First, the good news: The 46 million people (20.6 percent of all adults) who smoke in the U.S. are now outnumbered by former smokers. Between 1965 and 2004, smoking rates dropped by more than half, from 42.4 percent to 20.9 percent. About a month ago, New York City announced that just 14 out of 100 New Yorkers are still smoking. That's a 35 percent decline, or approximately 450,000 fewer adult smokers since 2002. So obviously people want to and can quit smoking.
Yet while most people quit relatively easily and without smoking cessation therapies like nicotine replacement therapy or counseling, other smokers struggle for years, further compromising their health. Some former smokers say quitting is the hardest thing they have ever done. Clearly, when it comes to quitting, all smokers are not alike.
For those who struggle mightily with quitting smoking, the belief that "some people just can't quit" resonates with their broken confidence in their ability to quit. Emotional beliefs and cognitions crop up around the physical realities of addiction such as: "I can learn to keep this under control," or "I need this to cope with stress" or "I just can't quit." The biology of addiction and withdrawal and the psychological dynamics of smoking addiction conspire to undermine the smokers' self-confidence, which is a central component of long-term quitting success (1). The addiction itself destroys smokers' confidence that they can quit, good therapy rebuilds it so they can restore themselves to a smoke-free life.
Recently, the destructive notion that "some people just can't quit" has opened up a way to market controversial products such as electronic cigarettes and smokeless tobacco to smokers desperate for a lifeline out of smoking. E-cigarettes are unregulated products (outside the scope of the FDA), with poor quality control and little unbiased research to guide consumers. E-cigarettes are essentially a new form of nicotine replacement therapy (NRT). They are now competing with the available forms of NRT by presenting themselves as a new kind of cigarette, and without going through all the usual product safety and effectiveness testing required by the FDA. This means they do not have to adhere to any quality control standards, except those imposed by the rough and tumble of the marketplace. So buyer beware.
A recent small pilot study (2), widely praised by the e-cigarette community, found that: "Sustained smoking abstinence at week 24 was observed in 9/40 (22.5 percent) participants, with 6/9 still using the e-cigarette by the end of the study." The study excluded participants with "a history of alcohol and illicit drug use, major depression and other psychiatric conditions" as well as smokers with a wide variety of smoking-caused medical problems. In other words, it excluded many of the people still smoking (and struggling to quit) today! While these findings may be encouraging to the e-cigarette industry, they probably indicate that e-cigarettes are unlikely to do any better helping smokers quit than FDA-approved NRT products. To put this small e-cigarette study in context, an analysis by the U.S. Department of Health and Human Services (3) of multiple rigorous scientific studies at six months postquit found that combining the nicotine patch and the nicotine gum produced, on average, a 36.5 abstinence rate compared to placebo.
Smokers may, however, take to e-cigarettes more readily than they take to established stop smoking therapies. Inhaling nicotine vapors directly into the lungs from e-cigarettes may be more rewarding, for example, and may make them harder to stop down the line. This bodes well for the bottom line of industries built on the premise that it's impossible to stop. In contrast, most people are happy to stop their nicotine patch (and other FDA-approved therapies) when they are confident in their newly smoke-free life. Smoking cessation medications are designed to boost the confidence of smokers who want to quit, not to profit from smokers' broken confidence.
The purveyors of e-cigarettes and smokeless tobacco usually exaggerate poor outcomes with traditional quit-smoking methods, such as nicotine replacement therapies, which are also meant to be combined, but seldom are, with proven counseling approaches. Quitting smokers can greatly benefit from the National Cancer Institutes' field-tested brief intervention program or motivational interviewing from health professionals, or cognitive-behavioral therapy (CBT) for smoking cessation. Recent treatment reports for extended CBT show it has the potential to help over half of smokers quit in a given treatment cycle (4).
When marketers capitalize on the unhelpful belief that it's impossible to quit, it reinforces addicted smokers' own broken confidence. Let's redouble our efforts instead to make available proven and safe methods which can inspire confidence in all of us.
