Cochrane review finds combining medication with behavioural support helps smokers quit

It’s been great to see all the tweets from people quitting smoking this month as part of the Stoptober campaign, and there’s been plenty of encouragement and support for them in the twittersphere, along with tips to help them beat the cravings and keep going. I’ve been doing my best to keep my neighbour Elder Elf up to it too (you can see the handy hint I’ve put in our bit of woodland in the photo!), but what kind of support works best? Of course, it’s a topic we keep returning to as we come across evidence that might help us answer this important question.

There are guidelines on helping people stop smoking which recommend combining behavioural support, like counselling sessions, with medicines, including nicotine replacement therapy as gum or patches. But surveys in the US and the UK have suggested that a very small proportion of smokers trying to give up use combined supports, and it’s not really known which treatments work best together.

A new Cochrane review has looked at the evidence on combining drug treatments with behavioural support to help smokers quit. Forty-one trials involving over 20,000 people were included and results combined where possible. A large trial (6000 people) was considered separately, as the treatment programme was very different from the others. All the studies compared people receiving a combined programme with ‘control’ groups, who typically were offered brief advice and self-help materials.

Here’s what they found:

  • Combining medicines and behavioural support was more effective than just brief advice or other types of minimal support, such as leaflets
  • In studies where most people actually used the treatments on offer, increasing the amount of contact time or the number of sessions seemed to make the programmes more effective. If all the studies are looked at, there is no clear evidence that increasing contact time helps and only weak evidence that offering more sessions makes programmes more effective
  • The large study of an intensive programme, with lots of group sessions, nicotine gum available over a long time and contact also continued long term, found this a very effective way to help smokers quit
  • The review authors judged the evidence to be of good quality overall and note that the findings are similar across the studies, despite lots of differences in the types of people involved and in where the programmes took place (such as health clinics or workplaces)

The authors conclude that clinicians should encourage smokers to use both types of aid, which they suggest might typically increase someone’s chance of successfully giving up smoking by 70% to 100%, compared with their chances if they received just brief advice or support.

I’d better go and check on Elder Elf and perhaps suggest that he listens to one of the authors, Lindsay Stead, talking about the review in a podcast, while he chews his nicotine gum. If you want to hear it, just click on the link below, where you’ll also find a summary of the review, or go straight to the full text.


Stead  LF, Lancaster  T. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database of Systematic Reviews  2012, Issue 10. Art. No.: CD008286. DOI: 10.1002/14651858.CD008286.pub2.

Cochrane summary and podcast of this review

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Sarah Chapman

My name is Sarah Chapman. I have worked on systematic reviews and other types of research in many areas of health for the past 17 years, for the Cochrane Collaboration and for several UK higher education institutions including the University of Oxford and the Royal College of Nursing Institute. I also have a background in nursing and in the study of the History of Medicine.

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