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

  • Can we predict who will quit? Does it matter?

    by john R. Huges, MD
    Vangeli et al (Addiction 106: 2110-2121, 2011) identified eight large, population based studies of smoking cessation in the real world. The surveys included both US and other countries. Six used data acquired between 2000 and 2010. These studies offer the most generalizable test of predictors of making a quit attempt or predicting success once one tries to quit.
    Posted in Addiction, Prediction, Quit Attempts, Treatment Matching

  • How Prevalent is Use of Face-to-Face Counseling for Smoking Cessation

    by john R. Huges, MD
    Most US surveys report that about a third (36%) of smokers trying to quit seek treatment; many (32%) used medications but few (4%) smokers used counseling (Shiffman, Am J Prev Med 34:103-111, 2008). However, a new survey suggests use may be greater (Borland, Addiction 107:197-205). In a survey of 10 countries, the incidence of use of counseling in the last year among those...
    Posted in In-person Treatment, Treatment Seeking

  • Does Promoting Insight into Addiction Help or Hinder Smoking Cessation?

    by john R. Huges, MD
    Oftentimes those addicted to drugs deny they are addicted. Methods to convince them they are, indeed, addicted (many of which are confrontational) to break down “denial” are common in the treatment of non-nicotine addictions. Randomized trials of breaking down denial as a treatment are not available. In fact, others have argued that emphasizing addiction undermines willingness to...
    Posted in Addiction

  • Pros and Cons of Describing Addiction as a Brain Disease

    by john R. Huges, MD
    A recent editorial (Gartner et al, Addiction 107:1199) discussed the pros and cons of describing addiction as a “brain disease.” It noted that advocates..
    Posted in Addiction

  • Scheduling of Counseling for Smoking Cessation

    by john R. Huges, MD
    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...
    Posted in Proactive Treatment, Therapy

  • Do Ex-smokers Return to Normal?

    by john R. Huges, MD
    We all have been at cocktail parties and heard innumerable stories of how smokers quit. Often we will hear former smokers say they can’t believe they ever smoked and have no desire at all to return to smoking; others say they have to remain vigilant because they still have desires to smoke at times. I recently published what is, I think, the first paper to try to quantify this. In an internet survey of 403 smokers who had been abstinent for 1-10 years (Hughes, NTR 12:459-462, 2010), 59% said they had a desire to smoke in the last year and 42% of these (or 25% of all former smokers) had a desire in the last week. Overall 9% of smokers said they had a craving that.....
    Posted in Craving, Former Smokers

  • Marijuana Intoxication

    by john R. Huges, MD
    Recently there has been an increase in emergency room visits for marijuana intoxication, perhaps due to the stronger potency of marijuana recently....
    Posted in Co-morbidity

  • Recent Survey Data on Smoking and Quitting in the US

    by john R. Huges, MD
    Two new CDC surveys (MMWR 60:1207-1211, Sept 9, 2011 and MMWR 60:1513, Nov 11, 2011) report some outcomes of interest to TTSs. The first survey reports that now, among daily smokers, 16% smoke less than 10 cigs/day. In addition, other surveys have found that 20% of smokers are non-daily smokers, so when you add the two together then about 1/3rd of smokers are light/nondaily smokers. As you know, most medications have been tested almost exclusively on smokers of > 10 cigs/day. The only study in light smokers I am aware of showed that light daily smokers benefited from NRT as much as heavier smokers (Drug Alcohol Dependence 77:311-314, 2005). Among those I have talked to, there is a significant divergence of opinion about whether to offer NRT to light smokers. Recent data suggest the biggest effect of NRT is....
    Posted in Hardening, Quit Attempts

  • Extended Counseling Improves Quit Rates: Empirical Support for What We Do

    by john R. Huges, MD
    In prior blogs I have reported the results of Sharon Hall’s and others’ studies of keeping treatment ongoing after the first few weeks. In the past Sharon and others have examined extending both medication and counseling but I want to focus on the latter. Two prior randomized trials have examined extending counseling with a cognitive-behavorial therapy (CBT) focus. One found a nonsignificant trend that extended treatment lead to higher quit rates. The other, by Dr Hall, more clearly showed extended CBT to be more effective. In a third, just published study, she again found more CBT improved quit rates (Am J Pub Hlth, 2011). The treatment was eleven individual, outpatient cognitive-behavioral treatment sessions lasting about 20-30 min between weeks 12 and 52. Even 2 yrs after the quit date, she found highest quit rates in the two CBT....
    Posted in Behavior Therapy, Extended Treatment

  • Recycling Relapsers

    by john R. Huges, MD
    This month’s blog focuses on options once a smoker has relapsed (is smoking regularly - usually defined as smoking for 7 consecutive days).
    The advice for lapses in the last blog also applies for relapses; i.e., discuss the possibility of lapse/relapse at treatment initiation, explore what caused the relapse and problem solve, continue medication, and smoke as little as possible. There is a belief that it’s best for relapsers to wait and recover from the disappointment of failure before they try to stop again. There is no evidence...
    Posted in Extended Treatment, Relapse, Rescue, Treatment Matching

  • The Diplomacy of Smoking Cessation “Advice”

    by john R. Huges, MD
    Many of us see smokers who want to quit but are not quite ready (about 80% of smokers). The USPHS recommends using the 5 A’s algorithm with such clients: i.e. “Ask about tobacco use, Advise to quit, Assess willingness to make a quit attempt, Assist in quit attempt and Arrange followup.” If a smoker is not ready to quit, it recommends the 5 R’s: discuss their Relevant reason to quit, their Risks of smoking, their Rewards from quitting, their Roadblocks to quitting, and Repeat. When I teach medical students, residents and doctors I vary from these 10 strategies in two ways. First, the USPHS guidelines recommends discussing treatment options only if the smoker states he/she is willing to quit in the next few weeks. In ...
    Posted in Motivational Interviewing, Physician Advice

  • How to Keep Up With the Scientific Literature On Smoking Cessation

    by john R. Huges, MD
    Several new databases and methods have made it much easier to keep yourself up-to-date on scientific evidence for the many claims one hears. Below I review my favorites (I apologize to our Canadian readers as this will be US-centric) First, the “bible” for me continues to be the USPHS “Treating Tobacco Use and Dependence” which can be found at www.surgeongeneral.gov/tobacco along with brief clinician guides, patient guides, etc. One caveat is that it is based on meta-analyses conducted in 2007 so is somewhat out of date. Another guideline for smokers with psychiatric or alcohol/drug problems is the American Psychiatric Association Practice Guideline for Substance Abuse (www.psychiatryonline.com) that has a good section on treatment in this group of smokers. A more up-to-date source is the Cochrane Library (www.thecochranelibrary.org) which is a set of....
    Posted in Certification