Smokers are often told the best way to nix their habit is to have a game plan, including a quit day and a quit strategy. But could that advice be counterproductive?
In a recent study, putting that question to the test, smokers who quit spontaneously, without advance planning, had a greater chance of succeeding than those who planned ahead. The results, published in the British Medical Journal, seem to flout traditional smoking-cessation guidance.
Dr Michael Siegel, a professor of social and behavioural sciences at Boston University who examines tobacco control policies and smoking behaviour, said the findings make a lot of sense.
"Planned quit attempts are implemented gradually and thus the level of motivation is probably rather low," he said. "But these unplanned, sudden attempts probably reflect some sentinel event or great tension that precipitates a very high level of motivation to quit. And thus these attempts are more successful," he reasoned.
Study authors, Robert West and Taj Sohal, liken the unplanned quit attempt to what mathematicians call "catastrophe theory". The idea is simply this: as tensions build up, even small triggers can lead to sudden and dramatic shifts in action. In nature, such forces might lead to, say, an avalanche.
In much the same way, a smoker becomes disgusted with his habit, creating tension that, eventually, triggers a split decision to kick the habit.
Siegel said the study points to the need to focus on motivating smokers to want to quit. He said there's been too much emphasis on promoting pharmaceutical aids to help people quit.
"If we can get smokers motivated enough, they will succeed in quitting, regardless of the mechanism."
More studies needed still
Thomas Glynn, director of cancer science and trends and director of international tobacco programmes at the American Cancer Society in Washington, D.C., said the research is intriguing.
"This study certainly requires us to take a step back and look at different decision-making styles that people have," he said. But without further study bearing out these results, the cancer society would not consider revisiting its smoking cessation advice.
"We certainly wouldn't want to do it on the basis of one study, particularly one that's based on retrospective data," he added.
For their study, the researchers compared data on 918 smokers who had made at least one quit attempt with the experiences of 996 successful former smokers. Almost half (48,6 percent) of smokers said their most recent quit attempts were made without previous planning, and these spontaneous attempts were more likely to succeed for at least six months.
Odds higher for quitting
In fact, the odds of quitting successfully for at least six months were higher for unplanned quit attempts than for those that involved some pre-planning.
Presuming their theory is correct, the researchers propose that public health campaigns focus on what they dub the "Three T’s" - creating motivational tension in smokers, triggering action in those who are on the cusp of change, and supporting them with treatment, such as nicotine patches and counseling.
"In practice, worry about health and being fed up with the cost of smoking seem to be the main sources of tension that people can report," said West, a professor of health psychology at University College London and lead author of the study.
As for what finally triggers a quit attempt, West has compiled a list based on results of monthly surveys he conducts of people on their most recent quit attempt. For some, it's health-related. They worry about future health problems or a current health problem, they get advice from a health professional or they get pregnant.
Others stop because they know someone who is stopping, decide it's too expensive, face smoking restrictions or encounter pressure from family or friends.
Quitting is up to the individual
"For most smokers, quitting is a process, and it may culminate for many people, more than we thought, if this study proves to be correct, that they do make a very spontaneous decision," Glynn observed. "But that's in all likelihood the culmination of a series of decisions over a period of years leading to that day."
What's unclear in this study, he said, is whether people defined that process as "planned" or "unplanned".
So, is quitting on a whim a better strategy? Or is planning a better option for some? "The truth is that we just don't know what the best strategy is," conceded West, who acknowledged that planning may help some smokers quit.
"The most important thing," he added, "is for smokers to realise that if they are experiencing powerful urges or feeling really bad because of withdrawal symptoms, they can help themselves by using nicotine patches or one of the other medications and by using specialist support, either by telephone or face to face." – (Karen Pallarito, HealthDay News)
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