Stop Smoking Treatment: Don’t Stop It Too Soon

Doctors may want their patients to stick with a smoking cessation regimen even if it’s not initially working, report researchers who found that “delayed quitters” accounted for a third of former smokers who went a year without cigarettes.

Quit rates may be significantly increased by just continuing in motivated but initially unsuccessful patients during the first eight weeks of treatment, according to research published online in the journal??Addiction. There’s actually two types of successful quitters: Those who quit immediately and those who are “delayed” but eventually successful.??

Researchers analyzed data from two identically designed, published studies (Gonzales et al. JAMA 2006 and Jorenby et al. JAMA 2006) conducted between June 2003 and April 2005. Participants included 2,052 healthy adult smokers who randomly received either varenicline or bupropion or a placebo for 12 weeks of treatment plus 40 weeks of follow-up. All participants received brief smoking cessation counseling at clinic visits. Investigators were blinded to the treatment assignments, and disclosed support from Pfizer and GlaxoSmith-Kline, the makers of the two drugs studied.

Successful quitters were defined as smokers who achieved continuous and absolute abstinence for the last four weeks of treatment. Among successful quitters, two groups were identified: “Immediate quitters,” smokers who quit and remained abstinent from their target quit date through the end of week 12, and “delayed quitters,” who smoked prior to attaining continuous abstinence for at least the last four weeks of treatment.

A substantial proportion of smokers who quit by the end of 12 weeks of treatment smoked in one or more weeks during the first eight weeks before achieving continuous abstinence. This was true of successful quitters treated with drugs and with placebo. Researchers described this as a previously unreported and natural pattern of quitting. Had the delayed quitters quit treatment, continuous abstinence could have been lost for up to 45 percent??of eventually successful people.

While delayed quitters did not fare quite as well as immediate quitters following the end of active treatment, they still accounted for approximately one-third of those who remained continuously abstinent at 12 months regardless of treatment group.