Internal Barriers to Seeking Smoking Cessation Treatment John Hughes, M.D.

6-8 Week Abstinence - Placebo Conditions

VT Adult Tobacco Survey 2004 Depending on treatment, 66-92% of smokers are aware of free treatment Yet, < 5%of VT smokers use any treatment when they try to quit

Internal Barriers to Stopping Smoking Grant Study 1- Qualitative item generation from experts and smokers Study 2- Item selection and psychometric testing Study 3- Predictive validity test

Internal Barriers to Stopping Smoking Grant Examines only quit-lines due to lack of external barriers and lack of research Outcome: Themes to use in media and counseling

Nicotine Literatures Barriers to making a quit attempt Barriers to using stop-smoking medications

Non-Nicotine Literatures Treatment seeking among those with alcohol/drug abuse Help-seeking among those with psychiatric problems Treatment seeking among those with medical symptoms

Major Categories of Internal Barriers Stigma (character/pride) Disbelief of efficacy Necessity of treatment Privacy Fear of coercion/judgment Embarassment if failed Lack of social validity

Example items Others have quit without it, so I should be able to also I would lose the opportunity to do it on my own

Example items Counselors would pressure me to quit You don’t need help, you just need to motivate yourself

Planning for Quit Attempts 51% unplanned (Larabie, 2005) 49% unplanned (West, in press) Thus, perhaps we need to first focus on motivating smokers to plan quit attempts

Summary Some smokers are unlikely to quit with motivation alone Removal of external barriers may not dramatically increase treatment use

Summary We need to know major internal barriers to design media and counseling strategies We need to learn from other literatures If quit attempts are very spontaneous, it will be harder to prompt treatment seeking

Treatment Seeking Acceptance of addiction means acceptance of treatment Comparison with depression treatment Good treatments Professional guild High profile testimonies DTC ads focus on disease Victims of industry vs victims of disease