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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
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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.
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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.
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