Dr. Daniel Seidman is director of smoking cessation services at Columbia University Medical Center, and author of "Smoke-Free in 30 Days: The Pain-Free, Permanent Way to Quit," with a foreward by Dr. Mehmet Oz (Simon & Schuster 2010). For more details about the book, go to www.danielfseidman.com.
REFERENCES:
(1) 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.
(2) Polosa, R. et al. Effect of an Electronic Nicotine Delivery Device (e-Cigarette) on Smoking Reduction and Cessation: A Prospective 6-Month Pilot Study. BMC Public Health 2011, 11:786 doi:10.1186/1471-2458-11-786.
(3) Treating Tobacco Use and Dependence: 2008 Update. Tobacco Use and Dependence Guideline Panel. Rockville (MD): US Department of Health and Human Services; 2008 May
(4) Hall, S.M., Humfleet, G.L., Munoz, R.F., Reus, V.I., Robbins, J.A., et al (2009). Extended treatment of older cigarette smokers. Adiction, 104, 1043-1052.
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Stop the press.....WHAT? Yeah, those that quit "easily" must be smoking those candy cigarettes.
Here's a tidbit for you- I completely quit smoking tobacco cigarettes after using to e-cigs. I haven't had a cig for 11 months now, and I smoked for 18 years.
The reason there is no quality control standards for e-cigs is because the idiots at the FDA said they are the same things as cigarettes. Well, my doctor and I completely disagree.
"E-cigarette opponent Daniel Siedman criticizes Polosa e-cigarette study protocol, exaggerates benefits of NRT products that were studied using similar protocols, hawks sales of his book."
Yeah, that sums it up.
Saying "I can't" relieves a smoker of responsibility since it's not their fault they can't quit. But I don't believe smokers "can't" quit, usually it means they don't know how, or they don't really want to stop smoking.
If smokers try to quit before their motivation is high enough, they relapse. Often smokers are ambivalent about quitting. A smoker at this stage will usually say, "I want to quit but...." It's what comes at the end of that sentence that I help counsel smokers in dealing with.
In the tobacco control field, we really do know how to help a smoker be successful but often smokers think they can quit on their own when actually if they would consult a tobacco treatment specialist (TTS), they could make their process much easier.
I love it when a smoker says to me, "You're my last resort, I've tried everything to quit."
First,they really want to quit, otherwise they would have given up. Second, I know they will be successful with some education of what it takes to be successful.
If you're thinking about an e-cig, please talk to your doctor about the inhaler instead. Similar concept but regulated by the FDA, and requires a prescription because it delivers a higher dose of nicotine than the OTC NRT's. Many TTS's are now recommending using a combination of different therapies.
For free quitting tips: www.StopSmokingStayQuit.blogspot.com
The sellers of e-cigs wanted to keep you addicted to nicotine through their product instead of cigarettes, so ultimately the cost over a lifetime would be considerably more than a few months of NRT (which can be covered by insurance).
There are 162 FREE posts on my blog, no one need buy my books, they only need to read my blog for free to get a lot of the same information.
www.StopSmokingStayQuit.blogspot.com
Don't believe ecf /casaa... With ecigs you are still smoking hand to mouth habit and inhaling dangerous chemicals.
Step 1 - Stop smoking!
Yep, all it takes to stop smoking is to stop smoking. Piece 'o cake! But the reality is that beating cigarette addiction is never ever "that simple".
Yes, patches and lozenges do work for some. The gum works for some. Electronic cigarettes work for some. Cold turkey works for some. But no one method works for everyone. I suspect the level of difficulty one faces when quitting smoking is partly dependent on how big of a role the MAOIs in tobacco play in their addiction. That's where anti-depressants like Wellbutrin and Chantix can factor into the quitting equation, but they're certainly not without their own risks.
You're misinformed about electronic cigarettes. They don't produce any smoke. There's no combustion — they use a battery-powered heating element to vaporize the liquid. It may look similar to smoking when you first see someone using one, but it's not the same thing at all.
Actually Doctors like Richard Hurt of the Mayo clinic suggests DON'T follow the directions. Seriously, patches and lozenges are under 3% effective at promoting cessation over 20 months.
Doctors like Richard Hurt suggest ignoring the directions and using NRPs for "as long as it takes".
