Science Lesson: New Year’s Resolutions And Ways To Quit Smoking
As we near the start of a new calendar year – and the accompanying spike in smoking cessation attempts – it is a good time to consider New Year’s resolutions, vaping and other smoking cessation methods. It turns out that most methods have more in common with New Year’s resolutions than widely realized.
The value of vaping – and other low-risk alternatives like smokeless tobacco – is that consumers can continue to enjoy some of what they liked about smoking while eliminating approximately all of the health risk. They often also discover aspects of the new product that they like even better. This is exactly what many smokers would prefer, though many might not realize it yet. Sometimes these advantages are phrased with a negative spin: some consumers are “addicted” to nicotine and “cannot” give it up, and so they “need” a substitute. But such spin does not diminish the benefits, for many smokers, of cessation-via-substitution.
People who quit smoking unaided, without a substitute or a medicalized intervention, are happy to give up all aspects of smoking (though many would be happier still with a substitute and just do not realize it). Quitting unaided (or “cold turkey”) is the most common method of smoking cessation. But it requires taking a step that is at least somewhat daunting and unappealing. That is where New Year’s resolutions come in. Almost everyone who quits unaided on a particular day could have done so just as easily the day before, but did not act. Why not? Because, as with most unpleasant or difficult efforts, no time seems like the best time. One day flows into the next, and nothing makes any particular day the best day to quit smoking. After all, the harm from smoking just one more day is not that great.
Some people manage to put a positive spin on this flow of time – “no time like the present!” – and see every day as the best day to get something done. Most of us do not. So New Year’s Day serves as what is called a focal point or a focusing event. It is a day that we decide is unlike other days when it comes to changing behaviors. Other such days include birthdays, religious observances and family events. This is, of course, completely in our heads. There is nothing inherently different about those rotations of the Earth. But if we decide a day is the right time to stop putting things off, rather than being just another day that is no better than the next, then that is what it becomes.
Most smoking cessation tools are basically just ways of creating a focusing event. Attending a smoking cessation clinic or signing up to get “motivational” text messages has no medical value. At best, these programs offer a bit of tactical advice that a smoker could find with a few minutes of searching the internet. More likely, they offer nothing that she did not already know. These tools do not make someone more willing or able to quit. But they do offer focus. Someone who was willing and able to quit, but had been putting it off, will feel a bit of pressure to do it before their session’s end. These methods are glorified New Year’s resolutions. This does not mean they are worthless. Each additional day of smoking might be the day that causes a fatal disease, so forcing a focusing event rather than waiting for January has value. Yet, the success of any given focusing event should not be confused as the educational value of an intervention.
In my last university position, my colleagues and I formulated a smoking cessation intervention that would have demonstrated this. (We had no chance to actually try it.) The intervention consisted of approaching smokers and asking them for contact information, under the ruse that we merely wanted to circle back in three months and find out if they had quit smoking. We would tell subjects that we wanted to interview ex-smokers shortly after they quit, so if they happened to quit during that period we would include them.
Our hypothesis was that this alone – without any hint that we were trying to encourage them to quit and no compensation for participation – would have as much effect as smoking cessation clinics and similar interventions. There were a few bells and whistles, such as asking subjects a couple of intriguing survey questions to fix the event in their minds, and employing the most attractive and charming members of the research team for the same reason. But the only real power of the intervention was to impose a focusing event. Someone who had been contemplating stopping would act merely because of the opportunity to do an interview and tell an interested stranger “yes, I did quit!”
It is interesting to consider the rhetoric about nicotine reduction therapies (patches, gum, lozenges, etc.) in this context. The current conventional wisdom is that simply buying NRT and trying it has approximately zero benefit. This is not surprising, because NRT is marketed as causing smokers to stop wanting to smoke. But it clearly does not do this, and thus it fails everyone who buys it based on that promise. However, the conventional claim goes, NRT coupled with counseling is effective. But is it really? This might just be the New Year’s resolution effect, with the NRT itself contributing nothing. Since those who are funded to do such research are interested only in engineering evidence that their pet approaches work, we are unlikely to ever see a definitive answer. But this seems to be the most likely story.
Focusing events and product substitution – the two most effective tools for quitting smoking – do not compete with each other. They can be synergistic. If you have a smoker friend who is a promising candidate to switch to vaping, take advantage of the calendar this week. Consider suggesting that a good New Year’s resolution would be to trying vaping instead, for just one week, assuring him that he can light up again after that if he wants to. There is good reason to believe that just committing to a substitute for a week, on the basis a friendly dare or challenge, is enough to convince someone that it is a good permanent substitute. And what better time for someone to take up a friendly challenge than January 1?
Follow Dr. Phillips on Twitter