Gradual Cessation Research Articles

Varenicline Helps in Gradual Smoking Reduction

Back to table of contents Previous article Next article Professional NewsFull AccessVarenicline Helps in Gradual Smoking ReductionVabren WattsVabren WattsSearch for more papers by this authorPublished Online:13 Mar 2015https://doi.org/10.1176/appi.pn.2015.3b5AbstractClinical guidelines from the Agency for Healthcare Research and Quality recommend promoting smoking-cessation aids that will help cigarette users quit smoking abruptly, though research suggests that 44 percent of cigarette smokers prefer to quit through a more-gradual approach such as a reduction in the number of cigarettes—implying that more-effective therapies are needed to meet the demands of some patients seeking abstinence from smoking.Brian Jackson/ShutterstockTo address the preferences of these smokers, researchers from the Mayo Clinic Nicotine Dependence Center conducted a large-scale study to determine the efficacy and safety of the smoking-cessation drug varenicline in increasing smoking abstinence rates through gradual smoking reduction.“This study is important because it opens the door to treatment for approximately 14 million smokers who have no intention of quitting in the next 30 days but are willing to reduce their smoking rate while working toward a quit attempt,” said lead author Jon Ebbert, M.D., a professor of medicine and researcher in tobacco cessation. “In the past, these smokers may have not received medication therapy, and we want them to know that different approaches are available.”According to the researchers, prior studies of pharmacotherapy-aided reduction have examined nicotine-replacement therapies that deliver nicotine through methods independent of tobacco, such as a skin-adhesive patch or chewing gum. Varenicline is a nicotine receptor partial agonist and key ingredient in the smoking-cessation drug Chantix (Psychiatric News, October 10, 2013). Recent studies have shown varenicline to be efficacious in increasing smoking abstinence rates in those cigarette users seeking to quit smoking abruptly, but the current study is one of the first, the researchers noted, to investigate the pharmacotherapy’s effectiveness in those seeking a gradual method for smoking cessation.Ebbert and colleagues randomly assigned 1,510 cigarette smokers to receive 1 mg of varenicline or placebo for 24 weeks. They recruited smokers who were not willing or able to quit smoking within the next 30 days but willing to reduce smoking and make an attempt to quit such behavior within the following three months.The results, published in the Journal of the American Medical Association, showed that 32 percent of the varenicline cohort achieved continuous abstinence during weeks 15 through 24, compared with 6.9 percent in the placebo cohort. In addition, the researchers observed that individuals in the varenicline group were three times more likely than the placebo group to maintain abstinence six months after treatment. Rate of serious adverse events did not differ statistically among the cohorts.“Smokers should know that varenicline can help them quit smoking if they want to reduce their smoking prior to completely stopping,” said Ebbert. “It’s an effective and safe way to increase long-term smoking cessation.”The researchers speculated that “the mechanism of varenicline action as an aid to gradual cessation could relate to a reduction in cigarette craving or a blockade of the reinforcing action of nicotine through partial agonist activity at the nicotine receptors,” subsequently giving patients the confidence to quit smoking. The researchers concluded that though guidelines from the U.S. Public Health Service and others recommend abrupt abstinence from cigarette use with smoking-cessation aids, the current varenicline-based approach allows clinicians to choose from more therapeutic options when caring for patients who are seeking to slowly wean themselves from smoking. The study was funded by Pfizer, which manufactures the Chantix brand of varenicline. ■An abstract of “Effect of Varenicline on Smoking Cessation Through Smoking Reduction” can be accessed here. ISSUES NewArchived

Nicotine replacement therapy to aid gradual cessation in smokers with no intention to quit: Association between reduction quantity and later abstinence

