Abstract 13872: Cue Restricted Smoking Increases Quit Rates With Varenicline

Abstract

Introduction: Varenicline effectively helps smokers quit by reducing withdrawal symptoms and blocking the reward of smoking. However, most quitters return to smoking within 1 year. “Cue-restricted smoking” is a behavioral technique designed to increase quit rates by asking smokers attempting to quit to restrict smoking to the standing position, while alone, in an isolated area facing a wall, with the cigarette as the only stimulus. Hypothesis: We compared the effectiveness of cue-restricted smoking cessation advice versus standard target quit date advice from day 8 of initiating varenicline in smokers making a quit attempt at the Smoking Cessation Service at the Prevention Department of the Heart Institute, Sao Paulo, Brazil. Methods: Using retrospective clinic records we compared quit rates in 281 smokers (50% males) instructed in the cue-restricted smoking cessation method during 2016-18 to quit rates in 324 smokers (46% males) advised to completely stop smoking on the target quit date which we previously used during 2011-14. All were prescribed varenicline for 12 weeks alone, with the addition of bupropion if needed after 4 weeks. Follow-up consisted of behavioral support at 4-6 visits during active drug treatment and telephone counselling at 24 and 52 weeks. The smoking cessation rate was confirmed with expired carbon monoxide at the 12-week clinic visit and only by telephone at 52 weeks. Results: The mean age of smokers was 49 ±12 years both groups and the number of cigarettes smoked daily was similar (18/day in the cue-restricted versus 19/day in the target quit day group). The smoking cessation rate at 12 weeks was 75% in the cue-restricted versus 45% in the target quit day group (relative risk 1.8; 95% confidence interval 1.4-2.2; p<0.001). At 52 weeks the quit rate was 65% vs 34% respectively (relative risk 1.9; 95% confidence interval 1.5-2.4; p<0.001). Conclusion: Cue restricted smoking substantially increased the chance of quitting compared with standard advice during treatment with varenicline . These results should be further studied in a randomized controlled trial.