Effect of extended counseling on smoking cessation

I’ve talked before about the effect of longer duration of treatment (either pharmacological or counseling or both) on success in quitting smoking. Although the evidence is generally consistent with the idea that more is better (including over a longer time period), I’m always interested in new studies that test the hypothesis that providing treatment over a longer duration leads to higher quit rates.

One such study, by Joel Killen and colleagues at Stanford School of Medicine, was published in the journal “Addiction” this month. They recruited 304 adult smokers who wanted help to quit. Everyone received the same pharmacotherapy: Bupropion SR plus the nicotine patch for 8 weeks. Everyone also attended 6 counseling appointments over the first 6 weeks. At 8 weeks, 56% of both groups were not smoking. But half of the sample (randomly selected) were given another 4 half-hour counseling appointments up to week 20, whereas the other half were given 4 five-minute telephone calls in which they were given general encouragement.

The main finding was that 20 weeks after the target quit date, 45% of those offered extra face-to-face counseling were still quit, as compared with 29% of those offered only the brief telephone calls from week 6 to week 20. This suggests that extended counseling produces higher medium-term quit rates.

The type of counseling used in this study is called “cognitive-behavior therapy” which focuses on identifying triggers for craving and smoking (including thoughts as potential triggers) and developing ways to manage these. The study also measured adverse events during the pharmacotherapy. Some symptoms were very common (e.g. insomnia: 58%, headache: 38%), and some less so (e.g. vivid dreams 14%, anxiety 13%). One participant experienced a severe adverse event, requiring hospitalization for depression.

All the participants were followed up at 52 weeks (i.e. after another 32 weeks with no treatment). By this time the difference between the groups was smaller, with 35% of those who had been offered extended counseling to 20 weeks, still quit, compared with 27% of those offered only brief telephone counseling to 20 weeks. It looks as though the extended counseling may have helped some people stay quit. However, after this stopped (i.e. at 20 weeks) some of those people relapsed to smoking. The results of this study are consistent with those of a randomized trial by Dr Sharon Hall who found that smokers who received both extended counseling for a year and extended medication for a year had a 50% quit rate after 52 weeks.

Not all smokers want or need extended duration treatment (i.e. beyond 6-12 weeks), but it is clear that participation in treatment will increase the chances of successfully quitting smoking, and the longer a person stays engaged in treatment, the less likely they will be to relapse.
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About the Author

MA, MAppSci, PhD

Dr. Jonathan Foulds is an expert in the field of tobacco addiction.