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Letter to the Editor

Editor, – While Mark Ragg (Aust Prescr 2008;31:60-2) is technically correct in saying that most people quit by themselves1, he overlooks the more important point that the unaided quit rate is around 5-7%.2It is not surprising that quitting is so difficult. Nicotine addiction is a chronic relapsing condition with a relapse curve that resembles that for heroin addiction.3Popularity of strategy should not be confused with likelihood of success.

Most smokers find it very difficult to quit and are reluctant to seek help.4It is difficult to capture the true natural history of smoking cessation in a study.1 Studies that have done so show that less than 2% of smokers quit per year.5On average, smokers make between five and eight attempts before they are successful despite expressing strong interest in quitting.6

In a survey, 92% of smokers used only one strategy to quit.1The majority of published evidence recommends the use of a combination of strategies that include some form of pharmacotherapy if nicotine dependent, referral to a proactive callback program like the Quitline, enlisting support, and addressing motivation and confidence.7,8,9,10 This is reflected in a reduction in the numbers needed to treat as selected strategies are combined. For example, eight smokers need to be treated with varenicline and supportive counselling to get one long-term quitter. Smokers shouldn't have to 'go it alone'. Health professionals should help them to increase their chance of success.

John Litt
Department of General Practice
Flinders University



  1. Doran CM, Valenti L, Robinson M, Britt H, Mattick RP. Smoking status of Australian general practice patients and their attempts to quit. Addict Behav 2006;31:758-66.
  2. Baillie AJ, Mattick RP, Hall W. Quitting smoking: estimation by meta-analysis of the rate of unaided smoking cessation. Aust J Public Health 1995;19:129-31.
  3. Hughes JR, Keely J, Naud S. Shape of the relapse curve and long-term abstinence among untreated smokers. Addiction 2004;99:29-38.
  4. Carter S, Borland R, Chapman S. Finding the strength to kill your best friend: smokers talk about smoking and quitting. Sydney: Australian Smoking Cessation Consortium and GlaxoSmithKline Consumer Healthcare; 2001.
  5. Tobacco Advisory Group, Royal College of Physicians. Nicotine addiction in Britain. London: Royal College of Physicians of London; 2000.
  6. Piasecki TM. Relapse to smoking. Clin Psychol Rev 2006;26:196-215.
  7. National Institute for Health and Clinical Excellence (NICE). Brief interventions and referral for smoking cessation in primary care and other settings. London: NICE; 2006.
  8. Wu P, Wilson K, Dimoulas P, Mills EJ. Effectiveness of smoking cessation therapies: a systematic review and meta-analysis. BMC Public Health 2006;6:300.
  9. International Primary Care Respiratory Group. Tackling the smoking epidemic. IPCRG International Guidance on smoking cessation in primary care. Aberdeen, Scotland: IPCRG; 2007.
  10. Zwar N, Richmond R, Borland R, Peters M, Stillman S, Litt J, et al. Smoking cessation pharmacotherapy: an update for health professionals. Melbourne: Royal Australian College of General Practitioners; 2007.

John Litt

Department of General Practice, Flinders University Adelaide