ObjectiveWe examined how quantity and trajectory of smoking reduction influence later abstinence in smokers without intention to quit and being prescribed free nicotine replacement therapy (NRT). MethodWe conducted an a posteriori analysis from a data archive of adult smokers in a randomized controlled trial of smoking reduction using counseling and free NRT (n=928). Reduction was analyzed as the absolute and percentage decrease in self-reported daily cigarette consumption at three follow-ups (1week, 1 and 3months) compared with the baseline. Logistic regression model and multiple imputation were used to examine the association between early reduction and abstinence at 6months. ResultsReducing 10% of cigarette consumption at the three follow-ups was associated with 16% (95% CI 5–28%), 23% (95%CI 11–36%) and 27% (95% CI 13–42%) increase in abstinence, respectively. Greater reduction predicted abstinence when the percentage reduction was more than one-third (above 31.4%). Progressive increase in the percentage reduction predicted more abstinence (OR=1.90, 95%CI 1.01–3.58). ConclusionsGreater percentage reduction by at least one-third and progressive reduction predicted abstinence in those who reduced smoking. Such new evidence can guide the improvement of clinical service for tobacco dependency treatment and support further studies on smoking reduction and cessation.

Urban and rural infant-feeding practices and health in early medieval Central Europe (9th-10th Century, Czech Republic).

In the Central European context, the 9th and 10th centuries are well known for rapid cultural and societal changes concerning the development of the economic and political structures of states as well as the adoption of Christianity. A bioarchaeological study based on a subadult skeletal series was conducted to tackle the impact of these changes on infant and young child feeding practices and, consequently, their health in both urban and rural populations. Data on growth and frequency of nonspecific stress indicators of a subadult group aged 0-6 years were analyzed. A subsample of 41 individuals was selected for nitrogen and carbon isotope analyses, applying an intra-individual sampling strategy (bone vs. tooth). The isotopic results attest to a mosaic of food behaviors. In the urban sample, some children may have been weaned during their second year of life, while some others may have still been consuming breast milk substantially up to 4-5 years of age. By contrast, data from the rural sample show more homogeneity, with a gradual cessation of breastfeeding starting after the age of 2 years. Several factors are suggested which may have been responsible for applied weaning strategies. There is no evidence that observed weaning strategies affected the level of biological stress which the urban subadult population had to face compared with the rural subadult population.

Ферментные препараты поджелудочной железы без кишечнорастворимой оболочки: используются ли они сегодня?

Введение. Для лечения экзокринной недостаточности поджелудочной железы рекомендована заместительная терапия высокодозовыми ферментными препаратами с кишечнорастворимой оболочкой. В связи с этим возникает вопрос о целесообразности клинического применения более старых низкодозовых ферментных препаратов без кишечнорастворимой оболочки (в качестве референсного препарата служил Мезим® форте). Результаты. Ряд анатомо-физиологических особенностей и активное применение средств, подавляющих желудочную секрецию — ингибиторов протонной помпы, антацидов (натрия бикарбоната), позволяют существенно повысить «выживаемость» панкреатических ферментов, не имеющих кишечнорастворимой оболочки, в желудочном соке и их доставку в двенадцатиперстную кишку. Данная лекарственная форма продолжает применяться для купирования болевого синдрома при хроническом панкреатите (препараты с кишечнорастворимой оболочкой неэффективны). Предложено использовать комбинацию обеих лекарственных форм — с кишечнорастворимой оболочкой и без нее — для более эффективной терапии экзокринной недостаточности поджелудочной железы. При функциональных заболеваниях желудочно-кишечного тракта (синдром раздраженного кишечника с функциональной патологией поджелудочной железы, функциональная диспепсия) ферментные препараты без кишечнорастворимой оболочки ускоряли выздоровление пациентов. При воспалительных заболеваниях кишечника (неспецифический язвенный колит, болезнь Крона) и хронической обструктивной болезни легких данная лекарственная форма увеличивала длительность ремиссии, причем при заболеваниях кишечника — и качество жизни во время ремиссии. Ферментные препараты без кишечнорастворимой оболочки применялись и при ряде других заболеваний, сопровождающихся мальдигестией/мальабсорбцией. Кроме того, их применяли для постепенного (мягкого) ухода от терапии высокодозовыми ферментными препаратами. Они также находят свое применение для коррекции экзокринной недостаточности поджелудочной железы при легких перекусах и погрешностях в диете. Финансовые показатели продаж свидетельствуют о высокой востребованности низкодозовых ферментных препаратов без кишечнорастворимой оболочки (Мезим® форте). Выводы. Низкодозовые ферментные препараты без кишечнорастворимой оболочки продолжают широко применяться в современной клинической практике.

