Many smokers try quitting "cold turkey" -- often repeatedly and without success -- while relatively few use therapies proven to be effective, in part because doctors fail to recommend them, the Wall Street Journal reported July 11.

Only about one in four of the 15 million smokers who try to quit each year use any type of smoking-cessation drugs, nicotine-replacement therapy, or counseling. "These treatments are tremendously underutilized," said Nancy Rigotti, director of Massachusetts General Hospital's Tobacco Research and Treatment Center.

Stop-smoking therapies generally have been shown to double the rate of abstinence in the year after treatment, and some specialized programs are even more effective. But doctors don't recommend them -- in fact, they are less likely to recommend smoking-cessation specialists than to refer patients to addiction treatment for alcohol and other drugs, according to the Wall Street Journal. "Can you imagine a physician wagging his finger at a crack addict and saying, 'Just quit'?" said Linda Ferry, a preventive-medicine specialist at Loma Linda University.

Ignorance is a big part of the problem: surveys have shown that 31 percent of physicians incorrectly believe that nicotine causes cancer, and 15 percent believe nicotine-replacement therapy is as addictive as smoking. Some also think that nicotine therapy causes heart disease.

The underutilization of effective treatment was a major focus of a conference last month sponsored by the National Institute of Health. "Among the pool of remaining smokers are many who are harder core," said Richard Hurt, director of the Mayo Clinic's Nicotine Dependence Center. "For them, this isn't something that they can will away."

The Mayo Clinic program, hailed as effective, combines drug therapy with counseling and treats smoking like a disease. "Here was this charismatic physician treating my nicotine addiction like the most serious medical problem in the world," said former smoker and Mayo Clinic patient Linda Holstein. "That put an enormous importance on my quitting ... Nobody at Mayo mentioned will power."

The Mayo program costs $4,500, with about half of patients getting care covered by health insurance. But it only is offered once a month, because demand has been so limited.