Funded by NIH
"I will tell as many people as possible about
SmokeSignals quit plans are built on principles of Scheduled Reduction. The scheduling
of cigarettes has proven even more important than the reduction of
cigarettes1. By removing smokers’ discretion, they do not give up
only low preference cigarettes2 and must balance their usage
throughout the day – sometimes having to smoke at inconvenient times that
create negative associations, and sometimes missing the chance to smoke during
their usual pleasurable situations.
Research shows that successful smoking cessation and relapse avoidance require
behavioral changes, and relearning takes time . Over the 4-8 week
regimens, smokers learn many coping skills and practice them hundreds of times.
This preparation for quitting is paramount to preventing relapse, which sadly
concludes most quit attempts within 7 days.
The process of scheduled gradual reduction titrates nicotine evenly throughout
the day. Nicotine fades so gradually and is dosed so evenly through the day
that quitters experience fewer withdrawal symptoms or urges3 .
Cravings that would normally trigger relapse are reduced when nicotine intake
is spaced smoothly throughout the day.
Quit rates have been exceptionally high with tailored reduction; urges and
withdrawal symptoms have been minimized and relapse rates have been lower in
several published academic studies. Dr. Paul Cinciripini and colleagues, in
pioneering trials at M.D. Anderson Cancer Center, developed this breakthrough
regimen, achieving 70%+ quit rates in two trials with 44% remaining smoke free
a year later.
Dr. Albert Jerome and colleagues working with early-stage hand-held computers
for smoking cessation implemented these principles in the LifeSign device from
the mid 1980’s. They reported abstinence rates of 13% to 24% in self-help
studies4 and quit rates as high as 36% when used with therapist
Three randomized controlled trials have been conducted on SmokeSignals®,
supported by NIDA and NCI SBIR funding. Our first
efficacy clinical trial yielded 36.4% abstinence among device-using
participants vs. 0% of the control group not using the device.
In a Harm Reduction trial aimed at
resistant quitters willing to reduce by half for five weeks, 49.5% of all
enrollees (n=47) met or exceeded weekly goals. Importantly, two-thirds of the
completers (21/ 33) opted to move on to cessation regimens at Week 6, and
two-thirds of those attempts (16) -- a third of the original pool of resistant
quitters) demonstrated abstinence.
A third recent trial compared a
group paced by our compliance adjusting algorithms to a group paced on a
three-week fixed schedule. The Adjusting group demonstrated a significantly
higher post-treatment bio-chemically validated 7-day point prevalence
abstinence rate (45.2% vs. 22.2%, SE = 9.3%; F = 102.74, p < 0.01), was more
compliant, and showed greater dependence reduction. When left to find their own
natural duration to cessation, the Adjusting group averaged 5. 5 weeks.
Two other long-term studies are in process and will be published next year.
Cinciripini, P.M., Wetter, D.W., McClure, J.B., (1997), Scheduled Reduced
Smoking: Effects on smoking abstinence and potential mechanisms of action.
Addictive Behaviors, 22, 6, 759-767
Pomerleau, O.F., & Pomerleau, C.S. (1984), Neuroregulators and the
reinforcement of smoking: Towards a biobehavioral explanation. Neuroscience
& Biobehavioral Reviews, 8, 503-513
Cinciripini, P.M., Lapitsky, L.G., Seay, S., Wallfisch, A., Kitchens, K., and
Van Vunakis, H. (1995). The effects of smoking schedules on cessation outcome:
Can we improve on common methods of gradual and abrupt nicotine withdrawal. , Journal
of Consulting and Clinical Psychology, 63, 388-399
Prue, D.M., Riley, A., Orlandi, M.A., Jerome A. (1990). Development of a
computer-assisted smoking cessation program: A preliminary report. Journal of
Advancement in Medicine, 3(2), 131-139.
Jerome, A., Perrone, R., & Kalfus G. (1992). Computer-assisted smoking
treatment: A controlled evaluation and long-term follow-up. Journal of
Advancement in Medicine, 5