DOES BELIEF THAT ONE IS ADDICTED PROMOTE OR DETER ATTEMPTS AT ABSTINENCE?

Authors


Heim [1] takes issue with my and my co-author's ‘bold assertion’ in our editorial about offering assistance to smokers to help them stop [2] that believing one is addicted does not dissuade people from making quit attempts; but that is to misunderstand our point. It is us who were challenging the bold assertion of ‘assistance sceptics’ that believing that one is addicted deters quitting, and we presented what appears to be the only direct evidence relating to the issue to show that the assumption appears to be unfounded. We noted that, in a large representative sample of English smokers, the association went in the direction opposite to that being assumed by assistance sceptics [3]. Heim presents a range of studies which, he argues, support the position of the assistance sceptics, but these provide only indirect support for the view and require a number of other assumptions to hold true. Thus, the only study to address the question directly is the one we cite. Until we have more studies such as this, none of us will be in a position to make bold assertions of any kind. In the meantime, logic and rationality dictate that assistance sceptics strike this line of argument from their armoury.

Heim also seems to suggest that I and my colleagues are in favour of trying to make smokers believe that they are addicted. This is not the case. Our position is dictated by the following simple logic: smokers need to stop as young as possible to mitigate or avoid the harm. To achieve this they should try to stop as often as they can and use the most effective methods available to do so on every occasion. Health-care systems in civilized societies should ensure that these methods are available and promoted. The message used to promote use of effective methods of stopping simply recognizes that stopping smoking can be very difficult, but that effective help is available. If anything, one could argue that this message has not been put strongly enough because, as Heim acknowledges, the evidence is that smokers typically overestimate their chances of stopping [4]. It must also be remembered that the large majority of smokers do not manage to stop before smoking has taken years off their lives [3].

Declaration of interests

R.W. undertakes research and consultancy for, and has received travel funds and hospitality from, companies that develop and manufacture smoking cessation medications. He has a share in a patent for a novel nicotine delivery device. He is a trustee of the stop-smoking charity, QUIT. His salary and that of much of his research team is funded by Cancer Research UK. He is co-director of the NHS Centre for Smoking Cessation and Training funded by the UK Department of Health.

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