Seventy percent of smokers are ready to quit at any time and more than one-half report attempting to quit smoking each year. We know that the combination of behavioral counseling and pharmacotherapy works well for helping people quit smoking.
Nicotine replacement therapy (NRT) when used in combination with behavioral therapy can double the odds of quitting.
However, only 10% of individuals who try to quit smoking use nicotine replacement as a cessation aid. If the treatment is so effective, why do so few people use it?
Accumulating evidence suggests that expectations influence treatment outcomes in patients with various medical conditions. Some of this may be mediated by adherence. That is, if we have negative expectations of a treatment, we may not keep taking it (i.e., adherence) resulting in the treatment not working.
It makes sense that attitudes toward a treatment impact its use; but, do we know this in the context of quitting tobacco? If we were to find this true, might it be important to consider our attitude toward treatment in deciding whether or not to embrace it?
Taking this a step further, if we do not have a positive attitude about NRT, should we even consider taking it at all even though everybody is telling us that we should?
In a study of 74 individuals who received NRT to quit smoking, researchers asked the question of whether attitudes about NRT impacted adherence to NRT (Kim SS, et al. Predictors of Nicotine Replacement Therapy Adherence: Mixed-Methods Research With a Convergent Parallel Design. Ann Behav Med. 2024 Mar 12;58(4):275-285. PMID: 38401531; PMCID: PMC10928836). They also asked the question of whether mood or anxiety impacted adherence to NRT.
The investigators learned that having a negative attitude toward NRT, as well as depressive symptoms, reduced NRT adherence. They also discovered that the attainment of any information needed, the readiness to comprehend that information, and experiential learning can contribute to the process of adherence.
So, what should we do with this information?
We have known for a while that patients who purchase NRT from the pharmacy, on their own without counseling, have worse smoking cessation outcomes than those who never use it at all.
This is likely related to expectancies and adherence, which are related and low, when not engaged in smoking cessation counseling as well.
Perhaps we should reflect on our attitudes before we think about embracing NRT for smoking cessation. Maybe there are things we need to learn or understand about the product or ourselves before we take it. Maybe we need to establish a level of readiness along with a “beginner’s mindset” of experimentation.
In summary, if we accept that a treatment only works if we take it, then we also accept that we should only take treatment if we do not have a negative attitude about it.