"With ecigs you are still smoking hand to mouth habit and inhaling dangerous chemicals."
No more than the nicotine patch actually, as demonstrated by the FDA sponsored lab test.
If a person says the want to quit, but has any reservation about the idea what so ever - they won't.
It's really the choice of the smoker. There isn't anyone on this earth that's really going to tell someone else what to do.
It's that simple.
So it's their own fault, so that 14% of the unwilling or unable to quit, they're a lost cause and deserve what they get? Even if they were kids when they started, and didn't have the mental capacity to understand the life long consequences?
"It's really the choice of the smoker. There isn't anyone on this earth that's really going to tell someone else what to do. "
This isn't really all that true either. Indoor smoking bans, outdoor smoking bans, in the home smoking bans, there is more people telling others what to do than you can shake a stick at.
This is the problem with the quit or die philosophy. People die, if we accept the CDC figures as fact, 45 per hour. Those people on oxygen, on trach tubes, you really want to look in their face and say it's your own fault, you deserve to die?
In case you didn't get the memo, smoking is REALLY addictive. No one deserves cancer, or heart disease, and it's really sad when the Tobacco companies are contributing more to public health than people like yourself whose final solution is to end smoking by letting smokers die.
That's where harm reduction comes in, a less harmful product and you can say what you did, and it won't be as callus as the users are not likely to get cancer and die.
You people who are not smokers trying to convince us not to smoke are sooooo annoying. We don't care what you think. Thats the fact. Everything that you've added to follow up my post is your opinion, not mine.
Should those people just be condemned to suffer from chronic diseases and die if they are too weak to quit cold turkey or unable to afford cognitive behavioral therapy? Excuse me for being cliche, but what about the children?? For the sake of their children, shouldn't we be encouraging people who have tried but been able to quit long term or those who simply don't want to completely quit using recreational nicotine/tobacco products to at least find a satisfying SMOKE-FREE alternative?
I tried the E-cig (greensmoke) and it REALLY helped me! The issue I ran into was ordering them online and having them available when I needed. When I have no cartridges (or I'm low) and only a few bucks, I'm going to have to go with cigarettes. Yes, part of this is poor planning on my part, but part of it is cash-on-hand. The only other problem I experienced with the e-cig is that feeling that I didn't "finish a cigarette", if that makes sense to anybody. lol Each cartridge is supposed to be like 10 cigs, but when there is no "cut-off" (for lack of a better term), it kind of messes with your head.
However, I plan on giving my e-cig another try. For me, it has worked the best...and, at the end of the day, that's what it's all about, right? Getting rid of toxins and carcinogens and second hand smoke? The last idea I'd like to throw out is: rehab. I know people laugh at this idea, but I think insurance companies would do well to offer it to those who have had a miserable time "quitting".
Yes, I was (and still am) hurting over the loss of my parents, but now I'm smoking again and that weakness drives me crazy!
I have never been a drug user or abused alcohol, yet it boggles my mind that an old habit like smoking can strike again without a thought. I want to stop it again, and I will, but it's a bad habit that can hold you down even years after you quit.
The "Emotion-Triggered Smoker" is one of the six basic types of smokers I describe, along with the different obstacles for each kind, in my book "Smoke-free in 30 Days".
It's not 100%, but statistically it's far more successful than any other method. You just have to want to quit and agree to go along and enjoy the relaxing session. One-on-one is better than the group sessions, but the group sessions do work for a lot of people.
Except the evidence for it is kind of lacking, but given around 14% cold turkey, can't do any harm.
Abbot NC, Stead LF, White AR, Barnes J. Hypnotherapy for smoking cessation. Cochrane Database of Systematic Reviews
1998, Issue 2. Art. No.: CD001008. DOI: 10.1002/14651858.CD001008
http://www.thecochranelibrary.com/userfiles/ccoch/file/World%20No%20Tobacco%20Day/CD001008.pdf
As a psychologist, for over 33 years, I assist people to re-gain the power they feel they've lost. Check out some of my Free Articles at: jamesbarrickphd.com/
Just Do It !!
I think the "quit or die" mentality needs to . . . die.