Phyto-Oestrogens and Chaste Tree Berry: A New Option in the Treatment of Menopausal Disorders

For a woman, menopause represents a transitional phase from a fertile to a non-fertile age, in which there is a gradual reduction in ovarian function accompanied by a gradual cessation of oestrogen production. The clinical presentation can involve a series of disorders, including hot flushes with episodes of sweating, particularly at night, palpitations, changes in sleep-wake rhythm, irritability, anxiety and mood changes, vaginal dryness due to a process of progressive atrophy with thinning of the outer and inner labia, reduction of vascularisation and elastic fibres, and decreased sexual desire; subsequently, Many women use alternative therapies to treat hot flushes and other menopausal symptoms. The purpose of this review is to summarize current information on the efficacy and safety of phytoestrogens and the herbal medicine. Given the importance that these symptoms assume for the woman, not only for the perceived quality of life, but also for the increased risk of developing all the diseases, all the treatments adopted for menopausal women are directed primarily to resolving vasomotor disorder.

Abstract 18483: Randomized, Double Blind Trial of Tapered versus Abrupt Interruption of Long Term Clopidogrel Therapy After Drug-Eluting Stent Implantation - ISAR-CAUTION

Purpose: Observational data suggest clustering of thrombotic events after cessation of antithrombotic therapy in patients with coronary artery disease. The underlying mechanism has been ascribed to a potential rebound platelet activity after discontinuation of chronic clopidogrel therapy. This may have a negative impact particularly in patients receiving drug-eluting stents. We therefore hypothesized that gradual clopidogrel therapy cessation attenuates the potential risks associated with abrupt clopidogrel therapy cessation in that patient population. Methods: Patients with planned discontinuation of chronic clopidogrel therapy after drug-eluting stent implantation were randomized in a double-blinded fashion to either gradual or abrupt interruption of clopidogrel therapy. The primary endpoint is a composite of cardiac death, myocardial infarction, stroke, stent thrombosis (definite or probable), major bleeding or rehospitalisation due to an acute coronary syndrome at 3 months after randomization. The trial is registered with ClinicalTrials.gov Identifier: NCT00640679 . Results: Enrollment was stopped prematurely due to slow recruitment. A total of 782 patients were enrolled. Follow-up has been completed. Results will be available in June 2013. Conclusions: The results will help to define the best way of clopidogrel therapy cessation after drug-eluting stent implantation.

Gradual Reduction vs Abrupt Cessation as a Smoking Cessation Strategy in Smokers Who Want to Quit

Is gradual smoking cessation associated with poorer success rates than abrupt cessation in smokers who want to quit? Gradual reduction may not be associated with a clinically significant difference in smoking cessation rates compared with abrupt cessation.

Gradual cessation of milking reduces milk leakage and motivation to be milked in dairy cows at dry-off

