Chapter 13

Searching for Help in All the Wrong Places

IN THIS CHAPTER

Bullet Knowing what doesn’t work for smoking cessation

Bullet Understanding how not to get suckered

Everyone wants to discover the latest and greatest, best, easiest, and cheapest way to quit smoking. People who’ve tried a variety of approaches numerous times, but ultimately failed, are particularly motivated to search high and far for something new and easy. And almost anything will work for some people, sometimes, somewhere, somehow.

Why should we want to stop you from this quest even if it’s a bit quixotic? Afterall, maybe you really can find something that works for you! Maybe you will and, if you do, that’s great.

But we suggest that you pause first. It’s all too easy to find new, interesting possibilities. But these can cost you both time and money (anywhere from a little to a lot). Sorry, for the vast majority of smokers, quitting isn’t quick or easy. Throughout this book, we give you science-based, insurance-covered, free or usually low-cost methods of quitting. Try those first; then try them again. If none of the techniques we describe works, you may want to try an alternative approach — but please watch your wallet!

In this chapter, we review some of what are called complementary or alternative strategies for quitting smoking. We also throw in some of what we think are pretty kooky or downright scams. We tell you which are which and what to look out for when you’re considering alternatives.

Tip Some alternative strategies involve an element of helping you relax, whether that’s with an herbal supplement or with hypnosis or massage. When you’re really relaxed, you’re unlikely to have an urge to smoke at a high intensity. So, for that moment, the alternative strategy may help you resist. However, the minute the relaxation goes away, the smoking urge returns. So, strategies that focus on relaxation alone are only temporary and incomplete. But as part of a quit-smoking package, they may have some value.

Surveying the Scene

This section covers a variety of quit-smoking approaches. These approaches range from interesting to wishful thinking to pure scams. You need to know how well strategies work so you can make informed judgments.

Taking dietary supplements

Eating the right foods and getting the right nutrients always make sense when addressing any health concerns. We’re all for eating healthy, especially when you’re stressed by trying to quit smoking. But, as of now, there’s very limited evidence that any particular diet or supplement by itself will help you quit smoking. Here are some you may hear about and our thoughts on each:

  • Sam-E is a supplement that has sometimes been suggested as a way to treat depression, anxiety, pain, and smoking urges. It’s formed naturally in the body. It has not been found to be effective in limited studies as a smoking cessation aid. It can also interact badly with some antidepressant medications. Never take Sam-E without talking to your doctor.
  • St. John’s Wort is another supplement that’s been recommended for smoking cessation but found to be ineffective. It can interact badly with antidepressants and a wide variety of other medications (including hormonal birth control). Because of these multiple interactions and lack of effectiveness, we recommend you not try St. John’s Wort in your smoking cessation plan.
  • Lobelia is a plant used to produce medicine. It has been used for breathing disorders, bronchitis, asthma, shortness of breath, and relaxation. Although it has been used as a smoking-cessation aid, there is little evidence that it works. Furthermore, it can be toxic or even fatal at high doses. The U.S. Food and Drug Administration (FDA) prohibits the inclusion of lobelia in smoking cessation products.
  • L-tryptophan is an essential amino acid. It’s commonly used for treating depression, anxiety, premenstrual syndrome, and insomnia. There is limited evidence that L-tryptophan can boost efficacy of conventional stop-smoking therapies and, other than drowsiness, there are very few side effects. There is insufficient evidence to support L-tryptophan as a stand-alone smoking-cessation treatment.

Technical stuff There is one exception: cytisine, which has been used in Eastern and Central Europe for many years for smoking cessation. This supplement is now nearing completion of drug trials in the United States. Preliminary evidence is promising.

Warning Watch out for crazy claims about supplements touted as smoking-cessation aids. One company that advertised on television, radio, and the Internet had to pay over a million dollars in damages. It had claimed elimination of all cravings; the absence of any side effects; and effortless, permanent smoking cessation. This astounding outcome was allegedly accomplished with dietary supplements, vitamins, and herbs.

Warning Promotions of various dietary supplements, herbs, and vitamin formulations abound on the Internet. Be skeptical.

Getting hypnotized

Hypnosis is rather difficult to define reliably, and it’s hard to determine whether someone is truly in a hypnotized state. Nonetheless, hypnotherapists generally define hypnosis as involving an altered state of consciousness, an increased susceptibility to suggestion, and reduced awareness of surroundings. There is scant current literature on the effectiveness of hypnosis as an aid for smoking reduction.

