The idea of scheduled smoking (or smoking on cue) had been explored in the early 1970’s. However, only recently have attempts been made to formalize this strategy into a treatment approach. The scheduled reduced smoking procedure developed and tested in our laboratory takes a highly systematic approach to nicotine dependence prior to a quit date and involves a progressive reduction in the smoking rate.
Scheduled Reduced Smoking. The primary objective is to control the timing of smoking for a pre-determined period of time before quit date. Individuals are prompted to smoke only at specific times during the day (based solely on the passage of time between cigarettes), and without regard for the social, behavioral and psychological cues that normally accompany smoking behavior. This is accomplished by prompting the smoker to smoke only at specific times during the day and progressively increasing the interval between cigarettes. By only smoking at specified times, the associations between smoking and the smoking cues that normally trigger smoking can be eliminated or minimized. As a result, pre-cessation smoking becomes less associated with preferred smoking times and situations, and therefore, less reinforcing.
By contrast, smoking reinforcement and/or expectations of reinforcement may actually be increased by non-scheduled gradual reduction techniques. That is, smoking may become more rewarding as the number of cigarettes are reduced and smoking becomes restricted to smokers’ most preferred times and situations. This increase in reinforcement and expectations of reinforcement may in turn increase withdrawal severity and relapse likelihood. Thus, the superiority of scheduled reduced smoking does not appear to be a simple function of a gradual lowering of nicotine dose prior to quitting. It is important to break the pattern of ad lib nicotine self-administration by systematically altering the timing of pre-cessation smoking. The smoking schedule appears to exert an effect independent of gradual nicotine reduction.
Example of a Scheduled Reduced Smoking Program. In a latest study conducted by our laboratory, the scheduled reduced smoking program is presented to the participants via a palmtop computer. Participants are required to reduce their nicotine intake over a 3-week pre-cessation period. The computer program generates a 21-day individualized schedule based upon the smoker’s baseline smoking frequency and average time awake per day. On every fourth day, the program reduces the number of cigarettes allowed per day and increases the interval between cigarettes, such that only 3-4 cigarettes are consumed the day before the quit-date. Participants carry the palmtop computer throughout the waking hours and are prompted by the computer to smoke at specified times. They are instructed to smoke only during the first five minutes of each specified smoking interval and that they are not be allowed to accumulate missed cigarettes for later use. Statistics for calculating a sample schedule are presented in Table 1.
Table 1
|
Baseline Data
|
Scheduled Smoking Data
|
Days of Schedule
|
Cigarettes/
Day
|
Inter-cigarette Interval (minutes)
|
Total Cigarettes/day
|
35
|
1-3
|
30
|
30
|
Wake Time
|
6:30 AM
|
4-6
|
25
|
45
|
First Cigarette
|
7:15 AM
|
7-9
|
19
|
45
|
Sleep Time
|
11:30 PM
|
10-12
|
14
|
60
|
Total Time Awake
|
16:15
|
13-15
|
11
|
75
|
Start Date
|
12/5/17
|
16-17
|
7
|
120
|
Quit Date
|
12/26/17
|
18-20
|
4
|
195
|
Potential Benefits of Scheduled Reduced Smoking. Scheduled reduced smoking has a number of potential benefits over other forms of smoking cessation treatment. First, it is relatively easy to implement and requires little training of the smoker. Second, it is intuitively appealing to smokers and treatment providers in that it involves a weaning component (i.e., smokers gradually reduce the number of cigarettes smoked per day prior to complete abstinence). This scheduled reduction appears to reduce withdrawal severity and urges to smoke. Third, scheduled reduced smoking may appeal to smokers who cannot, or prefer not, to use NRT or other pharmacological agents. There are no obvious medical contraindications or evidence of adverse treatment side effects that might interfere with compliance. Fourth, by limiting smoking to preset time points, scheduled reduced smoking begins to uncouple environmental and affective cues from actual smoking. This is perhaps the key advantage of scheduled reduced smoking over other behavioral techniques. Finally, scheduled reduced smoking has potentially broad applications. Its efficacy in combination with behavioral counseling and with NRT has been demonstrated, but future research may also find it to be useful as a means for harm reduction (i.e., reducing overall cigarette consumption without total cessation).
Webcassi
Web-CASSI aims to offer state-of-the-art smoking cessation treatments and counseling to M. D. Anderson patients and to serve as a portal for non-patients to find information regarding smoking cessation advice and treatments, and use of scheduled reduced smoking. This project’s is offered via the Internet and mobile devices allowing patients and non-patients to receive smoking cessation information and to use scheduled reduced smoking as a cessation treatment aid.