Introduction

Millions of smokers say they want to stop smoking. Is it as simple a matter of will power and having the desire to quit? There is no doubt that quitting is difficult, yet research shows us what helps people successfully quit, and what can hinder them. The authors of this study, a group of leading psychologists active in smoking cessation research, reviewed studies of smoking cessation conducted between 1988 and 1998. Here we present some of the highlights of their findings, with a particular emphasis on what this means for you if you are trying to quit smoking.

Smoking is a Complex Phenomenon

If you are thinking of quitting smoking, keep in mind that people smoke for various reasons. Smoking behavior is influenced by a combination of biological, psychological and social factors.

Biological factors include dependence upon nicotine. Psychological factors are involved when people smoke for pleasure or to reduce their stress. Social environments also exert an influence, in whether the people around us approve or disapprove of smoking.

Broadly speaking, there are two major aspects of the smoking cessation process: the process of quitting itself, and remaining a non-smoker.

Behaviors, thoughts, and the environment all combine to influence the start of smoking behavior and its continuation. These factors also influence an individual's ability to stop smoking and to remain smoke-free.

It is important to note that the psychology, and not just the biology of smoking is critical in both cessation and relapse. Some of the best outcomes in smoking cessation research (i.e. where 40 to 60% of the people refrained from smoking one year after quitting), involved programs that combined biological and behavioral approaches. Typically, these involved nicotine replacement therapy (e.g. patch) combined with counseling.

Don't go it Alone

The Agency for Health Care Policy and Research (AHCPR) has issued several guidelines concerning smoking cessation. Since most smokers use self-help programs, which are in fact not highly effective, the AHCPR recommends that self-help be combined with more intensive cessation measures to increase success rates in smoking cessation. So, in other words, do not go it alone if you have a choice. Seek help from professionals and increase your chances of successfully quitting. Professional help can be in the form of counseling from your health care provider, or structured group classes offered by various organizations such as hospitals, universities or the American Cancer Society.

Lapse and Relapse

Once a person quits smoking, they may experience a lapse or relapse. A lapse, also called a slip, means that the smoker has returned to smoking, but not for more than one week. A relapse occurs when the renewed smoking continues past one week.

What Causes a Lapse?

Lapses can be triggered by many things, including stress (due to life events or conflicts with significant others), depression, withdrawal symptoms, weight gain, lack of motivation to quit smoking, lack of support from significant others, and slips of a puff or two during an attempt to quit. (For more information on some of these causes of lapses and what you can do against them, please see links at the end of the article.)

If You Experience a Lapse

If you experience a lapse or relapse, do not become discouraged. Keep trying and remember that many people do succeed eventually.

Lapses do not always lead to relapse. However, each lapse does increase the probability that relapse will occur. Usually, the first cigarette in a lapse is quickly followed by a second cigarette. Each cigarette that is smoked after attempting to quit increases the likelihood of relapse.

Stop a Lapse from Turning into Relapse

Most slips or lapses happen early on during attempts to quit. If you experience a lapse while attempting to quit, it is essential that you focus on these slips, and on ways to keep a lapse from becoming a relapse.

Interestingly, how you understand your lapse can play a role in whether you will have a relapse. If you see this as a sign that you cannot be successful at quitting, you are more likely to fail. If you see this as a temporary slip that many people experience, and one that you can overcome, you will be more likely to overcome the lapse.

Likewise, it is important how you explain your lapse to yourself. For instance, when people attribute their lapse to stress, they are more likely to relapse. But if they attribute it to habit, (e.g. having a cigarette after a meal), they are less likely to relapse.

The Process of Re-cycling

If you are trying to quit smoking, bear in mind that some people require more than one attempt. Among smokers whose first attempt leads to lapse and relapse, a significant percentage (up to 38%) will "recycle", or attempt once again to quit smoking within the next 12 months¹. On average, it takes most smokers three attempts at quitting before they are able to successfully stop ².

Biological Aspects of Smoking

The biological aspects of smoking make quitting a challenge because the nicotine in cigarettes actually causes changes in the brain.

Medications have been found to be useful in helping people quit. The two most accepted ones in current use are nicotine replacement therapy (e.g. patch), and bupropion (an anti-depressant). In general, the best results are obtained when medication is combined with counseling from a health care provider. For instance, nicotine replacement therapy combined with professional counseling has been found to generate quit rates of 40 to 60% at one year follow-up².

Long-Term Success

You can think of long-term success as the avoidance of relapse. Studies with women smokers have found that exercise is effective in helping maintain cessation up to one year after quitting. To date, there are too few studies that say that exercise definitely helps smokers trying to quit, but the evidence looks promising.

Smoking and Weight Gain

Some smokers fear that they will gain weight when they quit smoking. In actuality, the average smoker weighs eight to 10 pounds less than a non-smoker, and tends to gain that much after quitting. For some smokers, this amount of weight gain is a real issue - from a psychological perspective³.

It has been found that caloric intake increases immediately following smoking cessation, but tapers off. In the long term, smokers and former smokers do not differ in their daily caloric intake. Although smokers are less likely to be obese than non-smokers, the weight increase that accompanies quitting smoking is far less dangerous to your health than continued smoking.

If you think that you will go on a diet while trying to quit smoking-think again. It has been shown that dieting while trying to quit smoking leads to greater failure rates for smoking cessation.

If you have legitimate concerns about your weight, you can attend to them once you are an established non-smoker.

Conclusions

Smoking offers people physical, emotional, and social rewards. Consequently, quitting is particularly difficult as there are costs and discomforts on all these levels. In addition to quitting, there is the added challenge of continuing not to smoke (i.e. avoiding relapse).

Weight gain appears to be a major concern for smokers trying to quit, and is especially of concern to female smokers. As the weight gain is far less detrimental to health than the smoking, those few extra pounds seem to be a very worthwhile trade-off for a decreased risk of heart disease.

If you are trying to stop smoking, professional assistance can increase your chances of success. Pay attention to what helps you and what might block you in your quitting attempt. Exercise can help, as does a positive attitude.

If you experience a lapse, work to keep it from turning into a relapse. How you understand your lapses can be crucial to your success. If you think that you just had a momentary lapse, you are more likely to resume cessation. On the other hand, if you begin to feel hopeless and lack confidence as a result of your lapse, you are more likely to experience a relapse.

Comments

Quitting smoking is extremely tough, and maintaining abstinence over time is as difficult, if not more so. If you are trying to quit, the findings in this study suggest that you should seek the help of your health-care provider. If your physician or nurse does not offer smoking cessation counseling, ask them for a referral so that you can get the appropriate support needed to succeed.

In addition, as most successful quitters try several times, do not be discouraged if you experience a slip, lapse or relapse. Know that they are part of the experience of quitting smoking -and that many people recycle- so keep trying.

There is the old saying: "A quitter never wins". But as far as smoking is concerned, quitting is definitely a winning strategy. Best of luck!