The limited data that exists suggests that hypnosis is not an especially effective method for helping people to quit smoking. However, some people claim it has worked for them. For that matter, some people say that jumping up and down while clucking like a chicken helps.

To be fair, there is some limited, mixed data that supports a possible slight therapeutic effect from hypnosis, but that’s it. If you want to try hypnosis, don’t pay a lot of money for prolonged treatment. Ask your primary care provider for a recommendation of a licensed mental health or licensed hypnotherapy practitioner. The hypnotherapy field has sometimes attracted poorly trained charlatans, so be careful.

Even if your doctor doesn’t recommend hypnotherapy and you’ve tried lots of other approaches, it may be worth taking a shot. David successfully quit with hypnosis after trying nicotine replacement, medication, and the cold-turkey approach (see the nearby sidebar).

Remember Hypnotherapy, in almost all cases should not be your first choice. What catches most people’s attention is the promise of an easy, painless, fast method of quitting. If that really worked, there would be long waiting lines outside the local hypnotherapists’ offices. There aren’t.

Tip Hypnosis, relaxation training, mindfulness, guided imagery, yoga, and meditation all share a few elements such as helping you learn to focus and relax. Therefore, they may help you deal with uncomfortable urges. These practices may have some value as part of an overall smoking-cessation intervention as opposed to stand-alone treatments.

Competing for dollars

A long, time-honored approach to increasing people’s motivation is to set up competitive challenges. The Quit and Win program was developed in the 1980s by the Minnesota Heart Health Program. Competitions have taken place across local groups, college campuses, cities, states, and nations.

The premise of Quit and Win is to sign up and pledge to quit smoking for a specified period of time in order to be eligible for prizes including cash. Although these Quit and Win contests continue to be held, the research on effectiveness for smoking cessation has been weak. This approach seems to result in slightly greater initial quit rates, but little is known about the long-term effectiveness. Less than one smoker out of 500 quits due to participation in such contests.

Study methodology has been poor, and relapse appears to be common. There were problems with people claiming to have quit so that they would have a chance of winning a prize. However, biochemical testing of their nonsmoking status often contraindicated their claims. In other words, some people tried to cheat.

These contests can be fun, and they can educate the public about the dangers of smoking and methods of quitting. Quit and Win contests can also provide opportunities for people to make their first attempt at quitting. We know that the more attempts people make, the greater the odds that they’ll eventually quit smoking. So, the bottom line is that Quit and Win contests are worth considering — just don’t put a lot of faith in them. And we don’t recommend voting for taxes to underwrite these contests because they’re not cost-effective!

Magnetizing smoking urges

You probably understand by now that smokers who want to quit sometimes feel desperate. Wouldn’t it be nice if you could just walk around with magnets in your ears, and your smoking urges would melt away?

That’s what manufacturers of ear magnets claim. You simply put one small magnet on each side of your left ear (don’t ask why the left). By the way, the magnets are 24-karat gold plated, though its unclear what the plating does other than to make the magnets more attractive. You’re instructed to wear the magnets two to four hours per day and do nothing else to address your smoking.

You continue to smoke until your urges magically disappear, supposedly within seven days. After seven days, you quit and have no more smoking urges!

If an urge does happen to pop up after you’ve quit using them, you’re instructed to put the magnets back in for a while. The manufacturer claims the magnets work due to acupressure principles, which cause a release of endorphins that squash urges.

Amazingly, the product website reports an 80 percent success rate. That’s far better than any other scientifically based smoking-cessation strategy available today. Wow!

Unfortunately, there is absolutely no reasonable scientific evidence that this product does anything at all to help with smoking cessation. However, it does seem to be somewhat successful at pumping up profits for the manufacturer and costing desperate smokers their hard-earned cash. The bottom line: We do not recommend this product even as an experiment. Don’t waste your money.

Analyzing acupuncture

Acupuncture is based on ancient Chinese therapy and typically involves inserting tiny needles into the skin at points thought to be critical for certain conditions. Modern procedures may use laser or electrical stimulation for the same purpose.

