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Cold turkey 'superior' method to quit smoking

Abrupt smoking cessation led to lasting abstinence more often than gradual smoking cessation, according to research published in the Annals of Internal Medicine.

Nicola Lindson-Hawley, PhD, Nuffield Department of Primary Care Health Sciences, University of Oxford, England, and colleagues said that their findings provide evidence-based advice for physicians to encourage patients to quit abruptly.

"Conventionally, smokers are advised to quit abruptly by setting a quit day to stop smoking in one step," they wrote. "Worldwide guidelines for smoking cessation generally recommend abrupt cessation and do not support a gradual reduction in smoking; however, many smokers report stopping gradually."

Lindson-Hawley and colleagues conducted a randomized, controlled noninferiority trial of 697 adult smokers in primary care clinics in England. Participants were randomly assigned to quit abruptly or to gradually reduce smoking over 2 weeks before quitting completely. All participants received support from clinic nurses and nicotine replacements.

Results showed that 39.2% (95% CI, 34-44.4) of participants who quit gradually and 49% (95% CI, 43.8-54.2) of participants who quit abruptly were abstinent after 4 weeks (relative risk = 0.80; 95% CI, 0.66-0.93).

After 6 months, 15.5% (95% CI, 12-19.7) of participants who quit gradually and 22% (95% CI, 18-26.6) of participants who quit abruptly were abstinent (RR = 0.71; 95% CI, 0.46-0.91).

The researchers reported that participants who indicated that they preferred gradual cessation were significantly less likely to be abstinent after 4 weeks compared with participants who preferred abrupt cessation (38.3% vs. 52.2%; P = .007).

Lindson-Hawley and colleagues said that physicians should not encourage patients to quit gradually.

"However, key future developments will be finding means to retain smokers in gradual cessation programs while they reduce smoking, seeking more successful reduction methods, or finding ways of aborting reduction before participants deem it a failure and abandon their quit attempt," they wrote. "For now, however, we may 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." – by Chelsea Frajerman Pardes

Disclosures: Lindson-Hawley reports a grant from the British Heart Foundation to conduct the reported study and grants from the National Institute for Health Research outside the submitted work. Please see the full study for a list of all other authors’ relevant financial disclosures.