Here in the U.S., Thursday Nov. 17th's dawn will herald the 29th Great American Smokeout and yet another opportunity to quit smoking. But there has been a slight change since the American Cancer Society's first Smokeout in 1976. Over the past two decades the pharmaceutical industry took the liberty of redefining the word "quitting."
Instead of the Smokeout being a day to discover that life without nicotine might actually be do-able -- and the days that follow as well -- over the next week millions in marketing will be spent encouraging smokers to spend the day toying with pharmaceutical grade nicotine, otherwise known as nicotine replacement therapy or NRT - the nicotine patch, gum, lozenge and inhaler.
The sales pitch is usually two-fold. First, it will be suggested that, in the real-world, use of the nicotine patch, gum or lozenge will double a quitter's chances of quitting for good. Next, it will likely be suggested that quitting cold turkey is extremely difficult or that few cold turkey quitters succeed. Both assertions are false.
As for few cold turkey quitters succeeding, nothing could be further from the truth. The American Cancer Society's Cancer Facts and Figures 2003 report indicates that over 90% of all long-term successful quitters quit smoking cold turkey. With 46 million ex-smokers, it means that more than 40 million Americans have successfully quit smoking cold turkey.
Contrary to it being rare for cold turkey quitters to succeed, a far more accurate and honest quiiting methods representation to make during the 29th Great American Smokeout would be that cold turkey it is the cessation method used by almost all successful quitters.
As for NRT being twice as effective, it occurred only in formal clinical studies that were "allegedly" blind, where NRT product users gained odds ratio victories over a group of placebo quitters. But not when used out in the real world.
California, Minnesota, London, Quebec, Maryland, never once in any quitter survey have NRT users generated a higher six month quitting rate than those quitting entirely on their own. Never! But how can that be?
The pharmaceutical industry has known all along that nicotine is a psychoactive chemical which produces dopamine/adrenaline intoxication. It provides a deeply soothing unearned "aaahhh" dopamine reward sensation. A central nervous system stimulant, it also makes the heart pound faster, the fingers grow cold and the senses perk.
Clinical study participants were often enticed to join by being promised a 50/50 chance of receiving weeks or months of free NRT products. But half were randomly assigned to a placebo group where they were given an inert patch, gum or lozenge which was normally nicotine-free.
When quitting, every two hours the amount of nicotine remaining in the bloodstream is cut by half. Studies have shown that smokers with any significant quitting history know what it feels like to be deprived of nicotine. Is it possible to blind a study involving a psychoactive chemical like nicotine?
A June 2004 study published in Addictive Behaviors examined blinding assessments during clinical NRT studies and found that they were generally not blind as claimed, as 71% of studies assessing blindness failed their own assessment. "Subjects accurately judged treatment assignment at a rate significantly above chance."
Let's put it this way. If you were a smoker hoping to get weeks or months of free nicotine gum, would you have stuck around and allowed yourself to be toyed with by researchers if you were confident that you'd been assigned to the placebo group and your expectations of receiving free nicotine had been frustrated?
The opposite is also true. If you were confident that your expectations were fulfilled and nicotine was flowing, would you have stayed and attended the study's quitting education programs, counseling sessions, accepted regular telephone support, or attended group support (which each have their own independent quitting effectiveness), and have generally cooperated with those you knew were your ongoing source of free nicotine products?
What does it all mean? It means that America has spent two decades toying with NRT when we have absolutely no scientific evidence that NRT's clinical odds ratio victories were earned. When combined with real-world quitting survey results, it means that the pharmaceutical industry is raking in billions in profits based upon "double your chances" marketing representations that it knows to be false in the real-world, and not proven in truly blind clinical studies.
Contrary to marketing innuendo, never once in any clinical study did NRT quitters compete with quitters wanting to quit cold turkey - quitters with every expectation of abruptly ending all nicotine use.
With each cold turkey quitting attempt and failure, the odds increase that the quitter will eventually -- through the school of hard-quitting-knocks -- discover the "law of addiction" and the power of one puff of nicotine to cause full and complete relapse. Not so with NRT.
What lesson can be learned by repeat toying with the very chemical the addict is dependent upon? The pharmaceutical industry has known since 1993 that NRT success rates actually decline with repeat use.
A 1993 study examined second-time nicotine patch use, what the industry terms "recycling." In that study 0% of second-time patch users had successfully quit at six months. A second nicotine patch study was conducted in 1995 (see Table III) and in it just 1.6% of second-time nicotine patch users were still not smoking at six months. Neither the FDA nor the NRT industry have yet warned repeat nicotine patch users of this critical finding.
There is no money to be made in on-your-own quitting. Cold turkey quitting understandably has few champions. But that isn't entirely accurate. It depends upon your definition of champion. America's cold turkey quitters are over 40 million strong and all 100% nicotine-free.