The theory suggests that the needles redirect imbalanced energy and blood flow through the body, which alleviates a wide variety of symptoms. Acupuncture has been purported to be effective for a wide variety of problems and disorders. The following list is just a sample of conditions that an acupuncturist might treat:

  • Hay fever
  • Low-back pain
  • Neck pain
  • Osteoarthritis
  • Tension headaches
  • Migraine headaches
  • Depression
  • Anxiety
  • Nausea and vomiting associated with chemotherapy
  • Menstrual cramps
  • Improved immune function
  • Neuropathy
  • Chronic fatigue syndrome
  • Various skin problems
  • Digestive disorders
  • Smoking cessation

Technical stuff Reviews of the literature on the effectiveness of acupuncture usually choose to assess studies that compare acupuncture to what’s called “sham” acupuncture. Sham acupuncture involves inserting needles into positions that are theorized to have no value in redirecting energy and blood flow. That means that the researchers compared normal acupuncture (inserting needles in their theorized ideal position for redirecting energy flows) with sham (or placebo) acupuncture.

Support for smoking cessation is weak. Smokers who choose acupuncture for their quit plan may have a decrease in urges in the short run. However, by six months, their rate of relapse is the same as those who get a placebo.

Tip If you’re someone who has had a particular problem with handling the first week or two of quitting, acupuncture may actually be something you could add to your quit plan. We don’t recommend continuing with the approach over the long term, however.

Managing cravings with massage

When looking for promising smoking-cessation options on the Internet, you’re likely to encounter positive messages about massage therapy. Massage certainly feels good and is relaxing. It makes intuitive sense that it would help for cravings. And it has been suggested that if your smoking is partly driven by anxiety, massage therapy can alleviate that part of the problem.

Like some other forms of relaxation, massage is a temporary, incomplete treatment for smoking or vaping. If you can find a really small massage therapist who fits in your pocket, you could probably pull the therapist out every time you have an urge to smoke. It’s possible that would work. Could be a long search, though.

You Don’t Always Get What You Pay For

Before writing this book, we knew almost all the strategies proven to be helpful for smoking cessation. However, we didn’t know the complete set of commercial offerings found on the Internet. So, we poked around. Frankly, we found ourselves a bit disgusted by some of the promotions.

The promises were often excessive and research specific to the product being offered was completely lacking. Some of the offerings are products; others are programs with supporting CDs or video downloads. Here are a few miraculous smoking-cessation promises we found:

  • Quit smoking in hours or minutes.
  • Take brain boosters that crush smoking urges.
  • Take proprietary vitamin formulas to rebuild neurotransmitters that wipe out cravings.
  • Use aroma therapy for quitting smoking.
  • Use nicotine-free oral spray to combat urges.
  • Use a special filter modifier promising a natural way to quit and removal of almost all toxins.
  • Use vitamin and supplement inhalers.

We also found a few cases of seemingly science-backed smoking cessation programs. Claims tended to be excessive and the costs were often high. For example, after signing up for one information video, we were bombarded with “free offers.” The program itself costs well over $500 and there were various supplemental products (for example, books, videos, and dietary suggestions complete with recipes) that ranged from $49 to $348.

We really have no idea how effective this program is. But the costs are higher than lots of available strategies. For example, we review free quit lines and apps in Chapter 11. And Chapter 9 reviews medications and their availability at subsidized costs. Chapter 24 lists website resources that can direct you to support groups and even professional counselors.

The point is, there’s lots of snake oil out there being hawked by unscrupulous marketers. Be careful, especially if costs are high and claims seem questionable.

Putting on Your Smart Consumer Hat

Promoters of smoking and vaping cessation products and programs often make unwarranted claims of effectiveness based on scientific evidence. They sometimes even cite “studies” to support their claims. But, as consumers, we must adhere to the principle of caveat emptor (buyer beware), or we run the risk of falling victim to shams.

When you read or hear about a potential smoking-cessation product, program, or strategy, the following sections review some things to keep in mind to help you evaluate whether any given claim holds up to scrutiny.

Remember We tell you the scientific basis for most of the strategies we review in this book. When there’s not much science to back something, we let you know. We want you to make informed decisions. We give you some of the most important scientific principles and guidelines in case you’re especially curious about a particular study. If you’re not so curious, feel free to skip these sections.

When things seem too good to be true, they usually are

You really can’t effortlessly stop smoking in a few minutes. You’ll probably have some uncomfortable urges no matter what product or program you use. So, when an advertisement or website promises much better, easier, and faster results than most, be skeptical. It’s unlikely.

