Nicotine, arguably the most difficult of substance use habits to ‘kick’, is highlighted in the following research, but one can apply this same ‘non-assisted’ exiting of drug use to other substances to.
This of course is and has been done by millions of citizens who through abstinence based programs and processes, including therapeutic communities and 12 Step programs, has seen people break free from the tyranny of addiction.
This exhortation, if you will, is not to denigrate medically assisted treatments that help an individual exit the drug using habits that are undermining their health and humanity – No, not at all! It is, however, wanting to put back in a more prominent place on the ‘treatment table’ that has been cluttered with a growing number of drug use maintenance vehicles masquerading as treatment options, and empower people to become the drug free human units they were born to be.
Also see ‘Drug Use, Stigma and Proactive Contagions to Reduce Both’
The Global Research Neglect of Unassisted Smoking Cessation: Causes and Consequences
Summary Points
- Research shows that two-thirds to three-quarters of ex-smokers stop unaided. In contrast, the increasing medicalisation of smoking cessation implies that cessation need be pharmacologically or professionally mediated.
- Most published papers of smoking cessation interventions are studies or reviews of assisted cessation; very few describe the cessation impact of policies or campaigns in which cessation is not assisted at the individual level.
- Many assisted cessation studies, but few if any unassisted cessation studies, are funded by pharmaceutical companies manufacturing cessation products.
- Health authorities should emphasise the positive message that the most successful method used by most ex-smokers is unassisted cessation.
Introduction
As with problem drinking, gambling, and narcotics use [1]–[9] population studies show consistently that a large majority of smokers who permanently stop smoking do so without any form of assistance [10]–[15]. In 2003, some 20 years after the introduction of cessation pharmacotherapies, smokers trying to stop unaided in the past year were twice as numerous as those using pharmacotherapies and only 8.8% of US quit attempters used a behavioural treatment [16]. Moreover, despite the pharmaceutical industry's efforts to promote pharmacologically mediated cessation and numerous clinical trials demonstrating the efficacy of pharmacotherapy, the most common method used by most people who have successfully stopped smoking remains unassisted cessation (cold turkey or reducing before quitting [16],[17]). In 1986, the American Cancer Society reported that: “Over 90% of the estimated 37 million people who have stopped smoking in this country since the Surgeon General's first report linking smoking to cancer have done so unaided.” [18]. Today, unassisted cessation continues to lead the next most successful method (nicotine replacement therapy [NRT]) by a wide margin [15],[16].
Yet, paradoxically, the tobacco control community treats this information as if it was somehow irresponsible or subversive and ignores the potential policy implications of studying self-quitters. Unassisted cessation is seldom emphasised in advice to smokers [19]. We know of no campaigns that highlight the fact that most ex-smokers quit unaided even though hundreds of millions have done just that. Reviews typically give unassisted cessation cursory attention [20], framing it as a challenge to be eroded by persuading more smokers to use pharmacotherapies: “Unfortunately, most smokers …fail to use evidence-based treatments to support their quit attempts” [21]; “If there is a major failing in the UK approach, it is not that it has medicalised smoking, but that it has not done so enough.” [22]. Clinical guidelines also ignore unassisted cessation [8]. Finally, although the US National Centre for Health Statistics routinely included a question on “cold turkey” cessation in its surveys between 1983 and 2000, this question disappeared in 2005 [23].
Because of these prevalent attitudes, smoking cessation is becoming increasingly pathologised, a development that risks distortion of public awareness of how most smokers quit to the obvious benefit of pharmaceutical companies. Furthermore, the cessation research literature is preoccupied with the difficulty of stopping. Notably, however, in the rare literature that has bothered to ask [24], many ex-smokers recall stopping as less traumatic than anticipated. For example, in a large British study of ex-smokers in the 1980s, before the advent of pharmacotherapy, 53% of the ex-smokers said that it was “not at all difficult” to stop, 27% said it was “fairly difficult”, and the remainder found it very difficult
(For complete research go to PLOS Medicine)