The effects of gradual versus abrupt cessation of milking at dry-off in dairy cows are not well understood, but gradually reducing milk production in human mothers is known to reduce discomfort and milk leakage. This study compared the effects of abrupt versus gradual cessation of milking on milk leakage and dairy cow behavior. Holstein dairy cows were housed in groups of 6 and randomly assigned to either abrupt milk cessation (i.e., dry-off on d 0) or gradual milk cessation (i.e., skipped milkings beginning on d 0; dry-off on d 5). Four replicates were performed over time, for a total of 24 cows (mean ± SD; parity=2.3±1.2; milk production the day before d 0=24±5kg/d). Intramammary antibiotic, internal teat sealer, and external teat sealant were administered at dry-off. Measurements were taken from d −3 to 8 relative to dry-off. Three periods were identified for behavior data: baseline (d −3 to 1), period 1 (abrupt cows dry, gradual cows milking; d 0–4), and period 2 (all cows dry; d 5–8). Lying time was recorded with data loggers. Video scan samples (5-min intervals) were used to measure feeding time and motivation to be milked (i.e., standing at the pen's exit gate). Milk leakage was monitored every 20min during the 2-h period following the milking times of 0500 and 1500h after complete cessation of milking (period 1 for abrupt vs. period 2 for gradual). Composite milk samples were taken before dry-off (d −1, 0, and 5) and at the start of the next lactation (colostrum, 24h and 7–10 d postcalving) to determine somatic cell score (SCS) and conduct bacteriological examinations in clinical mastitis cases. Regardless of treatment, dry-off resulted in reduced lying time [14.1 vs. 13.2h/d; standard error of the difference (SED)=0.2], reduced lying bouts (10.7 vs. 8.3 bouts/d; SED=0.2), increased lying bout duration (1.4 vs. 1.7h/bout; SED=0.03) and increased feeding time (5.0 vs. 5.9h/d; SED=0.2). Compared with baseline, the odds of standing at the gate increased for abrupt cows (period 1: odds ratio=6.2; 95% CI: 2.7–14.4; and period 2: odds ratio=5.2; 95% CI: 1.8–14.6). No increase in time spent standing at the gate was noted in gradual cows. Frequency of leakage was greater in abrupt versus gradual cows (75 vs. 27%). Although the gradual treatment showed an increase in SCS over the 5 d of reduced milking frequency, both treatments showed an increase in SCS at calving and both returned to pre-experiment levels within 7 to 10 d after calving. This work demonstrates that gradually reducing milking frequency in high-producing cows results in reduced time spent anticipating milking and reduced milk leakage after dry-off.

Spatio-temporal analysis of groundwater regime within Rawalpindi Municipal Jurisdiction, Pakistan

The study investigates the spatial and temporal variation of groundwater table within municipal precincts of Rawalpindi metropolitan city. The research was based on current and historic withdrawals as a primary source of drinking water supply. A geodatabase of 278 tube wells with three distinct timelines of recorded subsurface water levels was developed. Vertical sections were extracted from the interpolated surfaces and reconciled to a common x, y reference to isolate spatial and temporal trend of water table. Over exploitation of groundwater is leading to progressive depletion of the groundwater resource. The decline in groundwater level was observed to be steep in areas farthest from the potential recharge zones, a phenomenon that is also coincident with the density of the installed wells. Gradual cessation of pumpage within the metropolitan area and artificial means of replenishing the groundwater aquifer are recommended.

An updated algorithm for choosing among smoking cessation treatments

Although meta-analyses have documented the efficacy of treatments for smoking cessation, and guidelines have outlined treatment elements, few algorithms for choosing among treatments have been described. The current algorithm updates the author's prior algorithm. The major decisions in the algorithm are (a) use a motivational treatment if the smoker is not currently interested in quitting, (b) assess factors that influence choice of treatment, (c) consider both gradual and abrupt cessation, (d) use combined patch+gum/inhaler/lozenge or varenicline as first line medications, (e) use individual, group, Internet, and phone counseling as first line psychosocial treatments, and (f) continue treatment after a lapse or relapse. Further research is needed to determine whether algorithms improve treatment outcomes.

Holocene relative sea levels and paleogeographies of the Delaware River estuary: implications for current rates of sea-level change

Isolation basins, raised tidal marshes, coastal wetlands and dune systems around Arisaig in northwest Scotland produce a ∼16 000-year record of relative sea-level (RSL) change from the time of local deglaciation following the Last Glacial Maximum (LGM) to the present. New sea-level index points from Mointeach Mhor North define the culmination of the mid-Holocene RSL highstand to ∼7600–7400 cal yr BP and 6.74±0.2 m above present. Numerous sea-level index points indicate that the RSL highstand persisted more than 1000 years before the onset of any significant RSL fall. This points to a gradual cessation of melting of the Laurentide and Antarctic ice sheets, rather than an abrupt termination. Isolation basin evidence, from a marine limit ∼34 to 38 m above present down to sites close to current sea level, constrain the acceleration of eustatic sea-level rise during meltwater pulse 1a to ∼30 mm yr−1 or ∼11 km3 yr−1 meltwater discharge. Comparison of RSL observations with glacial isostatic adjustment (GIA) model predictions show differences in the pattern of residuals dependent upon the GIA model used. Changes to the far-field ice model components can partly explain the patterns of residuals.

