Quitting smoking 'cold turkey' and barriers to using support: Qualitative research
Summary of findings
Definition of “cold turkey”
There was no consistent definition of cold turkey. For some it was synonymous with ‘going it alone’, for others it referred specifically to the physical process of nicotine withdrawal. Others still thought that it was a spontaneous quit attempt, with no planning or preparation.
It always had drug connotations – and was universally seen as tough, hard, a painful struggle, although a successful cold turkey attempt is a great source of pride.
Triggers and motivations
There are many different reasons to quit, but the general reasons that surround a smoker are not usually the triggers that provoke a quit attempt. Triggers are usually personal and specific (a trigger is for instance ‘feeling out of breath when running’, whereas the motivation is concern for the health risks.)
How smokers prepare for a quit attempt
The quitting process begins long before the quit attempt actually starts, with the smoker subconsciously absorbing all kinds of quitting information around them, and then gradually falling out of love with their habit, before they then embark on the quit attempt itself.
Few actively researched quitting methods – word of mouth was the most important source of information. Many quitters already had their next quit method in mind before they began their attempt.
Willpower was seen as central to all quit attempts, whatever the method used and it was seen as a positive and desirable force. Hence smokers were often cast down by their perceived lack of willpower.
Those around the smoker (friends, family) were often seen as less supportive than they could be. The best support comes from those who have been through it.
The best time for a quit attempt is the time the smoker feels is best for them – not a date imposed on them from outside (like New Year’s Day).
The quitting journey
All smokers began by trying to quit with “cold turkey” alone. Everyone thinks they can do it by themselves and are always surprised by how difficult it is. Many try several times on their own. Often, after multiple attempts, smokers move on to NRT. Patches and gum were the most popular NRT options.
NRT is often used casually at first, but if casual use did not lead to success the smoker may then turn to outside help. Outside help was rarely sought before trying to go it alone, and casual NRT tended to precede more structured, supervised attempts. Many smokers do not proceed beyond going it alone, and some do not proceed beyond casual NRT.
Those who decide to try something else then tend to visit the doctor, and get introduced to a more structured use of NRT or referred to the NHS Stop Smoking Services. Alternative and pharmaceutical methods are always seen as more extreme and are usually only used after going it alone and NRT are exhausted.
Alternative methods (such as hypnotherapy) are quite alien to this target, and self-help books are not a natural fit.
Perceptions of NHS Stop Smoking Services
The NHS was not regarded as a quitting method so much as a source of NRT and prescriptions. There was little sense of a seamless quitting experience.
The initial contact with the Stop Smoking Services tended to be via the GP or the Helpline.
Perceptions of the helpline were unclear – was it a call centre? Or was it telephone counselling service?
GPs were not consistent in their response. While some seemed understanding and constructive, others were felt to be judgemental or unhelpful in their advice.
One to One support was seen as a potentially practical way to help stop smoking. However, the need for ongoing attendance at sessions was often seen as a negative.
Support groups were often an unappealing proposition. Smokers generally thought these sessions would be similar to counselling for ‘more serious’ addictions (alcohol or narcotics). Response to support groups was always more positive when considered as being similar to Weightwatchers. (Although this had a very female image.)
The role of the NHS
There was a lack of clarity of branding around the NHS Stop Smoking Services, which could act as a barrier to engagement. Smokers often did not have a clear understanding of the journey they would be making through the services. Smokers who had successfully quit with the NHS services often did not attribute their success to the services, and so there was a lack of positive word of mouth.
Definition of success
Smokers felt success had been reached when they no longer felt the urge to smoke, although acknowledged that this urge could return at any time.
Interestingly those methods seen as dynamic and positive tended to be seen as more successful – even if they did not actually work for that particular smoker. There was more a sense that ‘I’ve failed’ rather than ‘that method did not work for me’.
We often found that a change in routine was a key component of success, whether from outside circumstances or self-imposed.
When a quit attempt failed early, the smoker usually felt that they had tried to quit before they were ready, and that their attempt was flawed in some way. Later failure was usually attributed to a crisis from outside or complacency (‘just one cigarette won’t hurt...’).
Interestingly the triggers to relapse could be the same kind of crises that triggered a quit attempt (such as a death in the family).
It always took smokers longer than unexpected to recover from a failed quit attempt, leaving at least 3-6 months if not longer between attempts.
The aim of this research was to:
- Explore “cold turkey as a method” – in particular, the different meanings, connotations and terminology used around it and why smokers choose it
- Explore the broader quitting context – understanding smokers’ quitting journeys, awareness and perceptions of different quitting smoking methods
- Understanding smokers’ quitting histories – their first and subsequent quit attempts
- Understand the role of the NHS within this, and any perceived gaps in support available
The Department of Health need to reduce smoking prevalence amongst Routine and Manual workers to 26% by 2010. Research has shown that smokers are more like to quit if using NHS Support, however, going it alone (or “cold turkey”) remains a commonly used method despite having the lowest success rate.
Qualitative research to explore “cold turkey as a method” – in particular, the different meanings, connotations and terminology used around it and why smokers choose it.
Mid age (30-45)
Data collection methodology
15 x 90 minute group discussions (6-8 respondents)
11 were with groups of smokers, who were all seriously intending to give up smoking, and had tried to quit in the past, split between those who had only tried going it alone, and those who had used a spread of methods. Also recruited by weight of smoking.
4 groups were with ex-smokers, who had given up smoking within 2½ years
12 x 45 minute depth interviews
Depths were conducted with smokers with a varying weight of smoking and a range of attitudes to quitting (occasional quitters and serial quitters, and those about to undertake a quit attempt).
13, 14, 15, 19, 20, 21, 22 and 26 January 2009