experts had previously believed the idea that you have to plan your quit attempts ahead of time isn't necessarily true."
But is it possible that this simple survey finding -- quitter survey questions that could have been easily asked, answered and shared decades earlier -- is evidence of just how misguided "expert" quitting advice has been and still is? Has unchallenged group-think, and historic quitting tips with little foundation in science, needlessly cost thousands of believing and struggling quitters their very lives?
According to Joel Spitzer, a 30-year Chicago quitting counselor who is possibly the Internet's most widely read smoking cessation educator, the "real experts" are long-term successful ex-smokers, and this is not news to them. "Rarely do those with the longest initials for credentials do real research on how people quit smoking," says Spitzer.
Since January 2000, Spitzer has shared the lessons taught to him by what he considers the "real experts" at Freedom from Tobacco, a free online quitting forum. One such Spitzer lesson is entitled "Setting Quit Dates."
It asserts that,"conventional wisdom in smoking cessation circles says that people should make plans and preparations for some unspecified future time to quit. Most people think that when others quit smoking that they must have put a lot of time into preparations and planning, setting quit dates and following stringent protocols until the magic day arrives. When it comes down to it, this kind of action plan is rarely seen in real world quitters."
Spitzer has found that most successful quitters fall into one of three groups: (1) those who awoke one day and were suddenly sick and tired of smoking, who threw their cigarettes over their shoulder and never looked back; (2) those given an ultimatum by their doctor - "quit smoking or drop dead"; and (3) those who became sick with a cold, the flu or some other illness, went a few days without smoking and then decided to try to keep it going.
"All of these stories share one thing in common - the technique that people use to quit. They simply quit smoking one day. The reasons they quit varied but the technique they used was basically the same. If you examine each of the three scenarios you will see that none of them lend themselves to long-term planning. They are spur of the moment decisions elicited by some external circumstance," Spitzer's lesson asserts.
But Spitzer is careful to distinguish real-world quitters from the Internet phenomena where some do seem to spend an inordinate amount of time reading and planning before taking the plunge.
"Even at our site we see people say they were reading here for weeks or months before finally quitting and joining up." Still, relatively few real-world quitters are taking advantage of the Internet, few have local access to education resources as extensive as those offered on the Internet, and it does not change erroneous quitting advice that is older than the Internet itself.
Amazingly, the websites of Philip Morris (PM USA), the U.S. Centers for Disease Control (CDC), the National Cancer Institute (NCI), the American Cancer Society (ACS), the American Lung Association (ALA), and the Mayo Clinic (MC) all either expressly or impliedly tell smokers the same message: the key to successful quitting is to not quit smoking today, but instead to pick some future date and then plan around it.
The leading CDC quit smoking page not only tells smokers to "set a quit date." It then tells them that as part of their advance planning that they need to go out and buy "medication and use it correctly," primarily over-the-counter (OTC) nicotine replacement therapy (NRT) products such as the nicotine gum, nicotine patch and nicotine lozenge.
What all of the above websites fail to tell quitters is that during 2006 almost all successful long-term quitters (80 to 90%) will again quit entirely on their own without resort to any product or procedure. None will be told that almost all successful quitters are nicotine-clean within hours, not weeks or months.
In 1984 Spitzer inked an article on the latest quitting rage, nicotine gum. "Many hope the gum will be a panacea for the truly addicted smoker," he wrote. "But caution must be given. For while the gum may reduce the severity of initial withdrawal, it does so at a cost" ... "prolonged chronic withdrawal."
"Normally, when a smoker quits, physical discomfort will peak within 72 hours and totally subside within two weeks. While the first three days may be traumatic, with proper support any smoker can successfully get through this period," the article asserts.
Spitzer had no way of then knowing just how ineffective nicotine gum would eventually prove to be. All he knew were the simple truths taught him by the real experts, successful quitters.
A March 2003 study published in Tobacco Control and authored by GlaxoSmithKline (GSK) consultants, combined and averaged the seven over-the-counter (OTC) nicotine patch and gum studies and found that only 7% of study participants were still not smoking at six months.
In November 2003 the same two GSK consultants published a second study, also in Tobacco Control, asserting that up to 6.7% of nicotine gum quitters where still chronically using the gum at six months. When put together (7% minus 6.7%), the obvious question becomes, do any smokers actually break free from nicotine by chewing it?
