Abrupt smoking cessation is the most effective way, research suggests

Smokers who quit ‘cold turkey’ are more likely to stop longer term compared to those who give up gradually, a study has found. 

Researchers randomised 697 smokers who wanted to give up into two groups; all smoked at least 15 cigarettes a day, used 12.5g of loose tobacco or had a carbon monoxide respiratory concentration of 15 parts per million. 

The 355 smokers assigned to the ‘cold turkey’ group chose a quit day and give up smoking abruptly from that date. The second group of 342 smokers selected a day to quit and cut their smoking down gradually by 75% in the two preceding weeks. 

The gradual cessation group was given short acting nicotine replacement therapy (NRT) and nicotine patches before their quit day, whereas the abrupt group was given only nicotine patches. Both groups received counselling from a smoking cessation nurse and were given nicotine patches and short-acting NRT after quit day. 

The researchers, led by Nicola Lindson-Hawley from the UK Centre for Tobacco and Alcohol Studies at the University of Nottingham, looked at the quit rates of both groups at four weeks and at six months and found that smokers in the abrupt group were 25% more likely to stop smoking overall, regardless of whether they originally expressed a preference for quitting abruptly or gradually. 

Writing their findings in the Annals of Internal Medicine
^[1]
(online, 15 March 2016), the researchers say: “Quitting smoking abruptly is more likely to lead to lasting abstinence than cutting down first, even for smokers who initially prefer to quite by gradual reduction.”

At four weeks, 39.2% (95% confidence interval [CI], 34.0%–44.4%) of smokers who quit gradually were still not smoking, compared with 49.0% (CI, 43.8%–54.2%) of smokers in the abrupt group (relative risk, 0.80 [CI, 0.66 to 0.93]). At six months 15.5% (CI, 12.0% to 19.7%) of smokers in the gradual group were abstinent compared with 22.0% (CI, 18.0% to 26.6%) in the abrupt group (relative risk, 0.71 [CI, 0.46 to 0.91]).

The researchers also found that smokers who preferred gradual cessation were significantly less likely to be abstinent at four weeks than those who preferred abrupt cessation (38.3% vs. 52.2%; P=0.007).

“We found clear evidence that quitting abruptly was superior in the short and longer term,” they add. “Adherence to behavioural instructions and prequit NRT was good, and medication was well-tolerated. Participants who preferred to quit gradually were less likely to achieve abstinence, regardless of how they were allocated to quit.” 

The researchers conclude that supporting gradual cessation may be a useful way to increase cessation in the population, but abrupt quitting is the more effective method — even in persons who prefer not to. 

An accompanying editorial^[2]
by Gabriela Ferreira and Michael Steinberg from the Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey, says the results “call into question whether clinicians should encourage the practice of gradual reduction before a quit date in smokers who are ready to quit, including those who prefer reduction as a treatment strategy”. 

In England and Wales, guidance from the National Institute for Health and Care Excellence (NICE) – recommends that smokers should quit in one step. 

However, it does acknowledge that some smokers may not be ready or able to go ‘cold turkey’ and recommends a harm reduction approach which includes cutting down before quitting, reducing the number of cigarettes smoked or quitting temporarily. 

A spokesperson for NICE confirmed the guidelines are reviewed regularly and it takes account of any new evidence.