Willpower Isn’t Enough: What it Takes to Quit Smoking


Can anyone who wants it badly enough simply quit smoking? Should most smokers be encouraged to try to quit without using medications?

The answer to both questions is “no,” so let’s explore what actually influences a person to quit and the role of medications.

Influences on quit attempts

Recent evidence suggests that motivation and intent are the main factors that determine who will make an attempt to quit smoking (1).

Regardless of how you measure it — there are several different ways — motivation is an important component of predicting who will make a quit attempt. A practical counseling technique known as motivational interviewing is often used to increase motivation for quitting. Interestingly, extrinsic motivation (a sense that one has a “duty” or ought to quit) actually reduces the probability of a quit attempt.

A person’s intent to quit smoking also appears to be associated with a higher likelihood that a quit attempt will be made. The more immediate a person’s intent to quit — for example, “tomorrow” versus “in the next six months” — the higher the likelihood that an attempt will be made.

Predicting success

While an attempt to quit is obviously required for someone to stop smoking, simply making an attempt does not predict success.

The strongest predictor of success in any attempt to stop smoking is the level of tobacco dependence, which is best measured by determining how many cigarettes are smoked per day. The greater the daily smoking rate, the lower the chances for prolonged tobacco abstinence.

Role of medications

For the lightest smokers — non-daily smokers, and smokers whose daily use is consistently fewer than 10 cigarettes — medications may not be needed.

People who consistently smoke 10 or more cigarettes each day need more than a strong desire to quit. They need one or more approved tobacco dependence treatment medications to help decrease their urge to smoke and reduce tobacco withdrawal symptoms.

It’s the clinician’s job to give motivational messages to all smokers, as well as provide medications to those who are not likely to quit on their own. I believe that almost every smoker who is motivated to quit should receive one or more medications to help support the quit attempt.

One of Global Bridges’ main objectives is to provide clinicians with up-to-date information about the best ways to treat tobacco dependence. Clinicians play an indispensable role, both in motivating quit attempts among their smoking patients and providing evidence-based treatment to help smokers quit for good.

Borland R, et al. Motivational factors predict quit attempts but not maintenance of smoking cessation: Findings from the International Tobacco Control Four country project. Nicotine & Tobacco Research. 2010;12:S4.