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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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... -
Does Tobacco Treatment Decrease the Prevalence of Smoking? And Who Cares?
Several studies have found that the prevalence of smoking, of quit attempts or of long-term abstinence has not increased with the availability of smoking cessation medications. The most recent of these (Zhu, Tobacco Control, Epub ahead of print) concluded that the availability of varenicline did not change the population cessation rate. In that study 11% of smokers used varenicline in 2010-2011. Do we really think an intervention used by 11% of the population can influence the mean incidence of an outcome? It would have to have a huge impact to do... -
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 5 A’s and Its Cousins
The most recent USPHS 5 A’s algorithm recommends clinicians ask and advice smokers to stop (2008 USHPS National Guidelines; Baker, Addiction 110:388‐9, 2015). If they are willing to quit, the algorithm recommends providing medication and counseling treatments. If they are unwilling to stop, it recommends a brief motivational advice protocol called the 5R’s. Since then several alternatives to the 5 A’s have been suggested. A recent article by an ATTUD member (Kim Richter, Addiction 110:381‐6, 2014) and prior articles (Aveyard, Addiction 107:1066‐73, 2011) have also recommended that all smokers receive a treatment, but they question giving different treatments dependent ... -
Another New Behavioral Treatment for Tobacco Dependence
For many years there was a dearth of research on new behavioral treatments for tobacco dependence, but recently we have had several; e.g., Mindfulness therapy (MT), Acceptance/Commitment Therapy (ACT), Behavioral Activation Therapy (BAT) , Positive Psychotherapy(PP) and Contingency Management (CM). One other possible new treatment that has yet to be formally tested is manipulating behavioral substitutes and complements‐two constructs developed from Behavioral Economics Theory. Substitutes.... -
Could Helping Smokers Plan a Quit Attempt Be Harmful
Several experimental studies have suggested gradual cessation is, as effective but no more effective, than abrupt cessation. We completed a study in which we found that, surprisingly, smokers who wanted to quit gradually did somewhat better with abrupt than gradual. Followup studies suggested that perhaps part of the reason for this is that gradual cessation requires putting off quitting for several days or weeks and smokers may lose motivation over time. In addition, most, but not all... -
Natural History of Quit Attempts
I have tried not to use this blog to promote my own research, but thought I would violate that rule to show you some interesting findings. We recently completed a study having smokers who plan to quit sometime in the next 3 months call in each night to report on smoking for 3 months (NTR 16:1190‐1198, 2014). We provided no treatment.
Below are results from some randomly selected participants. Each column represents a day of the study and each row represents a single patient. The legend defines black, grey pixels and the “I” (the white pixel represent days that no change attempts going on). So for example, in just the first half of the study, subject number 204040 reduced smoking by > 50% on day 1, then did not try to change for 5... -
Have we failed to detect some withdrawal symptoms?
Thirty years ago, a list of signs and symptoms of tobacco withdrawal were derived from experimental studies. Amazingly, since then not a single new symptom has been included in the DSM or most other definitions of withdrawal. How likely is it that the scientists got it exactly right back then?
In fact, several new symptoms to include have been suggested. The two with probably the most data are anhedonia (decrease in pleasure or interest in... -
Combination Varenicline and Nicotine Replacement Therapy
Recently three randomized, placebo-controlled trials have tested whether adding NRT to varenicline increases quit rates. The rationale for adding NRT to varencline typically involves hypothesizing a) varenicline does not bind to all nicotine receptors leaving some to be influenced by adding NRT, b) some smokers who do not respond fully to varenicline will be helped by NRT, or c) NRT is better at relieving initial withdrawal than varenicline. An alternate hypothesis is.... -
Does specialist, in‐person treatment improve quit rates?
Many of us in ATTUD provide in‐person individual counseling and believe that, for some smokers, increased intensity treatment provided by specialists increases quit rates. Many studies have shown that in‐person therapy provides higher outcomes than no treatment, brief advice, internet and self‐help materials. However, fewer studies have compared in‐person vs telephone counseling. I think showing in‐person counseling more effective than phone‐counseling, at least in some smokers,... -
Combined Pharmacotherapy and Behavior Therapy for Smokeless Tobacco Cessation
Although there has much press about e-cigarettes recently, we should not forget that smokeless tobacco use is increasing in the US. For example, in a very recent survey, 2.4% of Americans were currently using smokeless vs 2.3% using e-cigarettes (Lee et al, Preventive Med 62:14-19). A recent Cochrane review concluded that person-to-person counseling was helpful for cessation of smokeless tobacco. However, neither NRT nor bupropion was consistently effective. One study... -
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...
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