About the Blog Author-John R. Hughes, MD
John R. Hughes, MD is Professor of Psychiatry, Psychology and Family Practice at the University of Vermont. Dr. Hughes is board certified in Psychiatry and Addiction Psychiatry. His major focus has been clinical research on tobacco use. Dr. Hughes received the Ove Ferno Award for research in nicotine dependence and the Alton Ochsner Award Relating Smoking and Health. He is a co-founder and past president of the Society for Research on Nicotine and Tobacco, and the Association for the Treatment of Tobacco Use and Dependence. Dr. Hughes has been Chair of the Vermont Tobacco Evaluation and Review Board which oversees VT’s multi-million dollar tobacco control programs. He has over 400 publications on nicotine and other drug dependencies and is one of the world’s most cited tobacco scientist. Dr. Hughes has been a consultant on tobacco policy to the World Health Organization, the U.S. Food and Drug Administration, and the White House. His current research is on how tobacco users and marijuana users stop or reduce use on their own, novel methods to prompt quit attempts by such users, whether smoking cessation reduces reward sensitivity and whether stopping e-cigarettes causes withdrawal. Dr Hughes has received fees from companies who develop smoking cessation devices, medications and services, from governmental and academic institutions, and from public and private organizations that promote tobacco control.
News
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How effective is internet treatment? Should we replace or add to our in-person/quitline programs?
Currently, 77% of Americans have a smartphone and 88% have daily access to the internet via computer or smart phone, with only a slightly lower prevalence in smokers. The major advantages of e-therapy are easy access, affordability and reach.
A recent meta-analysis (Do et al, Patient Preference and Adherence 2018:12, p 2065) examined 108 (!) internet studies, most of which were those using text messages. E-therapy using the internet increased quit success by 70-80% (i.e., from about 10% to 15%). However, these maybe over-estimates as.... -
Motivation vs Skill vs Dependence in Quitting Smoking
Smokers’ perceptions about quitting are just the opposite of what science says. A recent paper (Addict Behav 53: 175-180) has replicated the conclusions of a prior review (Addiction 106:2110-2121, 2011) that commitment/motivation/willpower predict making a quit attempt but does not predict ability to remain abstinent after a quit attempt. These papers also found the opposite for dependence; i.e., dependence does not predict making a quit attempt but does predict the ability to remain abstinent. Interestingly, surveys find that the large majority of smokers (> 70%) believe motivation is both a necessary and a sufficient condition to quit smoking, and few (<35%) cite addiction as a barrier (Drug Alcohol Reviews 27:21-27, 2007). I could not find empirical data, but my impression is that also most smokers do not see stopping smoking as a skill, but rather is matter of effort; i.e., they... -
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 .... -
AHA and ACS Position Statements on Using Electronic Cigarettes for Smoking Cessation
Recently the American Heart Association and the American Cancer Society issued statements on e-cigarettes that include guidelines on whether to recommend e-cigarettes for smoking statement. Both state e-cigarettes should be considered in those who have not responded to or are unwilling to use proven treatments. The AHA statement says “If a patient has failed initial treatment, has been intolerant to or refuses to use conventional smoking cessation medication, and wishes to use e-cigarettes to aid quitting, it is reasonable to... -
Keeping Up on Scientific Data on the Efficacy of Treatments for Smoking
Each year the Cochrane Colloboration publishes an update of all their reviews on smoking (www.thecochranelibrary.com). This is an easy way to check up on new treatment findings and whether any prior findings are no longer thought true. I like the Cochrane because it uses the same methods to test all the treatments and really strives to be unbiased (note I am a un‐reimbursed member of Cochrane Tobacco Addiction Review Group). This year’s summary (Hartmann‐Boyce et al, Addiction, epub ahead of print) includes 2 new reviews an 11... -
Self Control as a Finite Resource
Although many bemoaned the lack of innovative behavioral therapies for smoking in the 1990s, recently there has been a spate of new treatments‐mindfulness, acceptance therapy, persistence therapy, etc. These new treatments have often arisen from basic psychology theories that have been validated. One of these is the “Strength Model of Self‐Control” that posits one has a limited amount of self‐control and expending self‐control in one area, depletes this resource and, thus, one has less self‐control to tackle a new problem in a different area. A meta‐analysis of 83 tests of this theory found consistent support , including studies examining smoking (Hagger, Psych Bulletin 136: 495, 2010). More recent studies have suggested this effect is due, in... -
Scheduling of Counseling for Smoking Cessation
Most of you know that the incidence of relapse after trying to quit is high in the first few weeks, but you may not realize how high it is. Most studies find that, among self-quitters, half of smokers relapse in the first 2 days and two-thirds in the first week. Even with intensive treatment over half relapse in the first week. Given this, front-loading treatment during the first week has been advocated. A recent randomized trial compared front loaded counseling of four...