Do you know what the letters ATTUD stand for? It’s Association for the Treatment of Tobacco Use and Dependence, based in the US. We are further informed from their website that:

ATTUD is an organization of providers dedicated to the promotion of and increased access to evidence-based tobacco treatment for the tobacco user.

Before we go any further let’s try to sort out the turgid and repetitive language. To start with, they should make up their minds whether they want to be called an association or an organization. Anyway, for people who are members of this august body, I think we can take it as read that they’re dedicated, so we can leave out this word. ‘Increased access to’ – again, this is implied, because presumably it’s not an arcane association with restricted access. ‘Evidence-based’ – all right, this has a nice scientific ring about it so let it stand. But ‘evidence-based tobacco treatment for the tobacco user’? They want to treat tobacco users with tobacco? It’s like treating an alcoholic with alcohol. I can only assume this word crept in here through carelessness. In any case, the phrase tobacco user is almost as coy as mental health service user for psychiatric patient. Why not say smokers? Thus, for concision we could have: ATTUD promotes evidence-based treatments for smoking cessation. But even this is difficult because if we unscramble the acronym, it would read: Association for the Treatment of Tobacco Use and Dependence promotes evidence-based treatments for smoking cessation. We’re going round in a circle.

Even in the title we have a problem. It seems they want to convey the idea that there’s a difference between tobacco use and tobacco dependence. Unless you’re using the liquid residue from boiling tobacco leaves as a weedkiller, using tobacco in the usual sense, that is, smoking, is the same thing as tobacco (nicotine) dependence.

If you want to be any good in helping people to stop smoking it’s essential to understand that smoking is synonymous with nicotine dependency. So why don’t they drop the U and call it ATTD, Association for the Treatment of Tobacco Dependency? Or ATTA, Association for the Treatment of Tobacco Addiction. Or better still, Association for the Treatment of Nicotine Addiction, ATNA?

It seems to me they need to recast the name, the subtitle, and the mission statement.

Having got that out of the way, let’s take a look at what they actually do. It would be tedious to go through their whole website but we can examine a few representative sections, picked more or less at random.

To start with, there are the core competencies for Tobacco Treatment Specialists, developed jointly by ATTUD with another organization called the Center for Tobacco Treatment Research & Training.

Under the heading Treatment Planning is the repetitively stated requirement to ‘Demonstrate the ability to develop an individualized treatment plan using evidence-based treatment strategies,’ the first of which is, ‘In collaboration with the client, identify specific and measurable treatment objectives.’

Now wait a minute. Obviously the Specialist needs to develop the treatment plan in collaboration with the client, because there wouldn’t be much point in developing it in isolation from the client. But then it gets interesting: ‘identify specific and measurable treatment objectives.’ What could these be? It seems to me there can be only one: to stop smoking!

The Specialist needs to know a lot about pharmacotherapy, which means using prescription drugs and nicotine products. There’s also the requirement to ‘Communicate the symptoms, duration, incidence and magnitude of nicotine withdrawal.’ How cheery!

Under the heading Skill Set which an aspiring ATTUD trainee needs to attain, we have the requirement:

Collaboratively develop a treatment plan that uses evidence-based strategies to assist the client in moving toward a quit attempt, and/or continued abstinence from tobacco.

Just imagine it. A client, that is, a smoker desperate enough to want to stop smoking to put himself or herself in the hands of a Tobacco Treatment Specialist, approaches such an one and says, not ‘I want to stop smoking’, but, apparently, ‘Could you please help me to move towards making a quit attempt?’ Not even making a quit attempt, mind you, but to move towards making a quit attempt!

What ATTUD seems to be unaware of is that this is playing into the hands of the large number of smokers who, whatever they may say, don’t really want to quit, or who are looking for a method of quitting that will probably fail.

I recall one smoker patient who came to me for an unrelated reason and when I offered my simple, almost guaranteed method of smoking cessation, said: ‘Thank you very much, Dr Symonds, but I don’t want to undertake your smoking cessation method because, if I did, I’m afraid I would succeed.’

As is so common with the orthodox approach to smoking cessation, ATTUD seems fixated on the idea that smoking is largely a physical problem, so the focus of treatment is on nicotine products and drugs. Further, the impression is given that clients are helpless, passive people in the grip of an affliction beyond their control, who will regularly turn up to meet the Tobacco Treatment Specialist and are the recipients of the techniques being offered, including those for the inevitable relapses. Treat smoking as a disease.

Even if for the sake of argument if we do regard smoking as a disease, the decision whether to be cured or remain afflicted is entirely in the hands of the sufferer. To be cured there are only two things the patient needs to do: 1) Stop smoking, and 2) Don’t start again. In that order.

© Gabriel Symonds