Prognosis

Relapse

Habitual smokers find it extremely difficult to successfully quit smoking. Although 70% of smokers would like to quit, and 40% make at least 1 quit attempt per year, only 3% to 4% of smokers per year are successful in quitting long term on their own.[18]

The highest risk for relapse is within the first 8 days after quitting. Active smoking cessation interventions by the physician, a clinic staff member, or a behavioral counseling service (in-person or telephone behavioral counseling) should be initiated before or within the initial week after the planned quit date.[215]

  • Behavioral interventions used to help people avoid relapse usually focus on teaching the skills to cope with temptations to smoke.

  • Randomized trials have not demonstrated that skills training interventions are helpful, although the studies may not have been large enough to detect possible small effects.[216] [ Cochrane Clinical Answers logo ] [ Cochrane Clinical Answers logo ] [ Cochrane Clinical Answers logo ]

  • Internet- and cell-phone-based interventions are increasingly available to help patients avoid relapse.[118][217] [ Cochrane Clinical Answers logo ] Cell-phone interventions have been shown to have a beneficial impact on 6-month cessation outcomes.[120] [ Cochrane Clinical Answers logo ]

Responses to relapse

Relapse after quitting is common. Patients should be encouraged to learn from the experience and try again. Most smokers must make several attempts to quit. The circumstances of the relapse should be reviewed, and new strategies and alternative or additional pharmacotherapy should be tried.[2][73]

Extending medication duration has been examined in a limited number of trials.

  • Two trials of nicotine gum showed some effect, but extending the duration of bupropion use delayed but did not prevent relapse. Further studies of extended treatment with nicotine replacement are needed.[216] [ Cochrane Clinical Answers logo ]

  • Limited evidence supports the use of varenicline as an aid to relapse prevention.[130]​​

  • Extended-duration transdermal nicotine therapy (24 weeks) has been shown to increase success rates and decrease relapse when compared with standard-duration therapy (8 weeks) in adults.[218]

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