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For those who wish to quit, treatment is not the only option

This peer-reviewed paper is several years old, but I thought it was very interesting and brought up some important points about how we in society tend to deal with those who wish to give up a particular “vice.”

The Global Research Neglect of Unassisted Smoking Cessation

It’s a study related to those who quit smoking tobacco, but the relevance goes far beyond that. Here’s the basic point…

As with problem drinking, gambling, and narcotics use, population studies show consistently that a large majority of smokers who permanently stop smoking do so without any form of assistance. In 2003, some 20 years after the introduction of cessation pharmacotherapies, smokers trying to stop unaided in the past year were twice as numerous as those using pharmacotherapies and only 8.8% of US quit attempters used a behavioural treatment. Moreover, despite the pharmaceutical industry’s efforts to promote pharmacologically mediated cessation and numerous clinical trials demonstrating the efficacy of pharmacotherapy, the most common method used by most people who have successfully stopped smoking remains unassisted cessation (cold turkey or reducing before quitting. In 1986, the American Cancer Society reported that: “Over 90% of the estimated 37 million people who have stopped smoking in this country since the Surgeon General’s first report linking smoking to cancer have done so unaided.” Today, unassisted cessation continues to lead the next most successful method (nicotine replacement therapy [NRT]) by a wide margin.

Yet, paradoxically, the tobacco control community treats this information as if it was somehow irresponsible or subversive and ignores the potential policy implications of studying self-quitters.

There is a ton of financial incentive in convincing people that they need help in quitting whatever they wish to quit, including self-interest from the treatment industry and the pharmacological industry. (One of the most bizarre things in my mind to happen in recent years has been the development of drugs to help people quit cannabis.)

Particularly irresponsible in this area has been the incessant emphasis on treatment by the U.S. government and the irresponsible “third-way-ers,” who have practically come out in favor of forced treatment for all illicit drug users. Of course, the truth is that most drug users do so non-problematically and don’t need help. And of those who have a problem with their use and wish to reduce or quit, a very large number could do so on their own.

This is not to say that treatment procedures and medications are without value. For some problem users, they can be life-saving.

But we’re essentially telling people that they can’t quit unless they get treatment. And that’s not only wrong, it’s potentially damaging as it may actually convince people that they are unable to quit.

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32 comments to For those who wish to quit, treatment is not the only option

  • Dante

    This is the crux of the issue:

    You can’t quit drugs unless you pay the drug warriors for the privilege. Oh, and you gotta let us shoot your dog and raid your house.

    Just following “procedure”, you see, and keeping you “safe”. Sorry about the mess (not really).

    When pot-smokers donate more money to the corrupt political machine than the drug warriors do, we will be protected from this mess and some other group will be demonized and assaulted.

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  • claygooding

    It is the only claim of harm that most people will agree is harmful,,science or not,,smoking anything can’t be that good for your lungs,,just because cannabis repairs it’s own damage doesn’t mean it is necessary.,,,so remove the smoking and replace it with vaporization,ingestion or topical applications and the only major health issue with cannabis is removed.
    When you can walk into a store and buy a soda infused with cannabis extracts not smoking a joint will be a lot easier goal.

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    • Windy

      I prefer my cannabis smoked, through a double chambered bubbler. I find joints too harsh on my throat, and I’m not at all fond of edibles (too hard to control dosage). I’ve never enjoyed a high from vaping (very little effect at all, in fact, waste of my good bud and my time), The O-Pen is better than vaping and handy for when I’m away from home, but it’s not as good as the old bubbler for when I want to be high.

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  • NorCalNative

    Short Sabet and Frum: Who you calling irresponsible third-way-ers?

    That third-way crap is what turned me away from the Democratic Party.

    Drug Treatment is a form of legislated income.

    What kinds of employment will folks like Kevin Sabet be fit for when legalization robs then of their legislated income?

    And, Pete. That article is old. Are you fishing for tips on quitting smoking?

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    • And, Pete. That article is old.

      I’m pretty sure I said that right up front…. “This peer-reviewed paper is several years old, “

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    • darkcycle

      Ah, Nor Cal, a well done scientific study ages better than fine wine. The longer it stands, the stronger it’s truth. (That means it’s validity has not been disproven by subsequent research.)Good studies such as this are WORTH re-posting. Unlike the prohibitionists, who use time for the opposite purpose…to reanimate the lies disproven in the last generation…witness Man-teats and schizophrenia….

