Aversive smoking for smoking cessation
Abstract
Background
Aversion therapy pairs the pleasurable stimulus of smoking a cigarette with some unpleasant stimulus. The
objective is to extinguish the urge to smoke.
Objectives
This review has two aims. First, to determine the efficacy of rapid smoking and other aversive methods in
helping smokers stop smoking. Second, to determine whether there is a dose‐response effect on smoking
cessation at different levels of aversive stimulation.
Search methods
We searched the Cochrane Tobacco Addiction Group trials register for studies which evaluated any
technique of aversive smoking.
Selection criteria
Randomised trials which compared aversion treatments with 'inactive' procedures or which compared
aversion treatments of different intensity for smoking cessation. Trials must have reported follow‐up of least
6 months from beginning of treatment.
Data collection and analysis
We extracted data in duplicate on the study population, the type of aversion treatment, the outcome
measure, method of randomisation and completeness of follow‐up.
The outcome measure was abstinence from smoking at maximum follow‐up, using the strictest measure
reported by the authors. Subjects lost to follow‐up were regarded as smokers. Where appropriate, we
performed meta‐analysis using a fixed effects model.
Main results
Twenty five trials met the inclusion criteria. Twelve included rapid smoking and nine used other aversion
methods. Ten trials included two or more conditions allowing assessment of a dose‐response to aversive
stimulation. The odds ratio for abstinence following rapid smoking compared to control was 1.98 (95%
confidence interval 1.36 to2.90). Several factors suggest that this finding should be interpreted cautiously. A
funnel plot of included studies was asymmetric, due to the relative absence of small studies with negative
results. Most trials had a number of serious methodological problems likely to lead to spurious positive
results. The only trial using biochemical validation of all self reported cessation gave a non significant result.
Other aversion methods were not shown to be effective (odds ratio 1.15, 95% confidence interval 0.73 to
1.82). There was a borderline dose‐response to the level of aversive stimulation (odds ratio 1.66, 95%
confidence interval 1.00 to 2.78).
Authors' conclusions
The existing studies provide insufficient evidence to determine the efficacy of rapid smoking, or whether
there is a dose‐response to aversive stimulation. Milder versions of aversive smoking seem to lack specific
efficacy. Rapid smoking is an unproven method with sufficient indications of promise to warrant evaluation
using modern rigorous methodology.
PICOs
Plain language summary
No conclusive evidence that rapid smoking aversion therapy works, but it may be worth more research
Aversion therapy involves adding an unpleasant feature to an attractive stimulant or behaviour to reduce its
attractiveness. Rapid smoking is one of the aversion therapies to try and help people quit smoking. In this
therapy, people puff cigarettes every few seconds for several minutes, repeatedly, while concentrating on
the unpleasant feelings. The review of trials found no conclusive evidence that rapid smoking helps people
quit smoking, since the quality of the trials was poor. More research may be worthwhile. Milder versions of
aversive smoking did not seem to be effective.
