About the Blog Author-John R. Hughes, MD

John R. Hughes, MD is Professor of Psychiatry, Psychology and Family Practice at the University of Vermont. Dr. Hughes is board certified in Psychiatry and Addiction Psychiatry. His major focus has been clinical research on tobacco use. Dr. Hughes received the Ove Ferno Award for research in nicotine dependence and the Alton Ochsner Award Relating Smoking and Health. He is a co-founder and past president of the Society for Research on Nicotine and Tobacco, and the Association for the Treatment of Tobacco Use and Dependence. Dr. Hughes has been Chair of the Vermont Tobacco Evaluation and Review Board which oversees VT’s multi-million dollar tobacco control programs. He has over 400 publications on nicotine and other drug dependencies and is one of the world’s most cited tobacco scientist. Dr. Hughes has been a consultant on tobacco policy to the World Health Organization, the U.S. Food and Drug Administration, and the White House. His current research is on how tobacco users and marijuana users stop or reduce use on their own, novel methods to prompt quit attempts by such users, whether smoking cessation reduces reward sensitivity and whether stopping e-cigarettes causes withdrawal. Dr Hughes has received fees from companies who develop smoking cessation devices, medications and services, from governmental and academic institutions, and from public and private organizations that promote tobacco control.


  • Does the Addiction/Brain Disease Model Help or Hinder Tobacco Treatment

    I and others have often tried to decrease “cessation fatigue” by decreasing self-blame of those who have failed to quit on multiple occasions (e.g. via having smokers believe that their inability to quit may not derive from poor willpower but due to a surplus of the addiction “disease”. But is this an evidence-based strategy?
    The alcohol and illicit drug abuse treatment and research community has mostly believed that the “disease model” has been helpful. However, recent reviews suggest this may not be the case (Social Science and Medicine 96:95;...
  • Motivation vs Skill vs Dependence in Quitting Smoking

    Smokers’ perceptions about quitting are just the opposite of what science says. A recent paper (Addict Behav 53: 175-180) has replicated the conclusions of a prior review (Addiction 106:2110-2121, 2011) that commitment/motivation/willpower predict making a quit attempt but does not predict ability to remain abstinent after a quit attempt. These papers also found the opposite for dependence; i.e., dependence does not predict making a quit attempt but does predict the ability to remain abstinent. Interestingly, surveys find that the large majority of smokers (> 70%) believe motivation is both a necessary and a sufficient condition to quit smoking, and few (<35%) cite addiction as a barrier (Drug Alcohol Reviews 27:21-27, 2007). I could not find empirical data, but my impression is that also most smokers do not see stopping smoking as a skill, but rather is matter of effort; i.e., they...
  • Could Helping Smokers Plan a Quit Attempt Be Harmful

    Several experimental studies have suggested gradual cessation is, as effective but no more effective, than abrupt cessation. We completed a study in which we found that, surprisingly, smokers who wanted to quit gradually did somewhat better with abrupt than gradual. Followup studies suggested that perhaps part of the reason for this is that gradual cessation requires putting off quitting for several days or weeks and smokers may lose motivation over time. In addition, most, but not all...
  • Natural History of Quit Attempts

    I have tried not to use this blog to promote my own research, but thought I would violate that rule to show you some interesting findings. We recently completed a study having smokers who plan to quit sometime in the next 3 months call in each night to report on smoking for 3 months (NTR 16:1190‐1198, 2014). We provided no treatment.
    Below are results from some randomly selected participants. Each column represents a day of the study and each row represents a single patient. The legend defines black, grey pixels and the “I” (the white pixel represent days that no change attempts going on). So for example, in just the first half of the study, subject number 204040 reduced smoking by > 50% on day 1, then did not try to change for 5...
  • Can we predict who will quit? Does it matter?

    Vangeli et al (Addiction 106: 2110-2121, 2011) identified eight large, population based studies of smoking cessation in the real world. The surveys included both US and other countries. Six used data acquired between 2000 and 2010. These studies offer the most generalizable test of predictors of making a quit attempt or predicting success once one tries to quit.
  • Recent Survey Data on Smoking and Quitting in the US

    Two new CDC surveys (MMWR 60:1207-1211, Sept 9, 2011 and MMWR 60:1513, Nov 11, 2011) report some outcomes of interest to TTSs. The first survey reports that now, among daily smokers, 16% smoke less than 10 cigs/day. In addition, other surveys have found that 20% of smokers are non-daily smokers, so when you add the two together then about 1/3rd of smokers are light/nondaily smokers. As you know, most medications have been tested almost exclusively on smokers of > 10 cigs/day. The only study in light smokers I am aware of showed that light daily smokers benefited from NRT as much as heavier smokers (Drug Alcohol Dependence 77:311-314, 2005). Among those I have talked to, there is a significant divergence of opinion about whether to offer NRT to light smokers. Recent data suggest the biggest effect of NRT is....