THE BLOG

Quit Attempts: Confidence Builders or Breakers?

04/14/2014 04:34 pm ET | Updated Jun 14, 2014

A survey by the American Lung Association (ALA) found that 6 out of 10 former smokers "were not able to successfully quit on their first try and required multiple attempts to quit smoking for good." The idea, often repeated by those reaching out to help smokers, is that multiple quit attempts are "normal," and a "necessary" part of progressing to a successful result. The hope, expressed by the ALA, is that "each time you try, you learn a little more ... you become a little wiser about what to do and not do the next time." The ALA also, however, cautions that: "Unsuccessful attempts to quit can leave smokers feeling alienated and discouraged."

In fact, recent international research (1) suggests for some smokers, just trying to quit again, without recovering from a failed attempt, contributes to what they call "cessation fatigue." According to this research, there is a generalized capacity to quit, but that capacity needs to regenerate between tries. In other words, it's not just the number of quit attempts that leads to success, but rather their timing. The researchers found that:

(1) If you have tried to quit in the last year but failed, you are more likely to try again.

(2) However, if you failed to quit in the last year, you are also more likely to fail again.

When it comes to smoking, it seems the old adage "try, try again" doesn't automatically get you closer to successful quitting

Meanwhile, researchers at the University of California in San Francisco (2) highlight confidence in the ability to quit as a crucial therapeutic ingredient. They found: "Interventions for addiction may produce abstinence in part by increasing individuals' confidence in their ability to quit." More specifically, they found that what is called "self-efficacy," or the expectation of success, accounted for "61 percent to 83 percent of the total effect of treatment on abstinence."

If gaining confidence helps you quit, what happens if a quit attempt doesn't work out? While many smokers learn to be more confident through multiple quit attempts, other smokers, in my experience, develop a condition described by the psychologist Martin Seligman as "learned helplessness," or the loss of hope for a desired outcome.

Learned helplessness is the process of giving up when you realize that your efforts, in this case your attempt to quit, and achieving a desired outcome (actually quitting) are independent of each other. Seligman calls this a feeling of "uncontrollability." In this scenario, no matter how motivated these smokers are, no matter how many attempts to quit they try, the feeling of uncontrollability, or learned helplessness, takes away from their ability to quit successfully.

Being more addicted, by definition, means having less control over your drug. Loss of control is itself considered an important diagnostic feature of all compulsive substance use and dependence. But realizing that tobacco has control of them is something many smokers don't want to admit, even though admitting they have lost control, and feel powerless, can help them to ultimately avoid taking even "just one" cigarette once they have quit.

A recent review (3) of all available studies on predictors of outcomes of attempts to stop smoking found that motivation to quit only predicts how likely a smoker is to attempt to quit, not how successful those attempts will be. The only consistent predictor of success at quitting was having a lower level of cigarette dependence. In contrast, higher levels of cigarette dependence, such as heavy smoking or smoking first thing in the morning, were a consistent predictor of quitting failure.



To sum up these findings:

(1) Failed quit attempts in the previous year can decrease, rather than increase, the capacity to quit.

(2) Quit attempts by highly addicted smokers as a group, when compared with less addicted smokers, are less likely to bring about a positive quitting outcome, despite their being highly motivated to quit. Deciding and wanting to quit set the stage for quitting, but do not by themselves predict a successful outcome.

(3) Increasing confidence through proven strategies is a key therapeutic ingredient in successful addiction treatment. Seeking helpful outside assistance and guidance, learning to better cope with withdrawal, increasing daily pleasurable activities, and learning to become better at managing moods can all help contribute to building the necessary confidence to quit.

Attempts to quit are not risk-free, and smokers, especially those who are more highly dependent on smoking, need to find appropriate confidence-building measures when embarking on each new attempt.

Dr. Daniel Seidman is director of smoking cessation services at Columbia University Medical Center, author of the book Smoke-Free in 30 Days, and of the Up in Smoke program from Mental Workout for iPhone, Android, Mac, and PC.

References:

(1) Timea R. Partos , Ron Borland, Hua-Hie Yong, Andrew Hyland, K. Michael Cummings (2013). The Quitting rollercoaster: How recent Quitting History affects Future Cessation Outcomes (Data From the international tobacco Control 4-Country Cohort study). Nicotine & Tobacco Research, volume 15, number 9, 1578-1587.

(2) Hendricks, P.S., Delucchi, K.L., & Hall, S.M. (2010). Mechanisms of change in extended cognitive behavioral treatment for tobacco dependence. Drug and Alcohol Dependence, 109, 114-119.

(3) Vangeli, E., Stapleton, J., Smit, ES., Borland, R.,West, R. (2011) Predictors of attempts to stop smoking and their success in adult general population samples: a systematic review. Addiction, 106, 2110- 2121