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  • Servetus

    The prohibitionist therapeutic state needs regulation. So far, the government has been too busy regulating people’s personal lives to bother with drug treatment options. Today’s drug treatment industry is uniquely inconsistent in how it operates.

    For the wealthy, drug treatment can mean some peaceful, medicated isolation and rest from an addiction having detectable biomarkers. For the forgotten celebrity, it’s a way to get some new publicity, and perhaps revive a defunct acting career. For the drug convict, it’s a way to defer incarceration. For the not-so-wealthy, or weaker members of society, like children abandoned to the system by their parents, it can mean brutal mental and physical abuse at the hands of sadists.

    The style of treatment reflects the ideologies of the treatment professionals. Many people in the treatment industry care nothing about what drug use does or doesn’t do to a person’s physical health. Their concern is what they see as the health of the soul. Like medievalists, they believe recreational drug consumption is a sin worthy of burning the drug heretic at the stake, were the auto-da-fe still in fashion, and many probably wish it were. The carnival-like atmosphere of public punishment of heretics once drew as much excitement and entertainment as sports events do today. The ritualistic purging of the soul of the evil of drugs in some ghastly, cult-like fashion has in some cases morphed into full-blown modern religious cults, such as Synonon.

    The government must understand that it’s a bad idea to empower quacks, idiots and sadomoralists by putting them in charge of other people’s lives. To avoid the therapeutic state Thomas Szasz warned us about, addiction therapy must evolve from its Dark Ages origins and become a government regulated medical process based on real science. To protect against deceit and fraud, drug consumption and drug treatment must be made strictly voluntary and non-punitive at all stages of the process. This how a fee society operates, and it is how we should operate now.

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  • allan

    What? Self control, maturation, good advice and support is the most effective option to quitting an addiction? Shocked I am… not.

    When humans rely on their own personal strengths – especially with the possibility of an assist and support from fam/friends – they become more balanced beings and a new strength found can lead to discovering oh so many more possibilities for discoveries in personal growth.

    Funny that…

    But the boosters of chemical medicine are straight out of the darkest corners of the best speculative futurist fiction writers sordid imaginings. These medi-chem asshats really need to be dethroned and their grip on gummint policy and drug policy ideology needs to be severed at the wrist (maybe the elbow, that would remove the possibility of scratching their own noses).

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  • darkcycle

    One sees the same sort of phenomenon in mental illness. Schizophrenia is very often a life long condition. The “First Break” is usually the beginning of a long battle that is never really “won”. But some “first breakers” never have a second break. (Because the “first break” may not result in hospitalization, we really don’t have a grip on the numbers) When you interview these (non-chronic) people in follow ups, as I have many times, it becomes apparent that they somehow realize what is happening, and self correct their perceptions. This happens independently of intervention. No need for medications, no relapses. It is far from the rule, but it happens enough that it is noteworthy.

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  • Nunavut Tripper

    I think a strong mentor can sometimes help quit the tobacco habit.
    I have two friends who smoked cigarettes all their adult life and although they both hated the damn things they refused to try to end it just because they thought it was impossible for them to do so.
    One of them was hospitalized for serious COPD and the doctor said ” You must quit cigs or die and I don’t mean next month or next year ,I mean right now”
    My friend never took another cigarette and that was six years ago.
    The other friend was given a stern no nonsense tirade by his cardiac specialist or basically another “quit or die” rant.
    He also threw his cigs away immediately and never returned.
    It’s funny how a near death experience with some strong encouragement from a professional can change your attitude so quickly with no police,courts,rehab or piss tests necessary.

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    • claygooding

      The same response can be seen in the aged in regards to religion,,,a lot of people get more religion as more of their class mates and cronies start having obituaries in their local paper.

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      • primus

        Cramming for finals.

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      • Windy

        I’ve always been a contrary (to authority, to mob think, and to group think) kind of person, as I grow older I grow ever further from belief in any religion or deity. In 1962 i was still attending church, though irregularly (my pattern through the previous years, too), I transitioned through exploring many religions looking for the TRUTH, now I am a non-believer, I call myself an agnostic because the existence of a “God” can neither be proved nor disproved, but I’m really, at heart now, an atheist. I do not believe.

