Do You Need Treatment to Quit Smoking?
Those involved in what is called Tobacco Control certainly seem to think so.
I predict this will be found to be ineffective.
From a more conventional perspective, let’s take a look at an editorial in the learned journal Tobacco Control by two Australian cancer researchers. (Borland R, Garner C. Tob Control 2016;25:245)
In their esoteric world they are much exercised over the question as to why nicotine-containing products marketed as consumer goods (Swedish ‘snus’ and e-cigarettes, for example) are more popular than medicinal nicotine (gum and patches) promoted for smoking cessation. In considering this weighty matter they make various assumptions, such as that tobacco products have a use for ‘quelling cravings’ and why medicinal products are not as popular for ‘long-term substitutes for smoking’.
They also say the role of medicinal nicotine ‘is to reduce or eliminate the desire to smoke’ which it’s anticipated will be used only for a short time. On the other hand, recreational nicotine like snus or e-cigarettes, is ‘used for the experiences it generates, so persisting use is always a possibility’.
Then, interestingly if somewhat patronisingly, they say: ‘We may need to move beyond a simple medical model if we are to maximise the speed with which we move existing smokers away from tobacco cigarettes.’
I cannot resist quoting a couple of sentences from this sententious piece as to how they might try to achieve their worthy aim:
This requires a biopsychosocial (sic) approach, not a separate focus on either social determinants or on the biological pull of nicotine. This conceptualisation implies that the efficacy-oriented approach is far too limited…we need broader evaluation frameworks that incorporate both ease of encouraging use and efficacy when used.
I would challenge all these assumptions.
First of all, why can’t they let go of the idea that you need treatment to stop smoking? If you want to stop, you just stop! Millions of smokers have done this, and I’ve been able to help a few of them myself, not by any treatment, but by guiding smokers to understand why they really smoke, and then – amazing but true – they don’t want to do it anymore! The approach I use is based on the idea that there’s no difficulty in refraining from something you don’t want to do.
Secondly, the idea of using medicinal nicotine to reduce or eliminate the desire to smoke is counter-intuitive and illogical. As I point out in my books, if you wish to be a non-smoker you presumably wish to be free of nicotine in any shape or form. Using nicotine to suppress the desire for nicotine is rather like trying to get an alcoholic to stop drinking by offering alcohol. It just keeps the addiction going, makes it harder to stop, offers an inbuilt excuse for failure (it didn’t work!), reinforces the idea that quitting is terribly difficult, does nothing to assist understanding of why a smoker really smokes nor helps him or her not to restart after an interval of abstinence. In any case, studies show that of 100 people who try medicinal nicotine as an aid to quitting, 80 of them will still be smoking a year later.
Thirdly, the attempt through medical treatment to ‘reduce or eliminate the desire to smoke’ implies that smoking is only or mainly a physical problem with the smoker’s brain chemistry. This is not so, and my experience of successfully treating hundreds of smokers has shown very clearly that smoking is a psychological problem – see my recent book of this title. Therefore, it is the psychological aspects of smoking that need attention. Therefore, the attempt to suppress the desire to smoke by using drugs (medicinal nicotine or prescription drugs) is wrong-headed: it reduces the problem to a mechanical process which manifestly it is not.
Fourthly, the mention of ‘the experience [nicotine] generates’ suggests nicotine produces in users some wonderful or at least noteworthy experience: visions of heaven or an orgasmic sensation. Clearly, this is not what happens. How, then, can one find out what experience nicotine generates, if any? Let’s ask smokers themselves what they get out of it. The answer is: nothing. Actually, they do get something out of it: relief of the transient mild discomfort caused by the smoking itself.
Fifthly, the idea that smokers suffer ‘cravings’ is dubious and unhelpful and I would make a plea for abandoning this word in relation to tobacco use. The Oxford English Dictionary defines craving as a strong desire; an intense longing. In drug addiction it suggests an almost overwhelming need or compulsion to obtain another dose of the drug. Even if someone has stopped smoking for a few days and if they feel tempted to smoke, what do they say about how they feel? It is extremely rare for a smoker to say he or she is suffering from headaches, nausea, depression, fatigue, etc., or to mention other symptoms which could indicate craving. Usually, they merely say they feel mildly irritable or anxious and are thinking about smoking a lot, but it is striking that from what many smokers will tell you, the withdrawal symptoms are not that bad.
Finally, as for ‘long-term substitutes for smoking’ it needs to be stressed – especially to those working in the Tobacco Control world who seem unaware of this fact – that you don’t need a substitute for cigarettes. Do you need a substitute for the flu when you’ve recovered?
If smokers really want to quit and if they are given accurate and relevant information about the mechanism of addition, plus the right kind of support, it’s surprisingly easy. And it’s quite unnecessary to use any form of nicotine, prescription drugs, hypnosis, acupuncture, magnets in your ears – or even laser therapy.
Text © Gabriel Symonds 24 July 2016