Immediate and delayed quitting

Last week I attended the 4th annual meeting of the Society for Research on Nicotine and Tobacco (Europe) in Madrid. This is a conference where the top researchers present their latest research findings. As you can imagine a lot of fascinating stuff was presented. One that I particularly liked was presented by David Gonzales of the Health and Sciences University in Portland. He presented data on immediate quitting (i.e. those who succeeded in quitting on their target quit date with no lapses) and delayed quitting (i.e. those who had some lapses after the initial target quit date but then managed to get quit and stay quit) among patients treated with either varenicline (Chantix), bupropion (Zyban), or placebo.

For me the interesting thing was that Chantix and Zyban each improved the proportion who initially quit (over placebo), but Chantix also increased the proportion who managed to achieve abstinence after their initial target quit date. Dr Gonzalez presented a nice diagram showing that the number of patients achieving abstinence continued to increase across the first 12 weeks among those on Chantix or Zyban (although it increased faster among those on Chantix).

Colleagues have remarked that patients taking Chantix are less focused on the target quit day (typically day 8 of taking Chantix) than we are used to. We think that’s because almost all of the patients we treated before Chantix were also using nicotine replacement therapy (sometimes combined with Zyban/bupropion). The NRT (patch, gum etc) is typically started on the target quit day and so patients are very aware of the importance of that day. We don’t typically combine Chantix with NRT (as the Chantix is supposed to block the nicotine receptors in the brain) and so on Chantix its easier to see the target quit date as less distinct from any other day and just continue reducing cigarette consumption rather than quitting completely.

The take-home message for patients is that it still makes sense to select a target quit-date (day 8) and to try to quit smoking completely on that day. However, if you don’t immediately get quit, don’t give up on yourself or on the medicines. The evidence suggests that if you keep trying you will likely achieve abstinence, and that Chantix improves your chances, so long as you keep trying and keep taking the medicine. On the other hand, its important to be clear that the aim of the game is to quit completely, and its better in the long run to throw away the cigarettes and get on with it.

Labels: bupropion, Chantix, cigarette smoking, quit, varenicline, Zyban

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When is the best time to quit smoking?

Most of us are familiar with the statistic that in countries like the USA, UK, Canada and Australia (and many other developed countries) approximately 70% of current smokers say that they would like to quit smoking. An even greater proportion typically state that if they had their time again, they would choose never to start smoking.

However, if you ask them when they plan to quit, most give a time frame over 6 months in advance, but expect to have quit within 2 years. So we see a lack of urgency combined with an understanding that it would be a big mistake to let it drag on for much longer. The big problem, however, that the average smoker who stated 10 years ago, “I want to quit, but its not a good time right now, - I’ll definitely do it within the next 2 years” is still smoking today. What this means is that smokers tend to put off quitting for much longer than they plan to, and if they try to wait for “the right time” there is a very large chance that they end up waiting until the worst time – after the diagnosis of a serious illness caused by smoking.

A report by Professor Martin Jarvis and colleagues at University of London commented on the “delusion gap” between smokers’ expectations (53% expecting to be quit in 2 years) and reality (only 6% actually quitting in that time frame).

One of the reasons people often give for putting off a quit attempt is that they have too much stress in their life. Unfortunately, people who have stress now are fairly likely to continue having stress in the future. Cigarettes add to many of the most common stresses (financial problems, health problems etc) and the evidence is very clear that people who smoke are not less stressed than people who don’t. In fact, if you follow a group of smokers who successfully quit for 6 months the typical finding is that they report being less stressed as an ex-smoker than they did as a smoker. So stress is probably not a great reason for delaying quitting.

Another reason people sometimes have for delaying (often supported by psychologists like myself) is the belief that you need to do a lot of planning and preparation before trying to quit. Professor Robert West (University of London) recently published an interesting study that seemed to argue against that idea. Based on a survey of almost 2000 smokers and ex-smokers he found that almost half of the most recent quit attempts were made rather spontaneously (i.e. they made up their mind to try to quit on a day without prior planning on previous days), and perhaps more surprisingly, those who claimed to have made a quit attempt without any prior planning were twice as likely to still be quit at least 6 months later, compared with those planning ahead!

Now the tricky bit here is in interpreting what this means. No-one (or at least not the authors of the article, nor most of the commentators including myself) think this means that it is detrimental to plan your quit attempt. But what it does suggest that if you find yourself suddenly convinced by some thought, experience, or something you saw on TV, that now is the time to quit, then don’t talk yourself out of it by reasoning that you need to take time to plan. Go with the flow, get rid of your cigarettes and follow your instincts there and then.

So (perhaps predictably), the best answer to the question posed in the title is “right now”!


The paper by Professor Jarvis and colleagues can be found at: http://www.bmj.com/cgi/content/full/324/7337/608

The paper by Professor West and colleague can be found at:
http://www.bmj.com/cgi/content/full/332/7539/458

Labels: cessation, nicotine, nicotine addiction cigarette smoking tobacco, quit

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