Maybe someday, a blockbuster product or program will come along that really blows everything else out of the water. But we’re not holding our breath. You won’t have to search around on the Internet for such a breakthrough. If and when a breakthrough really does come out, you’ll see widespread news media coverage and lots of scientific support for it.

Using small groups limits conclusions

When scientists first become interested in studying the effectiveness of something, they often begin with a preliminary study. That’s because they don’t want to spend large amounts of time, effort, and money studying something that may not pan out.

So, they typically recruit a small group to participate in what they call a pilot study or preliminary study. These studies are great for looking at whether something has the potential or possibility of being effective. They aren’t so great at looking for absolute conclusions.

For example, when researching the effectiveness of massage therapy, a study from 1999 took 20 smokers and trained half of them to give themselves hand or ear self-massages. At the end of the month, the self-massage group smoked fewer cigarettes than the other ten, who didn’t get training in self-massage. That single study tells us very little about the effectiveness of self-massage for smoking or vaping cessation.

Studies using small numbers of participants can’t tell us much. The results can too easily be caused by the chance results of just a couple of individuals. There are always a few people who have a great response to almost anything. If one group of ten has two or three of these people, the results can look better than they should for that group.

It’s hard to make firm conclusions about effectiveness unless a study has large numbers of participants.

Lots of dropouts cause confusion

High dropout rates are rather common in smoking cessation studies because lots of people think they’d like to participate but discover it’s too much work and discomfort. So, they return to smoking. Those dropouts need to be taken into account and not ignored. High dropout rates also often suggest that there may be something unpleasant about the treatment the participants are receiving, such as side effects from a medication, which causes them to drop out.

At the very least, look for what percentage of participants dropped out from the beginning to the conclusion (often called the follow-up).

Choosing not to choose

You’ve probably heard the term randomized controlled study (RCT). That term refers to a basic principle in scientific research. Randomized refers to the way that research participants are chosen.

Imagine a fifth-grade gym class. The coach designates two captains to choose players for a soccer team. One of the captains begins to choose his players. Someone says, “That’s not fair; he’s getting all the best players!” The coach decides to have the students count off by two’s with the ones going to Team A and the twos going to Team B. That’s not technically a fully random approach, but it’s closer to fair than allowing one captain to choose.

Researchers want to give the same, fair shake to all groups so they can tell if the intervention was responsible for the results obtained.

Controlling for suggestion and expectancy

Researchers also want to know if a particular intervention, drug, strategy, or treatment works better than a placebo. Placebos lack any active treatment elements but look like they could be effective. For example, a placebo in a drug trial looks identical to the real, active drug, but does nothing. However, it induces as much expectation for effectiveness from the participants’ perspective.

Placebos are important to include in a study because people are strongly influenced by their expectations of getting help. That expectation alone often produces significant effects or change. Having a placebo group for comparison allows conclusions about treatment effectiveness above and beyond the placebo effect.

Technical stuff Placebo comparison groups are sometimes tricky to design. But a good study will at least compare an active treatment group to a group called treatment as usual, or what’s known as a wait-list control group. Without such a comparison, it’s hard to draw firm conclusions about a study’s findings.

Replication, replication, replication

Real estate agents are fond of saying that price and desirability of houses comes down to three words — location, location, location. Similarly, researchers greatly value three words — replication, replication, replication. Scientists don’t put a great deal of stock in the findings from a single study.

There’s always a decent possibility that a study’s findings were due to a fluke, random chance, or a subtle flaw in the way the study was set up. Therefore, repeating the study with different participants, at a different time and place, and sometimes with small changes in methods, helps give confidence to what’s being discovered. Replicating multiple times is even better.

Eating ice cream causes murder?

If you look at U.S. ice cream consumption in the months of May, June, and July, you’ll see that ice cream sales skyrocket during those months. Murder rates also skyrocket during that time. If you put these results on a graph, you’ll see that the lines showing ice cream sales and murder rates climb in tandem — what’s called a high, positive correlation. So, does eating ice cream cause people to commit murder? Or, after murdering someone, are people driven to eat more ice cream?

Um, well, neither. That’s ridiculous. Scientists know that correlations do not indicate causation. Just because two things go together, doesn’t mean something else is at play. With the example of increasing ice cream consumption and murder rates, it’s thought that hot weather likely causes both.

What does this issue have to do with smoking? Some smoking cessation treatments declare their effectiveness based on correlational findings rather than randomized controlled research. The nearby sidebar illustrates how such findings can lead you astray.