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.

News

  • Repeat quit attempts: Use new therapy or old therapy?

    Most smokers who seek individual treatment for smoking cessation have tried to quit in the past and many have already used a behavioral or pharmacological treatment. Assessing why past treatments were used, compliance and perceived benefit of the prior treatment is recommended in most treatment guidelines. However, whether it is best to repeat old treatments or use new treatments is unclear. Several studies have examined re-treatment with the same medication (i.e., recycling)...
  • Choosing a Counseling Therapy

    fter many years of stagnation in improving counseling approaches for helping smokers stop, we have several new counseling treatments. Most prominent are a) Motivational Interviewing, b) Reduction in cigarettes/day, c) Mindfulness Therapy, and Acceptance and Commitment Therapy. Randomized trials show that MI (Cochrane Review, 2015) and reduction in cigarettes/day (Cochrane Review, 2015) both increase quitting among those not ready to quit, and also among those already trying to quit (although there is...
  • Recent Data on Quitting Smoking in the US

    A recent CDC report (MMWR 65:1457) reports that the incidence of at least one quit attempt/yr has increased from 50% to 55%. That may sound encouraging but that also means that, despite stigmatization, taxes, smoking restrictions, free treatment in most states, almost half of smokers tried to stop. In addition, the CDC reports that 32% of smokers say they are not at all interested in quitting. Also only 31% used a treatment when they tried to quit and only 5% used....
  • Blog on Hardening

    As many of you know, I have been enamored of the hardening hypothesis (in terms of ability to quit on a given attempt). However, attached is what I think is the best test of that hypothesis from Robert West’s Smoking Tool Kit and clearly it is refuting it. Also, the CA survey has found similar results. So, I am abandoning the hardening hypothesis in terms of the general population. However, I must say the logic around the hardening hypothesis (social pressure...
  • How many attempts does it take to quit?

    We have all been asked “how many times does it take to quit smoking, on average?” I, myself, think this is a silly question. When I am asked this, I ask “why do you want to know.” What I hear is that smokers want to know whether they are abnormal in taking many attempts and should give up and clinicians want to know when to stop “nagging” smokers to quit....
  • Gradual Reduction for Smoking Cessation

    A recent randomized trial (Annals Int Med, epublication) found that, among smokers trying to quit, gradual cessation was inferior to abrupt cessation (6 month prolonged abstinence = 15% vs 22%) and this occurred even in smokers who preferred gradual reduction. This study was replication of our earlier trial (Drug Alcohol Dependence 111:105–113) that was more externally and internally valid and have more clear-cut results than our trial.....
  • Psychiatric co‐morbidity with smoking is increasing over time

    Smokers with a history of a psychiatric disorder are less likely to stop smoking than those without this history. In addition, whenever a society stigmatizes a behavior and makes it more deviant, then those who, nevertheless, take up or continue the behavior are more likely to have psychiatric comorbidity. As a result of these two phenomena, the association of smoking and psychiatric disorders should be increasing over time. Four articles have tested this notion. Two articles.....
  • Changing Multiple Behaviors Simultaneously vs Sequentially

    In two prior blogs I described the theory and evidence that self‐control is like a muscle in that one has a limited amount of self‐control and using that up on one task can make it harder to be successful at another self‐control task (Self‐control as a Finite Resource 5/20/14). But on the other hand training one’s self in unrelated self‐control tasks can improve self‐control on a later task (Building the Self‐Control Muscle, 2/26/16)....
  • Building the Self‐Control Muscle

    An earlier blog (Self‐Control as a Finite Resource, wwww.attud.org) discussed research that found practicing self‐control on Task A makes it harder to exert self‐control on Task B (Psychol Bulletin 136:495, 2010). In that blog I suggested this results implies that when trying to stop smoking, you should not try to also diet, exercise more, etc.
    However, other research presents a slightly different picture (Psychol Addict Behav 24:446, 2010). This study had smokers either repeatedly practice small acts of self‐control (avoiding sweets, holding handgrip as long as possible) or non‐self‐control tasks (math problems, keeping a diary) for 2 weeks prior to trying....
  • Results of Recent Cochrane Review on Efficacy of Different Tobacco Dependence Treatments

    The Tobacco Addiction Group of Cochrane (of which I am a member) published six new or revised meta-analyses of treatments for tobacco dependence. I am a big fan of the Cohrane reviews because they are all done using the same methods, usually locate all the available trials, and use rigorous methods.
    An updated review of motivational interviewing (MI) located 28 studies and found MI moderately increased cessation by 1.3 fold compared to brief advice....
  • Do We Need Tobacco Treatment Specialists?

    In the past blogs I have reviewed the evidence whether treatment from a trained TTS produces higher quit rates than from a less-intensive non-TTS therapy. The Cochrane review of this question examined 5 RCTs and stated “We failed to detect a greater effect of intensive counselling compared to brief counselling (5 trials, RR 0.96, 95% CI 0.74 to 1.25).” However, my earlier journal club article pointed out several observational trials that found trained TTS achieves a higher quit rate...
  • 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...