Avoid Relapsing Back To Smoking

At this time of year, less than a month after many smokers initiated their “new year” quit attempt, there will be a significant number of recent ex-smokers who are trying hard not to relapse.

Back in April 19th, 2009 I wrote about some things you can do to avoid relapse.

Since that time a few new studies on relapse have been published. One recent study examined the predictors of relapse in ex-smokers who had used varenicline (Chantix) successfully to be smoke-free after 12 weeks on the medicine. The study by Heffner and colleagues (University of Cincinatti) assessed the factors that predict relapse by 52 weeks among those who were abstinent at 12 weeks.

The main finding was that those who only achieved abstinence (by 12 weeks) relatively recently were 5 times more likely to relapse than those who remained completely abstinent from their quit date. This is not very surprising, but it underscores the importance of getting off to a good start when you quit smoking. That means getting rid of all your cigarettes and other tobacco at least the day before the Target Quit Date, and making sure you take your smoking cessation medications as prescribed. Of course in the study by Heffner and colleagues the ex-smokers ceased use of varenicline at week 12, so this study was primarily of smokers who had recently stopped using varenicline. There is growing evidence that using a smoking cessation medicine for longer than suggested by the labeling can help prevent relapse. Varenicline is the only smoking cessation medicine that actually states on the labeling that some may benefit from continuing the medicine for another 12 weeks (making a total of 24 weeks). But as discussed in previous articles, there is fairly consistent evidence supporting the longer term use of nicotine replacement therapies beyond the first few months.

The study by Heffner and colleagues also had an unexpected finding, namely that people who had achieved over 30 days of abstinence in the previous year were MORE likely to relapse in subsequent months. It is unclear why this might be the case, although it could simply be a sign that some smokers are better at achieving an initial quit, but poorer at maintaining it.

Another new study by Herd and colleagues (2009) found that people who believed that smoking provided certain psychological benefits were more likely to relapse back to smoking after an initially successful quit attempt. So it may be that the little devil on your shoulder saying things like “Just have one, it will make you feel less stressed,” really is a major part of the problem. It is therefore important to focus on the positive reasons for quitting, and not entertaining any thoughts of benefits of smoking.

So if you are currently an ex-smoker, well done. Don’t jeopardize all the effort it took to get this far, and keep your focus firmly on staying completely abstinent. An extra 10 healthy years of life is a pretty big benefit. Add on all the money saved, illnesses avoided, etc etc and its a no-brainer.


Heffner JL, Lee TC, Arteaga C, Anthenelli RM.
Predictors of post-treatment relapse to smoking in successful quitters: Pooled data from two phase III varenicline trials.
Drug Alcohol Depend. 2010 Jan 11. [Epub ahead of print]

Herd N, Borland R, Hyland A.
Predictors of smoking relapse by duration of abstinence: findings from the International Tobacco Control (ITC) Four Country Survey Addiction. 2009 Dec;104(12):2088-99.
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About the Author

MA, MAppSci, PhD

Dr. Jonathan Foulds is an expert in the field of tobacco addiction.