Is Nicotine Replacement Therapy Enough to Quit Smoking?

As I write this on Independence Day, I thought about my father, who like most of his friends, answered the call to duty to join the US Army during the beginning of World War II. He, like millions of other soldiers, fought the war but came back addicted to cigarettes, which were given freely to them during the war in their ration packs.

He struggled to quit during my entire early lifetime, despite having 5 children constantly tell him to quit. He would try and fail, try and fail; over and over again. I can still remember the day he told me he finally quit at the age of 63! He said it was hard but he now had a big enough reason; a chronic cough was diagnosed as lung cancer. He was now fighting for his survival as hard as he fought during the Battle of the Bulge, which became the turning point of the war that so shaped his life.

If it were just a matter of getting physically off nicotine, dumping this nasty habit for good would be relatively easy. Physicians would prescribe NRT (or other quit meds) and smokers would tough it out for the 1-2 weeks of withdraws and they would be done – forever. So why do so many start smoking again even after quitting for days, weeks or months?

It is easy to look at a smoker and wonder why they would keep smoking; there seems to be no benefit. But that conclusion is incorrect. When smokers quit, they experience sadness or distress at the loss of pleasure, the loss of smoke breaks with friends, and the loss of the calmness that they feel on the first puff, the lack of the entire “routine” of smoking. Smoking is not just about nicotine; it is about habits, emotions, patterns, coping skills and even pleasure. To successfully quit people need to learn new ways to deal with the urge to smoke. 

Tens of thousands of research projects have focused on this question and have provided numerous answers. It basically comes down to brain science, the reward center and psychology. But part of the problem is that these answers need to be applied to millions of people. And using professionals to do this is extremely time consuming and costly. And that is where a new digital startup, 2Morrow comes in. 2Morrow (no relationship to me) has created a smart phone app based on the premise that people just don't do things that don't benefit them.  

2Morrow has been working with behavioral scientists at Fred Hutchinson Cancer Research Center (FHCRC) who have created and tested a smoking cessation program based on an approach called Acceptance and Commitment Therapy (ACT). In 5 clinical trials, smokers who learn ACT skills were more likely to quit than those following traditional a CBT with motivational interviewing approach. Based on those successful studies, 2Morrow collaborated with FHCRC to create a mobile version of the program called SmartQuit. This smoking cessation "app" is the first of its kind to be clinically tested. It finished its second clinical trial last year and launched two more trails in 2016. 

2Morrow is no stranger to behavior change apps. They won the US Surgeon General’s Healthy App Challenge in 2012. Since then they have created and distributed app-based behavior change programs for health plans, states governments, employers, researchers, hospitals, wellness programs, coaches and more.

The company was co-founded by husband and wife team Brandon and Jo Masterson. Brandon, with a background in medical device, software and aerospace companies, had the vision of using the smartphone to create behavior change. Jo, an RN with an MBA, has been a serial entrepreneur and marketer and has a passion for creating products that help people. A match made perfect for ending smoking!

The SmartQuit program, offered commercially by 2Morrow, Inc., is distributed through contracts with employers, states and health plans for their members (typically for free). Individuals can download a lite version for free from the iTunes or google play app stores. The full version is available via in-app upgrade for about a month’s cost of cigarettes. Corporate and professional accounts have access to the 2Morrow Behavior Change Engine for real-time reporting and data. This can be used by coaches or to show meaningful use or ACA reasonable alternative standard compliance. The program can be used with or without quit medications.

My father lost the fight for his life about 18 months after he quit smoking and 3 months prior to our youngest child was born. None of his grandchildren were old enough to really remember this great man.

For today’s smoker, SmartQuit has proven results and can successfully help those millions who are fighting for their personal independence from tobacco. It’s up to payers to help them win this war.