In a review article in the December Nicotine and Tobacco Research, researchers at the University of Vermont have found an unexpected, effective alternative to motivate smokers to quit smoking – cutting back. According to the qualitative review of 19 studies on smoking reduction in individuals who did not want to quit, this method, typically coupled with the use of nicotine replacement products, led to an increase in quitting in 16 of the studies.
"Cutting back is approved as a method of quitting in several European countries, but not in the United States," said lead author John Hughes, M.D., a professor of psychiatry at the University of Vermont College of Medicine. "Our review contradicts the commonly held belief that quitting requires stopping abruptly and provides evidence that smokers can quit successfully by reducing the amount of cigarettes smoked. Furthermore, our review indicates cutting back is often a great way to start changing smoking that can lead to eventual quitting."
Hughes's report is the largest review of smoking reduction studies published to date. Among the 19 studies reviewed (many of which were randomized, placebo-controlled trials), the two considered the most important involved randomized, controlled trials that assigned smokers to either reduce or not reduce. Both of these studies found that smoking reduction leads to more cessation. Also, in three studies, the effect of reduction was found to be similar to the effect of providing smoking cessation advice. Based on this finding, Hughes suggests that clinicians try recommending reduction for smokers who have not responded to repeated cessation advice.
Hughes and colleague Matthew Carpenter warn that smokers do need to understand that there is no good evidence that cutting back alone decreases smoking-related health risks and thus clinicians should promote reduction only as a step towards eventual cessation to their patients.