Intended for healthcare professionals


“Catastrophic” pathways to smoking cessation: findings from national survey

BMJ 2006; 332 doi: (Published 23 February 2006) Cite this as: BMJ 2006;332:458

Setting Quit Dates

Below is a short commentary  I wrote in February of 2004 at an online
quit smoking forum I was co-managing.  I wrote it for both members of the
online support group and visitors reading at the site. I was trying to
pass along an observation that I realized decades ago when I first started
talking to people who were quitting smoking. I was trying to encourage
them to survey people who had stopped and were now long-term ex-smokers. I
have worked with and talked extensively with over forty five hundred
smokers since conducting my first clinics in the mid 1970's. I have also
encouraged all of those people to talk to all of the ex-smokers they ever
knew. In all that time I have never heard any of them come back saying
that the results they came up with varied differently with what I had

Here again is the piece I wrote in 2004 for an online quitting
support group.  I feel that this survey and the ensuing discussion ties
very well in with this piece:

Setting quit dates

Conventional wisdom in smoking cessation circles says that people
should make plans and preparations for some unspecified future time to
quit. Most people think that when others quit smoking that they must have
put a lot of time into preparations and planning, setting quit dates and
following stringent protocols until the magic day arrives.

When it comes down to it, this kind of action plan is rarely seen in
real world quitters. I emphasize the term real world quitters as opposed
to people quitting in the virtual world of the Internet. People who seek
out and participate in Internet sites do at times spend an inordinate
amount of time reading and planning about their quits before taking the
plunge. Even at our site we see people say they were reading here for
weeks or months before finally quitting and joining up. Although I suspect
there are a fair number of people who had already decided to quit right
away and searched us out after their quit had begun, and some people who
may not have actually decided to quit but who when finding and
seeing cigarettes for what they are decided then and there to start their

Getting back to real world experience though, the best people to talk
to when it comes to quitting smoking are those who have successfully quit
and have successfully stayed off for a significant period of time. These
are people who have proven that their technique in quitting was viable
considering they have quit and they are still smoke free. Talk to everyone
you know who is off all nicotine for a year or longer and find out how
they initially quit smoking. You will be amazed at the consistency of the
answer you get if you perform that little survey.

People are going to pretty much fall into one of three categories of
stories. They are:

People who awoke one day and were suddenly sick and tired of smoking.
They tossed them that day and never looked back.

People who get sick. Not smoking sick, meaning some kind of
catastrophic smoking induced illness. Just people who get a cold or a flu
and feel miserable. They feel too sick to smoke, they may feel too sick to
eat. They are down with the infection for two or three days, start to get
better and then realize that they have a few days down without smoking and
decide to try to keep it going. Again, they never look back and stuck with
their new commitment.

People who leave a doctors office who have been given an ultimatum.
Quit smoking or drop dead--it's your choice. These are people for whom
some sort of problem has been identified by their doctors, who lay out in
no uncertain terms that the person's life is at risk now if they do not
quit smoking.

All of these stories share one thing in common--the technique that
people use to quit. They simply quit smoking one day. The reasons they
quit varied but the technique they used was basically the same. If you
examine each of the three scenarios you will also see that none of them
lend themselves to long-term planning--they are spur of the moment
decisions elicited by some external circumstance.

I really do encourage all people to do this survey, talking to long-
term ex-smokers in their real world, people who they knew when they were
smokers, who they knew when they quit and who they still know as ex-
smokers. The more people do this the more obvious it will become how
people quit smoking and how people stay off of smoking. Again, people quit
smoking by simply quitting smoking and people stay off of smoking by
simply knowing that to stay smoke free that they must never take another


I really do encourage all medical professionals to conduct this
survey, talking to your long term ex-smoking patients, colleagues,
family  members and friends. People who you knew when they were smokers,
who you knew when they were quitting and who you still know as being
successful long-term ex-smokers. The more people that medical
professionals talk to, the more obvious it will become to them how people
quit smoking and how people stay off of smoking. Again, people quit
smoking by simply quitting smoking.

I don't believe that there is a single professional smoking cessation
"plan your quit" advocate who will suggest other medical
professionals should take a similar survey. For if they did their study
results would almost certainly be called into question when the health
care professional starts seeing the results of his or her real life
survey. The experts will end up having to spend quite a bit of time trying
to explain away the discrepancy, using rationalizations like the people
who planned their quit "didn't do it right" or didn't "plan" long enough
or were "just more addicted smokers." 

I see that one of the authors of this study and a few other
commentators who clearly have ties to pharmaceutical interests have tried
to link this survey results to the need to recommend pharmaceutical
interventions. As long as I am asking all health care professionals to
survey their own patients and others who they associate with as to the
kind of planning they had done to quit, I suggest that all health care
professionals go the extra step and find out how many of the successful
long-term ex-users* of nicotine actually used pharmaceutical products to
quit. They will likely find that most of the long-term successful ex-
users* that they survey will not have used any of these products in the
quit that actually succeeded. Tying pharmaceutical intervention
recommendations to the results of surveys showing that spontaneously
quitters as being more successful seems totally unwarranted and I suspect
that all health care professionals who conduct their own surveys will also
come to this very obvious conclusion.

*Long-term ex-user being defined as an individual who has not used
any nicotine from any source for at least a year or longer.

Joel Spitzer has over 30 years of experience in the development and
implementation of smoking cessation programs for adults and smoking
prevention programs for children in the Chicagoland area. While with the
American Cancer Society (Chicago Unit, Illinois Division)and the Rush
North Shore Medical Center and now for the Evanston and Skokie Illinois
Health Departments he has conducted over 350 stop smoking clinics with
over 4,500 participants. He has also presented over 570 educational
seminars to over 90,000 children and adults on smoking prevention.

Competing interests:
Educational Director of, the Internet's leading abrupt nicotine cessation resource.

Competing interests: No competing interests

07 February 2006
Joel Spitzer
Health Educator
Conduct Stop Smoking Clinics for the Evanston and the Skokie Illinois Health Departments 60201,60076