Do placebo response rates from cessation trials inform on strength of addictions?

Abstract

There is an implied assumption that addictions to different substances vary in strength from weak (easier to stop) to strong (harder to stop), though explicit definitions are lacking. Our hypothesis is that the strength of addictions can be measured by cessation rates found with placebo or no treatment controls, and that a weaker addiction would have a higher cessation rate than a stronger addiction. We report an overview of systematic reviews and meta-analyses of cessation trials, using randomised or quasi-randomised trials and reporting objectively-measured abstinence. The outcome for comparison was quit rates-typically the percentage of participants abstinent according to an objective test of abstinence at six months or longer. Twenty-eight cessation reviews (139,000 participants) were found. Most data came from reviews of smoking cessation in over 127,000 participants, and other reviews each covered a few thousand participants. Few reviews used data from studies shorter than three months, and almost all determined abstinence using objective measures. Cessation rates with placebo in randomised trials using objective measures of abstinence and typically over six months duration were 8% for nicotine, 18% for alcohol, 47% for cocaine, and 44% for opioids. Evidence from placebo cessation rates indicates that nicotine is more difficult to give up than alcohol, cocaine, and opioids. Tobacco is also a severe addiction, with a number of major deleterious health effects in a large number of people.

Keywords: addiction; alcohol; cannabis; cocaine; opiates; tobacco.

Figure 1

Cessation (quit) rates with placebo in NRT studies according to number in placebo group (size of symbol proportional to number in placebo group, inset scale) (data from Stead et al., 2008 [22]).

Figure 2

Cessation rates with placebo across different addictions (number of participants).