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    • DdC

      Prohibitionists are the same regardless of the substance. They have no life of their own so they want to force others to behave as they were told is correct. Just as the drug worriers tobacco worriers lie and manipulate the same. Putting their views onto others be-it religion, pot or manner of dress. None of their business. They support the chemical companies doing the harm adding to cigarettes what is not in tobacco. Used safely for hundreds if not thousands of years before Reagan commercials for your smoking pleasure. Liberals are evicting poor people from their homes for smelling smoke. No proof, just another way of profiling and removing undesirables. I enjoy my organic camel straights as a way to curb coughing so much on some types of buds. The addiction I have for them is my addiction and no one else’s business. Driving the price up only forces the poor to buy generic brands with even more chemical poisons to do harm. Then more taxes treating them in emergency rooms later down the line. paranoia produces profits. Ban carrots for turning people orange, same cage profits and court costs. Rehabilitation to broccoli!

      Organic Cannabis/Tobacco vs Chemical Cigarettes

      Cancer risk in relation to radioactivity in tobacco

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      • thelbert

        i quit in ’96 because the price of smokes went up to 2 bucks per pack, and i could no longer afford to smoke, cold turkey and very few cravings. the temptation isn’t there now that butts are 6 bucks. of course i smoked a lot more pot for a while, no problem, i’d rather have the pot habit.

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        • DdC

          …and that same price hike led millions of lower incomes to generic brands with more chemicals to make cheaper. More sick the Butt Prohibs are directly responsible for. Karma’s a bigger bitch than the prohibitches. Bennett used the same tactic trying to stop Ganja users by raising prices and it backfired. All denial does is let the poison and adulterant makers off the hook. Lets them hide in the shadows during the Congressional hearings and lets the same prohibition sales people sell another prohibition. Same corporations behind the Ganjawar, same chemicals sold on cotton, not on Hemp. Like I said used more as a political tool than for the safety of the smoker or than second hand smoke can travel across a field 10 feet from a highway spewing car and truck exhaust. No reality. Seems you quit over prohibition not because it was your choice.

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        • thelbert

          another reason that i quit was i had no job to support a habit like tobacco, plus after 30 or so years of smoking the lungs were getting weak. it was remarkably easy. for the last 18 years it never once crossed my mind that i was forced to quit smoking by some nefarious cabal, but even if that’s the case i don’t miss it at all. i’m just hoping to stave off the lung cancer w/cannabis.

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      • primus

        Yes, tobacco was used for millennia with no appreciable harms, however it was much different from today’s tobacco; it was loaded with alkaloids and made the person see visions and get massively sick. It was used only on certain occasions, infrequently, and mainly as an aid to a vision-quest. They didn’t smoke a pack a day, a few puffs on the pipe and the person was so loaded and sick they didn’t want any more, and most were reluctant to repeat the experience very often. Remember the first time you smoked tobacco? Imagine if every time you used it that is how you felt; sick to the stomach, head swimming, puking, and you can understand why. They only occasionally exposed their lungs to a small amount of very powerful tobacco smoke, perhaps once a month, so the harms did not build up as they do today. When mild Virginia tobaccos came on the scene and became the only kind to fill cigarettes, the pattern changed to the one we have today, because people could become accustomed to that lower level of toxicity. Now, sensitive tissues are exposed constantly to tobacco smoke and all the carcinogens it contains, as well as the tars etc. which plug up the lungs and lead to COPD. The real change in these harms are mainly due to changing patterns of use not additives etc.

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        • allan

          and indigenous tobacco use wasn’t limited to smoking. Tobacco is a sacred plant and as such was/is used as offerings, often in sacred bundles. My experience is that native American smoking ‘tobacco’ is/was a mix of herbs and maybe included a tasty bit of bark. But the use varied tribe to tribe. Wild tobacco grows all over CA’s central coast and the Chumash smoke/d it and use/d it in offerings.

          Some teach that smoke isn’t inhaled but held in the mouth and the smoke released is meant to carry the smoker’s prayers (indicating that the smoking is ritualistic).

          Again, Europeans – with their vastly superior understanding of all things – take a sacred/valued traditional substance with a clear history of its appropriate use and transform it into something antipodal to sacred. One of these days folks gonna realize them white boys be a crazy bunch (note to other inhabited planets – don’t let us stay more than an hour or two)

          Better wear your longies, knit caps and gloves if you’re living in the north central US. brrrrr…

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        • DdC

          They still sell organic tobacco without the chemicals, as I said. As you attempt to divert from.