Transitions in Smoking Behaviour and the Design of Cessation Schemes

The intake of nicotine by smoking cigarettes is modelled by a dynamical system of differential equations. The variables are the internal level of nicotine and the level of craving. The model is based on the dynamics of neural receptors and the way they enhance craving. Lighting of a cigarette is parametrised by a time-dependent Poisson process. The nicotine intake rate is assumed to be proportional with the parameter of this stochastic process. The effect of craving is damped by a control mechanism in which awareness of the risks of smoking and societal measures play a role. Fluctuations in this damping may cause transitions from smoking to non-smoking and vice versa. With the use of Monte Carlo simulation the effect of abrupt and gradual cessation therapies are evaluated. Combination of the two in a mixed scheme yields a therapy with a duration that can be set at wish.

Toward a recovery time: forest herbs insight related to anthropogenic acidification

AbstractAtmospheric deposition is a global concern contributing to soil acidification and biodiversity changes in forest ecosystems. Although acidifying deposition has decreased in the last decades in Europe, few evidence of ecosystem recovery from acidification has been reported until now. The objective of this study was to reconstruct spatiotemporal changes in soil pH across the entire French forest territory over the last 100‐year period through herb species assemblages. Data were collected from floristic databases resulting in a total of 120 216 plots covering French forests and spanning from 1910 to 2010. To define acidity figures, pH values were inferred from herb assemblages for each plot of the prediction dataset based on a weighted averaging partial least squares (WA‐PLS) model (R2 = 0.80, SD = 0.59 for the validation dataset). Spatiotemporal trends of mean pH changes were obtained by comparing plots with respect to the period (mean year of the period = 1933, 1966, 1984, 1997, 2007) and substrate (acidic and nonacidic forest areas). Bioindicated pH highlighted a decrease in soil pH in both acidic and nonacidic forest areas. The sharpest and most significant pH decrease occurred before 1984 in acidic areas, reaching 0.34 pH units. Subsequently, no significant changes were observed, with a tendency toward stabilization. By contrast, the pH decrease reached 0.19 pH units in nonacidic areas, only reaching significance between 1984 and 1997. Thereafter, we observed a slight and significant pH increase. Spatially, pH trends revealed a regionalized character of acidification regarding the substrate, which could not be related to the extent of deposition modeled by the European Monitoring and Evaluation Programme. Both temporal and spatial trends highlight the lagged responses of nonacidic areas compared with acidic areas. Hence, floristic reconstructed pH trends demonstrate a gradual cessation and recovery from acidification of French forests after a period of intense atmospheric pollution.

Inhibition of Ion Channels and Heart Beat in Drosophila by Selective COX-2 Inhibitor SC-791

