Characterization of Cognitive-Behavioral Counseling Duration Thresholds for Effective Tobacco Treatment.

Introduction: The purpose of this study was to characterize the dose-response relationship between duration of cognitive-behavioral counseling and abstinence in individuals who participated in a randomized controlled trial (RCT) for smoking cessation.

Method: This is a secondary analysis of participants enrolled in double-blind RCTs for smoking cessation consisting of 12 weeks of pharmacotherapy (placebo; n = 142; varenicline; n = 257) combined with counseling. Participants were 41% female, 66% non-Hispanic White, who smoked a median of 20 cigarettes per day (CPD). Seven-day point prevalence (7-dayPP) and prolonged abstinence were calculated at the end of treatment and at the 6-month follow-up.

Results: All abstinence outcomes exhibited sigmoidal (s-shaped) relationships with duration of counseling, and the median effective duration was similar (ranging from 130 to 160 minutes). The sigmoidal curves between placebo and varenicline were significantly different (7-dayPP at EOT: F = 14.68, p<.01) The difference between the maximum efficacy for the medications is 0.34 (p-value <0.01) for 7-dayPP abstinence at EOT, indicating approximately 35% higher rates of abstinence at the maximum efficacy of counseling for those in the varenicline group as compared with those in the placebo group.

Conclusions: Participants who received counseling and pharmacotherapy to quit smoking exhibited a duration-dependent response of abstinence to counseling captured by a sigmoidal curve that exhibited variation in the maximum efficacy between placebo and varenicline, suggesting either that counseling for smoking cessation enhanced the effect of varenicline on abstinence, or more likely, that counseling was more effective in achieving abstinence in the presence of varenicline.

Implications: The results suggest that cognitive-behavioral counseling for smoking cessation is more effective in achieving abstinence in the presence of varenicline or less likely, that counseling enhanced the effect of varenicline on abstinence. Optimizing the duration of counseling, particularly when coupled with pharmacotherapy, can offer more tailored and efficient cessation strategies. This finding emphasizes that the integration of behavioral and pharmacological approaches is crucial for maximizing the effectiveness of smoking cessation interventions, consistent with previous evidence and current guidelines.