          Yes, tobacco was used for millennia with no appreciable harms, however it was much different from today’s tobacco; it was loaded with alkaloids and made the person see visions and get massively sick. It was used only on certain occasions, infrequently, and mainly as an aid to a vision-quest.

          That is blatantly false. Hundreds of cultures smoked tobacco and it had no additives or alkaloids. They were separate herbs. Ayahuasca is nothing like tobacco. Or Datura or Jimson weed. I see no ref so I’ll stick with my original point that all prohibitionists are the same over zealous liars and manipulators as the drug worriers. Ask the Indians, or Turkish or Egyptians or Sir Walter Raleigh or our own founding fathers who grew it and smoked it. Maybe preferring Hemp and Ganja but still a market for tobacco. True the chemicals made it less harsh and the smoke white and the filters to resemble nipples for that psychological aid to entice new smokers.

          All that came with the 20th century and the diseases with it. Its Bullshit to profit on yet another hobgoblin banning it and like I said the results are the poor get sicker from the cheaper generic brands with more chemical additives and growing poisons. At the end of the day all the talk and denial means is more sick people and more anti American prohibitions. The organic tobacco today is no different than organic tobacco the past thousand years. Organic. Not adulterated with higher nicotine or flavorings or preservatives and curing chemicals.

          All of your claims are from 20th century for there are no records of cancers or lung problems with Chinese medical records or the other cultures using it. Its not the tobacco and my lungs are clear smoking it longer than most smoking with the chemical products. They can tax cigarettes, there is no tax on raw tobacco. As there should not be on Ganja in the field. Only products. So to me its the same and until I see differently I’ll stick with my observations of prohibitionists. Anyone who wants to instill their phobias and paranoia’s onto others is a potential prohibitch I wouldn’t trust as far as I could throw them. Even if it did cause harm, the only obligation is to warn the user, not ban adults from it just to collect on the punishment. Punishing tobacco users is no different than punishing Ganja users or darker skin colors or different languages.

          Now this is just an assumption but I would wager adding radioactive waste to fertilizers might possibly have a detrimental effect on people sucking it into their lungs. Or adding flame retardants and burn enhancers. But you dismiss it all as equal? Thats a bit farther than the drug worriers even. Clearly an agenda with not even checking the links and all those poisons not in Ganja or organic tobacco, yet just the same? Ridiculous. Sell your prohibition to the gullible buying the drug war. Not me.

          Cancer risk in relation to radioactivity in tobacco

          Organic Cannabis/Tobacco vs Chemical Cigarettes

          Then ask about the thousands of years breathing camp fire and fireplace smoke and now the car exhaust all protected with Ganja. Sound like a vape salesman. Fet one thing straight and it will be easier to accept that Nixon lied and you can’t build phantoms from his lies or try to compare them to Ganja without the adulterations just to sell vapes. Its as false as the drug worriers selling their hobgoblins.

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        • DdC

          Tobacco leaves are being researched for Parkinson and other potentials. Now the Chumash have a large smoke free casino. lol, seriously. And again it wasn’t only the native americans, Europe, Asia and South America grew tobacco. The Middle East and Africans. To dismiss the corporate chemical adulterations and lump it all the same as Ganja with crack or pcp, seems no different to me. It’s a good thing to warn others of danger. Its a business saving people from themselves for a fee.

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        • primus

          Research will enlighten you, DdC. Tobacco is a new world crop. Its use was restricted to the Americas until Raleigh introduced it to the Europeans. The lack of records in Chinese medical texts is directly related to this fact. Smoking was unknown in the rest of the world until after 1492, so your comments are somewhat misguided. I never advocated restrictions on your favourite smoke, just a more realistic, true account of its harms. You sound more like a zealot than a thinker on this topic.

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  • Duncan20903

    .
    .

    My greatest regret from my decision to become a cannabis law reform advocate and to become an expert in the mundane trivia of cannabis history is that it came at the price of getting to know how prohibitionists, both parasite and sycophant, think.* Never in my wildest dreams could I have invented such far fetched non-fiction, no doubt.

    (*think isn’t the right word but it’s the closest thing to accurately describe what I’ve seen come out of their hollow space where most people keep their brain.)

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    • curmudgeon

      Duncan, It’s not a hollow space, they just have brown matter where sane people have gray matter.