Recent findings suggest that modulation of ion channels might be implicated in some of the clinical effects of coxibs, selective inhibitors of cyclooxygenase-2 (COX-2). Celecoxib and its inactive analog 2,5-dimethyl-celecoxib, but not rofecoxib, can suppress or augment ionic currents and alter functioning of neurons and myocytes. To better understand these unexpected effects, we have recently investigated the mechanism of inhibition of human Kv2.1 channels by a highly selective COX-2 inhibitor SC-791. In this study we have further explored the SC-791 action on ion channels and heartbeat in Drosophila, which lacks cyclooxygenases and thus can serve as a convenient model to study COX-2-independent mechanisms of coxibs. Using intracellular recordings in combination with a pharmacological approach and utilizing available Drosophila mutants, we found that SC-791 inhibited voltage-activated K+ and L-type Ca2+ channels in larval body-wall muscles and reduced heart rate in a concentration-dependent manner. Unlike celecoxib and several other K+ channel blockers, SC-791 did not induce arrhythmia. Instead, application of SC-791 resulted in a dramatic slowing of contractions and, at higher concentrations, in progressively weaker contractions with gradual cessation of heartbeat. Isradipine, a selective blocker of L-type Ca2+ channels, showed a similar pattern of heart arrest, though no prolongation of contractions was observed. Ryanodine was the only channel modulating compound of those tested additionally that was capable of slowing contractions. Like SC-791, ryanodine reduced heart rate without arrhythmia. However, it could not stop heartbeat completely even at 500 µM, the highest concentration used. The magnitude of heart rate reduction, when SC-791 and ryanodine were applied together, was smaller than expected for independent mechanisms, raising the possibility that SC-791 might be interfering with excitation-contraction coupling in Drosophila heart.

Becoming independent storytellers: Modeling children’s development of narrative macrostructure

For parents to provide effective support for their children’s language development, they must be attuned to their child’s changing abilities. This study presents a theoretically driven strategy that addresses a methodological challenge present when tracking longitudinally the cessation or ‘fading’ of behaviors by capturing withdrawal of maternal assistance over time relative to change in child participation. Data are the co-constructed narratives of 31 mother–child dyads when the children were 3, 4, and 5 years old. Responsibility for providing narrative macrostructure shifted from children relying on maternal prompts to contributing them spontaneously, while maternal contributions showed a gradual cessation. The findings support the notion of bidirectionality in co-construction and are interpreted using a dose-effect model of the shift in responsibility for the narration over time with implications for intervention.

Gradual cessation of proton pump inhibitor (PPI) treatment may prevent rebound acid secretion, measured by the alkaline tide method, in dyspepsia and reflux patients

Gastro esophageal reflux disease and ulcer related or non-ulcer dyspepsia, attacks 20% of the Western population. These millions of patients are treated continuously with PPI for different periods, many for many years. Recently, rebound acid hypersecretion was recognized as a major clinical event after cessation of PPI therapy. Sustained hypergastrinemia due to daily PPI therapy causes increased acid-secretory capacity that appears when the drug is stopped. The transient increase in blood and urinary pH following gastric secretion has been termed the alkaline tide phenomenon. Carbonic acid, formed in the presence of the enzyme carbonic anhydrase, neutralizes intracellular hydroxyl ions produced as a result of luminal acid secretion. The bicarbonate generated is removed from the cell via the baso-lateral chloride bicarbonate exchanger. We have shown in several studies that this phenomenon parallels acid secretion. Thus, stimulation of acid secretion with test meal increased base excess maximally after 45min and these changes parallel peak acid output measured in gastric aspirate. We hypothesize that gradual step down cessation of PPI will prevent this clinical relevant event. By measuring alkaline tide after PPI cessation we may prove this hypothesis.

Conflict About Quitting Predicts the Decision to Stop Smoking Gradually or Abruptly: Evidence From Stop Smoking Clinics in Malaysia

AbstractBackground: Little is known about the extent to which smokers attending stop-smoking clinics experience conflicting motivations about their quit attempt, whether such conflict can be understood in terms of a single dimension and if this ‘conflict about quitting’ differs from motivation to stop smoking and is associated with a smoker's choice of method to stop smoking (stopping gradually or abruptly). Method: Sociodemographic, smoking and quit attempt characteristics as well as measures relating to conflict about stopping smoking were recorded in a cross-sectional survey of 198 smokers attending five quit smoking clinics in Malaysia. Results: Five measures (having seriously thought about quitting before, being happy about becoming a non-smoker, being strongly motivated to stop, intending to stop smoking completely and believing in stopping for good this time) were loaded onto a single factor that could be labelled ‘conflict about quitting’. The resultant scale had moderate internal reliability (Cronbach's α= .625). Most smokers exhibited conflicting motivations about stopping smoking, with over half (52.0%, 95% CI 45.1–59.1) scoring 2 or higher on the 5-point conflict scale. ‘Conflict about quitting’ was significantly associated with the decision to stop smoking gradually rather than abruptly controlling for other variables (OR 1.36, 95% CI 1.05–1.76) and was more strongly associated with the choice of smoking cessation method than motivation to stop smoking. Conclusions: ‘Conflict about quitting’ can be conceptualised as a single dimension and is prevalent among smokers voluntarily attending stop-smoking clinics. The finding that smokers who display greater conflict about quitting are more likely to choose gradual cessation may explain contradictory findings in the literature regarding the effectiveness of different methods of smoking cessation.

