The effects of smoking schedules on cessation outcome: can we improve on common methods of gradual and abrupt nicotine withdrawal? Smoking cessation--gradual or sudden stopping? Format and quitting instructions as factors influencing the impact of a self-administered quit smoking program. Nicotine gum treatment before smoking cessation: a randomized trial. A comparison of alternative theoretical approaches to smoking cessation and relapse. A randomized, controlled trial of NRT-aided gradual vs. abrupt cessation in smokers actively trying to quit.
This study compared the efficacy of 2 traditional methods of smoking cessation, gradual reduction and "cold turkey," with a new approach involving variation in the intercigarette interval. One hundred twenty-eight participants quit smoking on a target date, after a 3-week period of (a) scheduled reduced smoking (progressive increase in the intercigarette interval), (b) nonscheduled reduced smoking (gradual reduction, no specific change in the intercigarette interval), (c) scheduled nonreduced smoking (fixed intercigarette interval, no reductions in frequency), or (c) nonscheduled nonreduced smoking (no change in intercigarette interval or smoking frequency). Participants also received cognitive-behavioral relapse prevention training. Abstinence at 1 year averaged 44%, 18%, 32%, and 22% for the 4 groups, respectively. Overall, the scheduled reduced group performed the best and the nonscheduled reduced group performed the worst. Both scheduled groups performed better than nonscheduled ones. Scheduled reduced smoking was associated with reduced tension, fatigue, urges to smoke, withdrawal symptoms, increased coping effort (ratio of coping behavior to urges), and self-efficacy, suggesting an improved adaptation to nonsmoking and reduced vulnerability to relapse. One hundred ten patients addicted to nicotine were subjected to either sudden or gradual withdrawal in the course of a smoking cessation programme. Eighty-two patients emerged from the treatment as non-smokers. In a follow-up after 1 year 70% of these successful clients replied to an anonymous questionnaire. Concerning the relapse rate, no significant difference could be found between the two treatment groups, but patients who underwent slow withdrawal smoked significantly less when comparing their current consumption with that before the start of the therapy. Patients who underwent sudden stopping reached their original level of nicotine use again. This article presents results from an experimental study designed to evaluate the effects of two features of self-help smoking cessation booklets, format (i.e., day-by-day plan for quitting versus a less structured menu format) and quitting instructions (i.e., "cold turkey" versus gradual reduction) on smoking cessation. Four separate self-help booklets were developed for comparison in this study. Each varied on a combination of the two study factors, but were similar in content, length, style, and readability. The four booklets provided similar advice on how to quit smoking, emphasizing behavioral self-management principles. In addition to the experimental booklets, a fifth control booklet provided general information about smoking and its adverse effects, but no specific advice on quitting. Study subjects included 1,534 adult cigarette smokers who called a stop smoking hotline in Buffalo, New York seeking information on how to quit. Subjects were followed up by phone one month and six months after enrollment to assess changes in smoking behavior. Overall, 18% of subjects reported of being off cigarettes for at least one week at the time of the six month follow-up interview. The format of the booklet and quitting instructions had no effect on smoking cessation rates. In addition, the four booklets emphasizing behavioral self-management skills were no more effective than the control booklet (6 month non-smoking prevalence rate: 17% versus 19%). It is recommended that future self-help quit smoking booklets include information aimed at motivating cessation and focus less attention on teaching strategies for quitting. New ways of improving the efficacy of nicotine therapy need to be explored. We tested whether starting nicotine polacrilex gum treatment 4 weeks before the quit date improved smoking abstinence rates compared with starting treatment on the quit date.
                An open randomized trial of 314 daily smokers (mean, 23.7 cigarettes/d) enrolled through the Internet and by physicians in Switzerland from November 2005 to January 2007. In the precessation treatment group, participants received nicotine polacrilex gum (4 mg, unflavored) by mail for 4 weeks before and 8 weeks after their target quit date, and they were instructed to decrease their cigarette consumption by half before quitting. In the usual care group, participants received the same nicotine gum for 8 weeks after their quit date and were instructed to quit abruptly. Instructions were limited to a booklet sent by mail and access to a smoking cessation Web site. Results are expressed as self-reported abstinence rates at the end of treatment and as biochemically verified smoking abstinence (cotinine plus carbon monoxide) after 12 months.
                Eight weeks after the target quit date, self-reported 4-week abstinence rates were 41.6% in the precessation treatment group and 44.4% in the usual care group (P = .61). One year after the target quit date, biochemically verified 4-week smoking abstinence rates were 20.8% in the precessation treatment group and 19.4% in the usual care group (P = .76).
                Starting nicotine gum treatment 4 weeks before the target quit date was no more effective than starting treatment on the quit date. Two theoretical approaches to smoking cessation were compared. Participants were randomly assigned either to (a) a traditional treatment program that used contingency contracting and that emphasized the necessity for absolute abstinence (AA) or to (b) a relapse-prevention (RP) treatment that focused on gradual acquisition of nonsmoking skills. It was hypothesized that participants in the RP treatment would be less successful initially but would have better maintenance skills and thus would relapse less during a 1-year follow-up period. Each program was evaluated in two formats: group-based treatment and self-help materials. Results indicated comparable 1-year abstinence rates for all treatments, although more participants dropped out of the self-help formats. Participants in the RP intervention were more likely to lapse sooner after quitting and were more likely to quit again during the 1-year maintenance period. Exploratory analyses of successful participants suggested that women were more successful in the RP program and that men had greater success with the AA approach. Most smoking cessation programs advise abrupt rather than gradual cessation. We conducted a randomized, controlled trial of gradual cessation (n=297) vs. abrupt cessation (n=299) vs. minimal treatment (n=150) among smokers who wanted to quit now and preferred to quit gradually. Participants were recruited via newspaper and radio advertisements. The gradual and abrupt conditions received five phone calls (total=90 min) and the minimal treatment condition received two calls (25 min total). The gradual condition received nicotine lozenge (via mail) to reduce smoking prior to their quit date. After the quit day, all participants received lozenge. The primary outcome was prolonged abstinence from 2 weeks post-quit day through 6 months. Prior to the quit day, the gradual condition decreased cigarettes/day by 54%, whereas the other two conditions decreased by 1% and 5%. Prolonged abstinence rates (CO<10 ppm) did not differ among gradual, abrupt and minimal treatment conditions (4%, 7% and 5%), nor did 7-day point prevalence rates (7%, 11% and 11%). Fewer smokers in the gradual condition (48%) made a quit attempt than in the abrupt (64%) or minimal (60%) conditions (p<.001). In the gradual condition, every week delay to the quit date increased the probability of lapsing by 19% (p<.001). We conclude that among smokers who want to stop gradually in the near future, gradual cessation with nicotine pre-treatment does not produce higher quit rates than abrupt cessation. One liability of gradual reduction may be that it allows smokers to delay their quit date.
                Copyright 2010 Elsevier Ireland Ltd. All rights reserved.
Reducing cigarettes smoked before quit day and quitting abruptly, with no prior reduction, produced comparable quit rates, therefore patients can be given the choice to quit in either of these ways. Reduction interventions can be carried out using self-help materials or aided by behavioural support, and can be carried out with the aid of pre-quit NRT. Further research needs to investigate which method of reduction before quitting is the most effective, and which categories of smokers benefit the most from each method, to inform future policy and intervention development.