Striking While the Iron is Hot Revisited

In prior blogs, I have reviewed the retrospective studies suggesting that smokers who quit spontaneously do not have worse outcomes and often have better outcomes than those who delay and plan their quit attempt. These findings challenge the common practice of asking smokers to delay quitting in order to engage in several preparatory activities (e.g. gather social support, self‐monitor when smoke during the day, or explore medication use). Recent work now challenges the original retrospective findings. First, studies suggest that the finding can be an artifact because smokers recall failed quit attempts more than failed spontaneous attempts (Addiction 104:1901). In addition, when questioned more closely, in one study the spontaneous quitters had actually done some planning (Psychol Add Behav 28:899). Recently, a prospective study (which avoids many of the biases of retrospective studies found planning was associated with greater, not lesser quitting (NTR 16:1190). But more importantly, a recent experimental study by Borland et al found that among those with no immediate plan to quit, those encouraged to quit as soon as possible, ideally immediately, did not do better than those allowed to quit to their own timetable (Ann Behav Med, epub ahead of print). In addition, whether pre‐quit date planning is important has not been well‐studied as most studies just show behavioral treatment works but not whether pre or post‐quit date is more effective. This same study showed that those assigned to an intervention focused on after quitting actions had higher quit rates than those who did not receive this treatment. In addition, a correlational analysis suggested that in the other groups, those who engaged in pre‐quit date preparatory activities had worse outcomes. The authors interpret their results to indicate that planning for coping with smoking urges, etc., is best left to when the need is the greatest. This fits with my own anecdotal observation that it is hard to get smokers to plan for relapse problems because many think that their sheer willpower will get them through. But once they are having difficulty, then they are willing to engage in treatment actions. Nevertheless, the key is not waiting too long to implement planning post‐quit date. This is exemplified in an experimental study showing that front‐loading treatment to occur immediately after the quit date increases quit success (NTR 14:578). Although all this sounds convincing, it is important to note the absence of an experiment directly comparing treatment before vs after the quit date ‐or, more appropriately, treatment before and after the quit date vs treatment only after the quit date. Would love to hear how others decide on how much to press for quitting soon vs delaying to teach some core principles.