Comparing abrupt and gradual smoking cessation: A randomized trial

AimsTo compare abrupt and gradual smoking cessation. Design and settingRandomized trial and observational study, Internet, 2007–2010. ParticipantsSmokers with no strong preference for abrupt or gradual quitting were randomly assigned to quitting immediately (n=472), or to gradually reducing their cigarette consumption over 2 weeks and then quit (n=502). Smokers who strongly preferred to quit abruptly were instructed to do so immediately (n=2456), those who strongly preferred gradual were instructed to reduce their cigarette consumption over 2 weeks, then quit (n=1801). Follow-up was conducted 4 weeks after target quit dates. FindingsThose who preferred abrupt quitting were the most motivated to quit and the most confident in their ability to quit. At follow-up, quit rates were 16% in those who preferred abrupt cessation, 7% in those who preferred gradual cessation and 9% in those who had no preference (p<0.001). In the latter group, quit rates were equal for those randomized to abrupt or gradual (9%, p=0.97). In those who expressed a strong preference for either method, there were interactions between quitting method, motivation to quit and confidence in ability to quit: those who had low levels of motivation or low levels of confidence were more likely to quit at follow-up if they preferred and used abrupt rather than gradual. ConclusionsIn those who had no strong preference for either method, abrupt and gradual produced similar results. Those who preferred and used the abrupt method were more likely to quit than those who preferred and used the gradual method, in particular when they had low motivation and confidence.

Delirium as a Symptom of Tricyclic Antidepressant Withdrawal

A withdrawal syndrome following abrupt or gradual cessation of heterocyclic antidepressants has been well documented [1,2]. Common symptoms are nausea, emesis, anorexia, diarrhea, rhinorrhea, diaph...

A randomized, controlled trial of NRT-aided gradual vs. abrupt cessation in smokers actively trying to quit

Most smoking cessation programs advise abrupt rather than gradual cessation. We conducted a randomized, controlled trial of gradual cessation ( n = 297) vs. abrupt cessation ( n = 299) vs. minimal treatment ( n = 150) among smokers who wanted to quit now and preferred to quit gradually. Participants were recruited via newspaper and radio advertisements. The gradual and abrupt conditions received five phone calls (total = 90 min) and the minimal treatment condition received two calls (25 min total). The gradual condition received nicotine lozenge (via mail) to reduce smoking prior to their quit date. After the quit day, all participants received lozenge. The primary outcome was prolonged abstinence from 2 weeks post-quit day through 6 months. Prior to the quit day, the gradual condition decreased cigarettes/day by 54%, whereas the other two conditions decreased by 1% and 5%. Prolonged abstinence rates (CO < 10 ppm) did not differ among gradual, abrupt and minimal treatment conditions (4%, 7% and 5%), nor did 7-day point prevalence rates (7%, 11% and 11%). Fewer smokers in the gradual condition (48%) made a quit attempt than in the abrupt (64%) or minimal (60%) conditions ( p < .001). In the gradual condition, every week delay to the quit date increased the probability of lapsing by 19% ( p < .001). We conclude that among smokers who want to stop gradually in the near future, gradual cessation with nicotine pre-treatment does not produce higher quit rates than abrupt cessation. One liability of gradual reduction may be that it allows smokers to delay their quit date.