The CDC, NCI, PM USA, ACS, and the ALA are all aware of these studies. More importantly they're aware that a June 2004 study published in Addictive Behavior found that NRT's two-fold odds ratio victories were generated by clinical studies that were not blind as claimed. The study taught our nation's quitting experts that nicotine is a psychoactive chemical producing alert dopamine/adrenaline intoxication and that far more participants than expected guessed their assignment.
Aside from pharmaceutical companies selling NRT devices no longer being able to legitimately assert that NRT's odds ratio victories over placebos were "science-based," the CDC, NCI, PM USA, ACS and ALA are each fully aware that unlike cold turkey quitting, where the odds of success actually increase with each subsequent cold turkey attempt, the odds of success dramatically decline for second-time nicotine patch users.
An April 1993 study published in Addiction found that 0% of second-time nicotine patch users were still not smoking at six months, while an August 1995 study (see Table III) published in the British Medical Journal found that only 1.6% percent were not smoking.
"You'd think that the CDC, NCI, PM USA, ACS and ALA would notice that instead of NRT doubling U.S. cessation rates as promised, that over the past two decades successful quitting has almost ground to a halt," says John R. Polito, editor of WhyQuit.com, the Internet's leading cold turkey quitting resource.
"National health policymakers are so entwined in pharmaceutical influence that it's almost impossible for them to admit to being duped, and immediately make much needed life-saving national course corrections," contends Polito.
Philip Morris' website is a postponement rationalization paradise for nicotine addicts, including a five day quitting countdown. "Plan and prepare - that's the first key to quit-smoking success, it proclaims." "Choose a specific quit date - perhaps your birthday or anniversary, or your child's birthday and mark it on your calendar. If you give yourself at least a month to prepare, you're more likely to succeed than if you decide New Year's Eve to quit the next day. Pick a week when your stress level is likely to be low."
Delay quitting until your next birthday? Wait for life to become nearly stressless? In 1984 Joel Spitzer wrote an article entitled "I Will Quit When ..." It opens with the following rather lengthy list of quitting delay rationalizations that fit right in with Philip Morris's planning advice.
"I will quit when my doctor tells me I have to." "I can't quit now it's tax season." "Maybe I will quit on vacation." "School is starting and I'm too nervous to quit." "I will quit in the summer when I can exercise more." "When conditions improve at work, I will stop." "Quit now, during midterms, you must be nuts!" "Maybe after my daughter's wedding." "My father is in the hospital. I can't quit now." "If I quit now, it will spoil the whole trip." "The doctor says I need surgery. I'm too nervous to try now." "When I lose 15 pounds, I will stop." "I am making too many other changes to stop now." "I have smoked for years and feel fine, why should I stop smoking now?" "I'm in the process of moving, and it's a real headache. I can't stop now." "It is too soon after my new promotion, when things settle down I will stop." "When we have a verifiable bilateral disarmament agreement, I will consider quitting." "It is too late. I'm as good as dead now."
"The best time to quit is NOW. No matter when now is. In fact, many of the times specifically stated as bad times to quit may be the best. I actually prefer that people quit when experiencing some degree of emotional stress. In most cases, the more stress the better. This may sound harsh, but in the long run it will vastly improve the chances of long term success in abstaining from cigarettes," the 21 year-old article by Spitzer asserts.
Spitzer's lessons are also at odds with a number of "conventional" CDC quitting recommendations including advice encouraging new quitters to "prepare for relapse," and telling them "don't be discouraged if you start smoking again." Spitzer's free book asks readers to think about giving such advice "to a family member or friend who you cared for tremendously, while knowing that they were a recovering heroin or cocaine addict."
Many of the lessons "the real experts" taught Spitzer are shared in his free 149 page PDF electronic quitting book entitled "Never Take Another Puff." It can be downloaded at WhyQuit.com/books. During the six-month period since Aug. 1, 2005, a record 205,018 copies have been downloaded.
Smokers can only hope that some of those downloads were by self-anointed "experts" who until now have been telling smokers when and how they should quit instead of studying and sharing when and how the "real experts" actually did quit.