Tobacco cessation programs: Why most don't work

Tobacco use is addictive, extremely dangerous, and costly—all are powerful motivators to stop smoking, chewing, or vaping.

It’s therefore not surprising that 70% of adult smokers openly want to quit.

However, the vast majority just don’t know how: studies like this one show that many smokers make 30 or more failed attempts before eventually quitting.

And it’s not just the tobacco user who pays the price. So does their employer. As documented in the behavioral cost report we released earlier this year, a smoker costs their employer an average of nearly $6,000 per year—more than half of which is due to lost productivity.

With costs like this, it’s easy to understand why many corporate wellness programs either offer their employees an incentive for being tobacco-free or levy a penalty for using tobacco. Common examples are discounted health insurance premiums for non-smokers or premium surcharges for smokers.

However, with a new plan year on the horizon, it’s important to remember that if tobacco incentives or penalties are involved, the organization is required by law to offer its tobacco users what is known as a Reasonable Alternative Standard (RAS).

The RAS is a treatment program that will allow the tobacco user to earn the incentive (or avoid the penalty) if completed—regardless of whether they quit tobacco. Not offering an RAS—or offering it incorrectly—can result in costly legal consequences, as Macy’s and its third-party administrators found out the hard way.

Common Reasonable Alternatives include nicotine replacement therapy (NRT)—gum, lozenges, or patches—to medications, to counseling quit lines, or any combination of these.

But how effective are these solutions in helping a smoker to quit? According to the statistics, not very.

A study from Penn State University that was done for California reported the following:

  • NRT had a marginal success rate of 5.8%
  • When combined with counseling, NRT success rates improved slightly to 8.0%
  • Medications examined in the study ranged in success from 7% to 14.9%

So, the question becomes, why are the success rates of the commonly recommended tobacco cessation treatments so low?

The answer is that there are in fact two separate addictions going on—not just one—and most tobacco treatments unfortunately don’t deal with the second one. Let’s explain …

Addiction #1: Virtually everyone has heard of the first addiction—the physical (chemical) dependency on nicotine. Most people are aware that this substance is both highly addictive and fast-acting. However, the truth is that nicotine is usually eradicated from the body within three days of abstinence. And its physical withdrawal symptoms are relatively minor … about the same as caffeine withdrawal would be for a habitual coffee drinker.

If smoking was simply about delivering nicotine to the smoker, then it stands to reason that replacing tobacco with NRT products would have much higher success rates. Same thing with medications that mimic the physiological effects of nicotine. However, the reality is that physical addiction to nicotine is only a tiny part of the smoking addiction.

Now let’s turn our attention to the second addiction which is the real reason most smokers can’t stay quit …

Addiction #2: This second addiction—which remains largely unrecognized, even by doctors—is far more difficult to get rid of. It is described by the American Cancer Society as “a strong emotional (psychological) dependence.”

It is the presence of this second addiction that explains why NRT, medications, and counseling quit-lines have such low efficacy rates: they address the physical aspects of the addiction, but they ignore the far more powerful emotional (psychological) aspects of it.

The bottom line is that unless a smoking cessation program deals with a nicotine user’s emotional dependence on smoking, chewing, or vaping, they will almost always return to their health-robbing habit within just a few weeks or months after quitting.

That’s where SelfHelpWorks’ LivingFree online tobacco cessation program comes in. The reason it’s so effective is that it addresses both addictions at once—the physical and the emotional/psychological. And it does this as a stand-alone solution … without the need for NRT, medications, or any other stop-smoking aid.

The success rate of LivingFree far surpasses the other methods. John Martin, PhD, Professor of Psychology and Director of the Behavioral Medicine Research and Training Clinic at San Diego State University, conducted a study involving 250 smokers who were randomized into taking one of two treatments: one group took LivingFree, the other used the American Cancer Society self-help materials. After six months, of all participants who had finished at least one session of LivingFree, 38.1% were successfully tobacco free. Of those who were assigned the American Cancer Society’s self-help materials, 13.3% were successful.

LivingFree employs a proprietary cognitive behavioral training process, derived from cognitive behavioral therapy (CBT). The process is designed to rewire the part of the brain that has become emotionally dependent on tobacco, as well as addressing the physical aspects of breaking free of nicotine.

