Do Specialists Obtain Higher Quit Rates and, If So, Why
A recent article (McDermott et al, Nicotine and Tobacco Research , advance publication) briefly reviewed four studies that found tobacco treatment specialists were associated with higher quit rates than non-specialists. Unfortunately, these were not randomized trials, but observational findings and thus the differences in specialist vs nonspecialist outcomes could be due to other factors (e.g. client characteristics). Nevertheless, this is important observational evidence to justify allocating extra resources to intensive treatment programs. Now if we could just obtain some empirical data to let us a priori know which smoker will need this more intensive treatment. The article also reported on a survey of specialists and non-specialists and found that the former a) were more likely to use abrupt cessation model, b) had longer first sessions, c) always discussed medication treatments, and d) reported more training in recent past. Importantly, that these differences accounted for the higher quit rates with specialists. In the past when we find outcome differences across therapists, we often think this is due to their charisma, empathy, and other variables that are almost impossible to teach. However, this study found that simply increasing the amount of training and providing more feedback on counseling was associated with an increase in quit rates. Interestingly, this has been difficult to show in the treatment of many psychiatric disorders, including other forms of drug dependence. As stated above this was not a randomized trial and, thus, is not conclusive. Nevertheless, these findings are good evidence that training programs and supervision do matter. And finally, along with other empirical work on the attributes of successful treatment (West et al, Nicotine Tobacco Research 12:747), these results indicate successful tobacco treatment is not a “black box” we do not understand, but is something we are getting better and better at being able to train.