Relapse to smoking and its prevention

Figure 1.Percentage abstinent after quitting smoking

Figure 1.Percentage abstinent after quitting smoking

Blondal T, Gudmundsson LJ, Olafsdottir I, et al Nicotine nasal spray with nicotine patch for smoking cessation


: randomised trial with six year follow-up. BMJ 1999 318: 285-9. ________________________________________________________________________________






Relapse rates are currently unacceptably high.

One of the most successful studies ever reported for Nicotine Replacement Therapy shows 80% of quitters relapsed within 1 year, and 87% within 6 years. (Fig. 1). Other studies with NRT are not likely to show greater success.

We averaged the data for the two treatments at each stage in Figure 1.

15% relapse occurs within the first 24 hours. The percentage abstinent decreases steeply to 31% at 3 months, decreases to 19% at 12 months, then to 13% still abstinent after 6 years.

Out of the 31% still abstinent at 3 months, more than half, a further 18%, relapse to smoking. Of these 12% relapse before 12 months, and another 6% over the following 5 years.


NRT reduces the risk of relapse

The results may seem dismal enough with NRT, but would be worse without it. If NRT is continued about half the relapses are prevented. The effect fades over time, but even after nearly 5 months, NRT has a 20% protective effect for relapse. The risk of relapse increases after stopping NRT.1


1. Medioni J, Berlin I, Mallet A. Increased risk of relapse after stopping nicotine replacement therapies: a mathematical modelling approach. Addiction 2005; 100: 247-54.

Research is needed to reduce:

1) Early relapse. Strong urges to smoke are important in this period. Far more effective drugs or combinations are needed to raise 3-month abstinence rates much higher than the 31% in Fig 1. New combinations merit research, for example, snuff + patch. Would this combination make it easier to prevent lapses, which in most cases lead to relapse.

2) Late relapse. Social cues, cigarette availability and living with a smoker are important triggers.

Can switching to snuff long-term reduce late relapse to smoking? (Snuff used for quitting is often used long term in any case.)

3) Relapse at any stage. Using nicotine gum with patch is now recommended. Logically some gum (or snuff for those unwilling to quit tobacco should be always kept at hand in purse or wallet for at least one year after quitting, to cope with “break through” cigarette cravings.


A law ending cigarette sales can save 4000 lives and $22 billion annually

 Dr Murray Laugesen QSO chair; Prof Ross McCormick, Sir John Scott KBE, Trish Fraser MPH, Dr Marewa Glover, Trustees

Making it easier to quit smoking for good 2009 End Smoking NZ