Tobacco Use Relapse Prevention

Tobacco use dependence is a chronic disease. Most patients will not be able to achieve permanent abstinence in their first attempt, and will cycle through periods of remission and relapse. Using a Chronic Disease model may help in understanding the nature of the tobacco use dependence and the need for ongoing care, rather than just acute care.

Most relapses occur soon after a patient quits, yet some relapses occur months or even years after the quit date. To counter this, relapse prevention interventions should be part of every patient encounter with those who have recently quit.

Encourage the patient's active discussion of the topics below:

  • The benefits, including potential health benefits that the patient may derive from remaining quit.
  • Any successes the patient has had in quitting (duration of abstinence, reduction in withdrawal, etc.). Don’t forget to offer congratulations and strong encouragement to remain quit.
  • The problems encountered or anticipated threats to maintaining abstinence (e.g., depression, weight gain, alcohol, other tobacco users in the household).
  • Encourage the patient not to fall into the trap of thinking that, "I'll just have this one cigarette, but I won’t go back to smoking." The reality is that the one cigarette will be the first of many.
  • Don't forget to provide your patients with materials that reinforce your message and helps them to cope with stresses that may cause relapse. For more information see "Common Patient Concerns" listed under Patient Education Materials.

Use these potential response strategies to help patients overcome common problems that can threaten abstinence1:

Lack of support for cessation

  • Schedule follow-up visits or telephone calls with the patient.
  • Refer the patient to QuitlineNC for additional counseling or support.

Negative mood or depression

  • If significant, provide counseling, prescribe appropriate medications, or refer the patient to a specialist.

Strong or prolonged withdrawal symptoms

  • If the patient reports prolonged craving or other withdrawal symptoms, consider extending the use of an approved pharmacotherapy or adding/combining pharmacologic medications to reduce strong withdrawal symptoms.

Weight gain

  • Recommend starting or increasing physical activity; discourage strict dieting.
  • Emphasize the importance of a healthy diet.
  • Maintain the patient on pharmacotherapy known to delay weight gain (e.g., bupropion SR or nicotine-replacement pharmacotherapy, particularly nicotine gum).
  • Drink more water and avoid sugary drinks and diet sodas.

Waning motivation/feeling deprived

  • Reassure the patient that these feelings are common.
  • Recommend rewarding activities.
  • Probe to ensure that the patient is not engaged in periodic tobacco use.
  • Emphasize that beginning to use tobacco (even a puff) will increase urges and make quitting more difficult.
For materials to reinforce your message, see "Common Patient Concerns" listed under Patient Education Materials.

References:

1 http://www.surgeongeneral.gov/initiatives/tobacco/
Treating Tobacco Use and Dependence. Quick Reference Guide for Clinicians, October 2000. U.S. Public Health Service.