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  • DonDig

    .
    .
    Perhaps OT, (begging indulgence) but regarding any choice we make, and continue to make, (even those we wish we were not making), I love the light shed by this (excerpt of a) quote from Marianne Williamson,
    “Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness, that frightens us most. We ask ourselves, ‘Who am I to be brilliant, gorgeous, talented, and famous?’ Actually, who are you not to be?…”

    I suspect we all knew this about our power, voice and capacity, at least until x (pick your detractor) taught or beat it out of us for protracted periods of time. Then if we continued to think for ourselves, we may have spent significant living capital in restoring that awareness.

    If only society, and those around us, encouraged us to retain this truth from childhood, and use it for our benefit, harmful addiction might be a thing of the past. Clearly we can help those who follow with this.

    At least the prohibidiots seem to be losing their grip. Many many things keep getting better and better. (Ah, patience my heart.)

    Happy New Year everyone!

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  • allan

    OT but a mighty fine read in the New Yorker:

    A Mission Gone Wrong – Why are we still fighting the drug war?

    -snip-

    The next year, President George H. W. Bush appointed William Bennett the director of the newly created Office of National Drug Control Policy. Bennett, who was known as the “drug czar,” coördinated anti-drug activities and published, each year, a book-length National Drug Control Strategy. Bennett initially called drugs “a crisis of national character” and asserted that casual drug users were more dangerous than hard-core addicts. They were “willing and able to proselytize,” which made them “highly contagious.”

    Congress required Bennett to set quantifiable goals. He promised a ten-per-cent reduction in the population of illicit drug users by 1991, and a fifty-per-cent reduction by 1999. His targets were naïve at best. Since 1990, the number of users has almost doubled. Between 1990 and 2007, the street prices of cocaine and heroin, which Bennett sought to drive up in order to price out new users, declined by as much as eighty per cent, according to one recent study. Falling drug prices weren’t due to a lack of enforcement. During the same period, the D.E.A.’s budget tripled.

    -snip-

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  • Servetus

    Rehab for dolphins hooked on puffer fish? Dolphins get high.

    The dolphins then entered what appeared to be a trancelike state.

    “This was a case of young dolphins purposely experimenting with something we know to be intoxicating,” said Rob Pilley, a zoologist who worked as a producer for the series. “After chewing the puffer gently and passing it round, they began acting most peculiarly, hanging around with their noses at the surface as if fascinated by their own reflection.”

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  • strayan

    I have been quoting this article for years.

    It’s good because it puts the lie to the claim that drugs ‘enslave’ people who take them and that if you take them regularly enough you are likely to end up with the ‘disease’ of addiction (a label which turns it into a condition completely amenable to, indeed requiring, a medical cure to the obvious financial benefit of the third-way-ers).

    Here is one of my new favourite articles: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3644798/?report=classic

    Disclaimer: I’m employed in the treatment industry.

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    • primus

      I did not read the whole thing, but it appears to validate an epiphany I had a while ago that ‘addiction’ or ‘compulsive’ behaviour must be just an expression of normal human behaviours which are beneficial to the person in some way, which reinforces the behaviour. In other words, to be addicted is to be human, to be human is to be an addict. How then can we throw someone in prison who is just being human?

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  • Servetus

    Impaired autophagy, not marijuana, LSD, et al., appears to be the gateway to schizophrenia. A new paper from Tel Aviv University, Toward a Molecular Explanation for Schizophrenia, may provide some real answers:

    Autophagy is like the cell’s housekeeping service, cleaning up unnecessary and dysfunctional cellular components. The process — in which a membrane engulfs and consumes the clutter — is essential to maintaining cellular health. But when autophagy is blocked, it can lead to cell death. Several studies have tentatively linked blocked autophagy to the death of brain cells seen in Alzheimer’s disease.

    Brain-cell death also occurs in schizophrenics, so Prof. Gozes and her colleagues set out to see if blocked autophagy could be involved in the progression of that condition as well. They found RNA evidence of decreased levels of the protein beclin 1 in the hippocampus of schizophrenia patients, a brain region central to learning and memory. Beclin 1 is central to initiating autophagy — its deficit suggests that the process is indeed blocked in schizophrenia patients. Developing drugs to boost beclin 1 levels and restart autophagy could offer a new way to treat schizophrenia, the researchers say.

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