Head To Head

Should smokers be advised to cut down as well as quit?

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g2787 (Published 19 May 2014) Cite this as: BMJ 2014;348:g2787
  1. Paul Aveyard, professor of behavioural medicine1,
  2. Nicola Lindson-Hawley, research fellow1,
  3. Gerard Hastings, professor234,
  4. Marisa de Andrade, impact fellow2
  1. 1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG
  2. 2Stirling University, Stirling, UK
  3. 3Open University, UK
  4. 4L’École des Hautes Etudes en Santé Publique, France
  1. Correspondence to: P Aveyard paul.aveyard{at}phc.ox.ac.uk, G Hastings gerard.hastings{at}stir.ac.uk

Paul Aveyard and Nicola Lindson-Hawley say that reducing smoking is a worthwhile step towards cessation, but Gerard Hastings and Marisa de Andrade argue that the lifelong nicotine replacement therapy being recommended in support may benefit industry more than public health

Yes—Paul Aveyard and Nicola Lindson-Hawley

Currently, more than half of all smokers in England are trying to reduce the number of cigarettes that they smoke.1 It seems perverse to discourage this positive behavioural change, but is it useful to encourage more smokers to cut down and to support those who do? We believe that it is.

Cutting down aids quitting

People who are cutting down are more likely to attempt to quit and to succeed than are those who are not cutting down.2 This may be down to motivation to stop. People who are not cutting down are probably less motivated to stop than people who are. However, even when we take every possible step to adjust for differences in motivation, people who are cutting down are more likely to make a future quit attempt than people who are not.3 There are some good reasons why reduction might promote cessation. Nicotine addiction leads to neuroadaptation, and cutting down on smoking might reverse some of this, leading to less craving and withdrawal after stopping—the primary drivers of relapse.4 Reduction may weaken the conditioned response created by smoking, making relapse less likely to be triggered by exposure to cues to smoke after quitting. In addition, reduction is more similar than abstinence to the smoker’s current behaviour, and this could increase smokers’ confidence that they might succeed.

However, despite showing that reducers are more likely to quit than non-reducers, the evidence shows that people are not very successful at cutting down, with reducers smoking only about two cigarettes a day fewer than non-reducers.5 Teaching people methods to …

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