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Kicking a Habit : It’s Easier to Quit Cold Turkey Than Through Expensive, Formal Programs

<i> Miriam Shuchman is a physician in the Clinical Scholars Program at UC San Francisco Medical Center. Michael S. Wilkes is a physician in the Clinical Scholars Program at the UCLA Medical Center. Their column appears monthly. </i>

RECENTLY, a man who was addicted to cocaine came to us determined to kick his habit. His sister, who was with him and who offered her complete support, wanted him to enter a hospital program. What did we think? Our first question was: “What other ways have you tried to stop using the drug?”

During the past few years, with the media watch of the detox of the rich and famous, hospital and clinic programs have gotten increased attention. While this does offer much-needed hope for addicts, it often implies that these institutions are the first and only answer for people with drug problems. That is not the case. Recent studies indicate that people hooked on addictive substances such as cigarettes, alcohol, cocaine and heroin may be far more successful quitting the drug on their own--cold turkey--than people who enter formal treatment programs.

Such programs usually are recommended only for strongly addicted persons who have repeatedly tried and failed to quit on their own. And, unfortunately, the programs are not accessible to everyone--they are often quite expensive (and are not fully covered by insurance plans) and, in most cases, have long waiting lists.

But many people are able to break even the most solidly established addictions on their own. Harvard Medical School psychologist Howard J. Shaffer, co-author with Stephanie B. Jones of the 1989 book “Quitting Cocaine,” says there is no question that certain people who “have seriously abused and become dependent on the excessive use of cocaine” can stop using without medical treatment. His book documents 30 such cases.

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But it’s never easy. Some people find the resolve to stop only after they reach rock bottom. Others build up a support system--work structure, friends, family, a 12-step group--that enables them to quit. “There are as many different approaches to quitting as there are different people using cocaine,” Shaffer says.

Though we tend to think of cigarettes in a different category from cocaine, nicotine is equal to heroin and cocaine in terms of its addictive potential. An estimated 390,000 Americans die annually from smoking-related illnesses. But 1.3 million Americans also quit each year, and the overwhelming majority of those do so on their own: According to national surveys, people who try to quit on their own are almost twice as likely to succeed as those who use formal programs.

Because the behavior and biology of addiction to nicotine is very similar to that of narcotics and alcohol, experts believe that these findings might also apply to other addictions.

Going straight takes many forms: One of our patients set a date to quit smoking after discovering she was pregnant. She decided to stop smoking as of the day of a family party the following weekend. She hasn’t picked up a cigarette since.

Whatever the technique, most people need the aid of family and friends. Programs such as Alcoholics Anonymous, Narcotics Anonymous can provide that crucial support. In any case, the idea is to confront the addiction and resolve to stop.

For people who have failed repeatedly to break an addiction, or for those who describe themselves as hard-core addicts, a formal addiction-recovery program, inpatient or outpatient, may be in order. New research on the brain shows that, in some cases, these heavily addicted people may have imbalances of brain chemistry that make them especially vulnerable to psychological problems, such as depression or anxiety. For these individuals, addictions can serve as a means to cope--cocaine or alcohol may be used to “self-medicate” a depression.

Much of the current research on the biological basis for addiction is aimed at figuring out how to help these individuals, but it will be a while before scientists can translate the findings in the laboratory into techniques we can use.

For now, we encourage people hooked on cigarettes, cocaine or other drugs to try to stop using them, through whatever method seems most likely to work: setting a date to stop, joining a group or calling on a supportive family member.

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This advice applies even to those who feel ready for a formal treatment program, because you may not be able to enter one immediately. The patient who came to us for advice decided to try an inpatient program, but we were only able to get him on a waiting list because of his limited insurance coverage. While he waited, his only choice was to try to quit on his own.

He says he thinks he will make it.


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