Throughout the 12 sessions of the LivingFree program, participants are guided through the cognitive behavioral training process in a highly structured manner. They watch videos, take short quizzes and surveys, and complete assignments that change the way the brain perceives cigarettes and smoking or chewing/dipping. This process allows the smoker to become aware of the thought patterns and false beliefs that have kept them from being able to break free. Gradually, the smoker’s self-image changes, along with their brain’s trained cognitive response to tobacco, empowering them to permanently break free of their habit in as little as three weeks.

Apart from its superior efficacy rates, LivingFree is becoming a leading solution for the smoking problem and the RAS of choice in the workplace because of several other factors. First, it is a highly convenient option for employees. They can log on from home or from work, any time of day, and the mobile app allows course-accessibility from the phone. Second, the pricing: the cost per successful intervention is drastically lower than any other option. Third, LivingFree (and all the SelfHelpWorks programs) are easily implemented. Last but not least, SelfHelpWorks offers detailed real-time participant progress/completion reporting and downloadable program completion certificates.

To see a 3-minute overview video of the program, including the actual user experience, visit the LivingFree Smoking Cessation program page.

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The science behind the LivingFree tobacco cessation course

Smoking

LivingFree is a unique online course designed to eliminate and replace the dysfunctional, emotionally-charged subconscious thought patters that drive tobacco addictions.

This report details four independent studies that confirm the efficacy of the LivingFree smoking cessation program:

  • Study 1: Summary of Penn State University Study, with Comparative Data Added – Compares the LivingFree intervention with standard counseling and pharmaceutical treatments.
  • Study 2: Synopsis of Critical Evaluation of SelfHelpWorks Methodology – An evaluation of the scientific substance of the SelfHelpWorks method by two expert PhDs in the field of addictive behavioral treatment: John E. Martin, PhD and Scott T. Walters, PhD.
  • Study 3: LivingFree Randomized Trial at San Diego State University – In a study led by John Martin, PhD, 250 smoking volunteers were randomized into one of two treatments: LivingFree vs a standard American Cancer Society self-help intervention.
  • Study 4: LivingFree Trial at Saint Luke’s Hospital & Medical Center, San Antonio – In a study led by Michael Wooley, MD and John Whitlock, PhD, 157 smoking volunteers were divided into two groups, one of which took the live instructor-led version of LivingFree while the other took the Internet version. 

Download the PDF to learn the results of these studies.

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St. Luke’s Tobacco Cessation Study: LivingFree Live vs. Online​

Cigarettes in a graph

In this study, Michael Wooley, MD and John Whitlock, PhD compared the effectiveness of the self-guided online version of the LivingFree smoking cessation program against the same program given live in a classroom setting. Results were as follows:

  • 78% – smokers who remained quit for 6 months after completing the LivingFree course online
  • 83% – smokers who remained quit for 6 months after completing the live LivingFree course

Download the study to learn more, including:

  • How many subjects took part and how they were recruited
  • The materials and tools included for each delivery method
  • Participant drop-out rates for each method
  • Success rates for those who didn’t complete all sessions
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SDSU Tobacco Cessation Study ​

Man breaking a cigarette

In a study led by John Martin, PhD, Professor of Psychology and Director of the Behavioral Medicine Research and Training Clinic at San Diego State University, 250 smokers were randomized into one of two treatments. Results were as follows:

  • 38.1% – smokers who remained quit for six months after taking at least the first session of LivingFree
  • 13.3% – smokers who remained quit for six months after using the American Cancer Society self-help materials

Download the study to learn more, including:

  • Interesting statistics about smoking, smokers, and smoking treatments
  • How the study participants were selected and incentivized
  • Participant drop-out rates
  • Why the LivingFree program was more successful at helping more participants stay “quit”
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HRA Study: 60,000+ Participants

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A leading US wellness vendor compared the year-to-year annual Health Risk Assessment (HRA) information of 60,000+ employees across numerous industries who had taken a SelfHelpWorks program.

In this case study, you will learn how much the participants reduced each of the following costly health risks:

  • Stress
  • Physical inactivity
  • Tobacco use
  • Weight
  • Alcohol consumption

You will also gain valuable insights about: 

  • How much each of these unhealthy behaviors costs American employers
  • Average completion rates of SelfHelpWorks online programs
  • Two key factors that determine the success or failure or any population health management effort
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