The Rubbish Way to Stop Smoking

If you were new to the piano and wanted to play Bach’s C major prelude you would need to practise. (There are a number of YouTube videos showing how to do this.) But if you decided to give up learning this wonderful piece – which would be a pity – all you would have to do is close the piano and walk away; there would be no ‘trying’ about it. It would be nonsense to talk of failing to stop playing the piano.

On the other hand, in relation to cigarettes, the concepts of ‘trying’ and ‘failing’ to stop smoking feature a great deal.

Dr Colin Mendelsohn, a ‘tobacco treatment specialist’ as he mysteriously calls himself (http://nicotinemonkey.com/?p=675), might be said to represent the mainstream medical approach to the smoking problem. He has set out his philosophy, or credo, in a published paper (Medicine Today 2011; 12(10): 35-40).

This paper is contentious from the first sentence:

Most smokers repeatedly fail to quit because they are addicted to nicotine and have lost control of their smoking behaviour.

This is either a tautology (they are addicted and have lost control of their smoking behaviour) or he implies that some people, in spite of being addicted to nicotine, are nonetheless in control of their smoking behaviour – a contradiction in terms.

The meaning of the opening phrase, ‘repeatedly fail to quit’, is obscure – or it could be taken as the defining characteristic of all smokers who repeatedly fail to quit all the time. Each cigarette stubbed out could be viewed as a quit attempt, but the attempt fails because it’s followed by another cigarette.

On his website (http://colinmendelsohn.com.au/posts/cold-turkey-effective-way-quit-smoking/) Dr Mendelsohn says:

We often hear that many smokers quit ‘cold turkey’ (without professional advice or support) and that this must therefore be the most effective way to quit. Of course this is rubbish! Research clearly shows that using willpower alone is the least successful method for quitting smoking. (Emphasis added.)

In support of the last sentence he cites a paper in the journal Nicotine and Tobacco Research (https://doi.org/10.1093/ntr/nts164) with the presumably humorous title, ‘The Most “Successful” Method for Failing to Quit Smoking is Unassisted Cessation’. The three authors of this paper, one of whom is the self-styled world expert on smoking and addiction, Professor Robert West, take issue with the claim that ‘unaided quit attempts are effective because many former smokers report to have quit without help’, adding that ‘This argument is based on a logical fallacy, which ought to be obvious, but clearly it is not.’

They then try to explain what they mean by this curious last sentence:

…the most popular method used by people who failed to quit smoking was unassisted cessation. To put it another way, the ‘most successful’ method for failing to quit smoking is to use willpower alone. What does this tell us about the best way to try to quit? Nothing.

The charge of logical fallaciousness applies to these authors rather than to those who conclude that their research shows unassisted quitting is the best way to stop smoking. Here’s why: to talk of a ‘method’ of failing to stop doing something is meaningless – you simply carry on doing whatever it was. Also, on what grounds do they assume that the alternative to assisted cessation is willpower? What about smokers who just get fed up with smoking and decide they are not going to do it anymore? You don’t need willpower to refrain from something you don’t want to do!

They continue:

The problem…is that effectiveness cannot be inferred from the number of individuals using a specific method to achieve a goal only amongst those who have already achieved that goal.

But this is just what can be inferred from taking a random sample of former smokers and asking how they stopped. In a paper of the sort so condescendingly criticised by the world expert on smoking and addiction and his colleagues, there appears this encouraging conclusion:

Research shows that two-thirds to three-quarters of ex-smokers stop unaided.

(Interested readers can find it at http://dx.doi.org/10.1371/journal.pmed.1000216. It’s called The Global Research Neglect of Unassisted Smoking Cessation: Causes and Consequences by Simon Chapman and Ross MacKenzie, February 2010.)

The concept of a ‘quit attempt’ is hollow and pointless. If a smoker has stopped smoking and has no intention of starting again, that is someone who has successfully quit – not someone who has made a successful quit attempt. Even the word ‘successful’ in this context is redundant. If we allow it, however, then what is an unsuccessful attempt? The idea of attempting to stop smoking is an excuse that the smoker has handed to him on an plate, or rather on an ashtray, to indulge his unwillingness to quit: he’s trying, so that’s all right then. And in the meantime – which often means a long time – he carries on smoking!

Our world expert mentioned above even goes so far as to say in a book he wrote (see review http://nicotinemonkey.com/?p=75) that if you don’t stop smoking ‘you have not failed – there is no such thing as failure when it comes to trying to stop smoking.’ Really? All smokers could be considered as having failed to stop. Similarly, we could well say there is no such thing as ‘trying to stop smoking’. Those who stop, have stopped; those who are trying to stop, smoke.

If the experts don’t like this way of looking at it, would they please tell me what is the definition of a quit attempt? Is it the same as not smoking for a certain length of time? If so, how long and why? Such a criterion would be arbitrary. Suppose a smoker has ‘attempted’ to quit and manages not to smoke for a year, but the next day she starts smoking again. Does this mean the attempt has failed? Using the length of time of non-smoking as the criterion for successful quitting, therefore, means one would have to follow-up ex-smokers until they died, but this would be rather impractical.

I have pointed out before that when smokers say they are trying to quit, this is not the expression of a wish to stop smoking, but a statement of their intention to continue.

Therefore the concept of a ‘quit attempt’ in relation to smoking is unhelpful and should be abandoned.

Text © Gabriel Symonds

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