The Truth About Quitting Smoking

Usually, I like to point out all of the positives of the self-help methods available to help an individual with a specific problem in life. Whether it be reading a self-help book about your relationship, or trying out a self-help program online to combat depression, I find such methods a good first step toward seeking help. Or getting better.

But sometimes such methods obscure the truth. For many — but not all — mental health concerns, the truth is that time alone will often heal a person — it just takes longer as you grapple with the concern. This doesn’t work for things like bipolar disorder or schizophrenia, but for an adjustment disorder or even a simple phobia, treatment is often unnecessary (adjustment disorders usually resolve on their own over time and simple phobias can usually be avoided).

So let’s turn our attention to a habit that many people have trouble kicking — smoking. We’ve been told over and over again that it’s difficult to quit because the nicotine in cigarettes is addicting. You know, like cocaine. Or caffeine. But what you’re rarely told is that it is the behaviors associated with smoking that are often the strongest reinforcers of smoking. Taking a smoke after eating? That has nothing to do with your addiction to nicotine, but has everything to do with the association you’ve built up between food and smoking.

Guess what — all the nicotine patches in the world won’t do squat about that behavior. The Neuroskeptic has the lowdown about researchers who took a look at all the smoking cessation studies published in 2007 and 2008:

[The researchers’] point is deceptively simple: there is lots of research looking at drugs and other treatments to help people quit smoking tobacco, but little attention is paid to people who quit without any help, despite the fact that the majority (up to 75%) of quitters do just that. This is good news for the pharmaceutical industry and others who sell smoking-cessation aids, but it’s not clear that it’s good for public health. […]

Their argument is not that drugs never help people to quit; nor are they saying that tobacco isn’t addictive, or that there is no neurobiology of addiction.

Rather, they are saying that the biology is only one aspect of the story. The importance of drugs (and other stop-smoking aids like CBT), and the difficulty of quitting, is systematically exaggerated by the medical literature…

Of the 662 papers [about “smoking cessation” published in 2007 or 2008], 511 were studies of cessation interventions. The other 118 were mainly studies of the prevalence of smoking cessation in whole or special populations. Of the intervention papers, 467 (91.4%) reported the effects of assisted cessation and 44 (8.6%) described the impact of unassisted cessation (Figure 1)…. Of the papers describing cessation trends, correlates, and predictors in populations, only 13 (11%) contained any data on unassisted cessation.

And although pharmaceutical industry funding of research plays a part in this, the fact that medical science tends to focus on treatments rather than on untreated individuals is unsurprising since this is fundamentally how science works.

He goes on to compare the lack of research into the spontaneous quitters to those who grapple with a mental health issue in their lives but never seek treatment.

There’s certainly value to understanding how and why some people can stop a habit on their own. But I think it has limited value when compared to most serious mental disorders. As I said, while time alone does indeed help many mild concerns, it does little for people with serious disorders, such as schizophrenia or agoraphobia.

But the real message here is one that does translate and generalize — no matter what we may eventually discover about mental disorders’ underlying cause, it would be silly and short-sighted to focus solely on pharmaceutical treatments. Mental disorders are not purely biological or neurochemical in nature — they have real associated thoughts and behaviors that don’t go away just because you take an antidepressant or other medication.

It reminds me of a time earlier in a previous century when doctors had pretty much gotten the science of amputation down and understood the need to tie off the major arteries and keep the wound clean. What the surgeons and doctors never understood was why people just didn’t go back to their normal life after that. “Here’s a crutch, now get back to work!” Understanding about the psychological effects of losing a limb took another century for physicians to appreciate and begin treating.

Mental disorders are the same way. No matter what their eventual cause, any treatment that focuses solely on a single aspect of the problem is inevitably going to miss the other aspects. For most people, a single type of treatment for most serious mental illnesses is only going to be partially effective.

So while a nicotine patch may indeed be helpful in kicking the habit, it’s often going to take more effort to break the psychological habits associated with the act of smoking. Unless you’re one of those people who can quit just like that, and never look back.

Read the full entry: Neuroskeptic: How to Stop Smoking