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.


  • Self Control as a Finite Resource

    Although many bemoaned the lack of innovative behavioral therapies for smoking in the 1990s, recently there has been a spate of new treatments‐mindfulness, acceptance therapy, persistence therapy, etc. These new treatments have often arisen from basic psychology theories that have been validated. One of these is the “Strength Model of Self‐Control” that posits one has a limited amount of self‐control and expending self‐control in one area, depletes this resource and, thus, one has less self‐control to tackle a new problem in a different area. A meta‐analysis of 83 tests of this theory found consistent support , including studies examining smoking (Hagger, Psych Bulletin 136: 495, 2010). More recent studies have suggested this effect is due, in...
  • New Cochrane Reports on Pre-operative Treatments and Antidepressant Treatment

    A new Cochrane meta-analysis examined 13 trials of pre-operative smoking cessation treatment. Intensive treatment (e.g. 4 sessions prior to surgery plus medications) increased abstinence at the time of surgery (OR = 10.8) and long-term cessation after the surgery (OR = 3.0). Brief treatment increased abstinence slightly at the time of surgery (OR = 1.3) but not over the long term. The trials also showed intensive treatment substantially decreased the incidence of surgical complications (OR = 0.42). These results are consistent with those among other groups of smokers who have good medical reasons to stop smoking (e.g. those with COPD or pregnant) but have not done so; i.e., intensive treatments are needed. This is probably because not stopping smoking despite clear evidence it’s harming you...
  • Nicotine Replacement Therapy

    Oftentimes, surgeons recommend not using nicotine replacement therapies before or after surgery because nicotine is a vasoconstrictor; however, recent studies show that nicotine causes “angiogenesis;” i.e., increased new small arteries in tissue (that would help healing) that could outweigh the negative effects of vasoconstriction Two articles have reviewed this literature (Reuther and Brennan Br J Oral Maxillofacial Surgery ,e‐pub for 2013; Martin et al Experimental Dermatology 18: 497‐505). The second article reviews several studies and concludes “nicotine exposure enhances angiogenesis, but cannot compensate for the adverse ....
  • Is Face‐to‐Face Counseling Worth It

    In my prior entries, I have mentioned the need for studies showing that face‐to‐face counseling is worth the extra cost. Such individual treatment can never be as cost‐effective as less‐intensive treatment. In fact, in medicine there are very few cases where more intensive treatment is more cost‐effective.
    Recently, two studies have tested more vs less intensive treatment. In one study, 300 smokers in dental care were randomized to low intensity treatment (one 30 min session) or high intensity treatment (eight 40 min sessions over 4 months‐i.e. 320 min)....
  • Utility of Face-to-Face Counseling

    Many members of ATTUD provide face-to-face individual counseling. Since funding for tobacco treatment often originates from public health funding, many funders are concerned that the increased cost of such treatment is not warranted, given the known efficacy of group and phone counseling. As in many fields, the onus for burden of proof of the utility of more intensive treatment lies with those who believe such treatment is needed. One 
  • Varenicline vs. NRT

    My ATTUD blog in April (“Is Varenicline More Effective than NRT?” - now on ATTUD website) concluded that varenicline was probably more effective than single NRT but whether it was better than dual NRT was unclear. Since then a new study and a new meta-analysis on this question have appeared that you may have heard about.
    The study was a non-randomized study (Kralikova et al, Addiction, preprint available ...
  • The New DSM Criteria for Substance Use Disorder: What Does It Mean for TTSs?

    I served as a consultant on nicotine to the DSM-V Workgroup on Substance Use Disorders and thought you might like to know about how The American Psychiatric Association has pretty much decided on the new criteria for substance use disorders (www.dsm5.org). DSM-IV had two categories “Substance Dependence” and “Substance Abuse.” The former included seven criteria indexing tolerance, withdrawal and loss of control criteria. The later included four criteria indexing harm from substance use. However, since these four all indexed harm from intoxication and illegal use and since nicotine use causes neither, DSM-IV did not include Nicotine Abuse..
  • Is Varenicline More Effective than NRT?

    In several studies of varenicline vs. placebo, the magnitude of benefit from varenicline appeared to be more than that usually obtained with NRT. Only two randomized trials have directly compared varenicline with NRT. One trial was a large (n=746), well done study (Thorax 63:717) that found varenicline was more effective than standard dose NRT (26% vs. 20% at 1 yr). The other study was a small (n=32) study (Circulation Journal 74:771) that compared varenicline to high dose nicotine patch (52.5 mg initially). It found very high success rates in both conditions and no difference between varenicline ...
  • 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...
  • Efficacy of Adding Counseling to Medications for Smoking Cessation: When is Counseling Justified

    A recent Cochrane review (“Behavioral Interventions as adjuncts to pharmacotherapy for smoking cessation”, Issue 12, 2012) reviewed 38 studies found individual in-person or phone counseling of at least 4 sessions were 1.3 times higher than that with medications alone (mostly NRT) with some evidence of greater quit rates with greater intensity of treatment. In comparison, in....
  • Changing Treatment in Non-Responders

    A common practice in medicine is to monitor response to a treatment and, if it seems to be inadequate, to increase the intensity or add/change to a new treatment. What is the empirical evidence for such a strategy in treating smokers?
    Four studies have tested changing treatment in non‐responders. Two studies found no benefit. One study provided nicotine patch to all smokers (15 mg daytime patch) and randomized them to receive a second patch of 10 mg if they had not stopped smoking or were having difficulty in the first week or to receive a placebo patch (Stapleton et a Addiction 90:31‐42, 1995). The increased dosage of patch did not improve quit rates. The other study examined increasing counseling with...
  • 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.