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fail. A study of self-quitters (Garvey et al. 1992) found that the majority of relapses occurred in the first few days and weeks post-cessation. Although most self-quitters (87.2 percent) relapsed within 1 year of their quit date, the majority of relapses occurred in the first few days and weeks after stopping: 13 percent relapsed by 1 day after quitting, 32 percent by 3 days, 49 percent by 1 week, and 62 percent by 2 weeks.

The results of another study of motivated self-quitters support the findings of an early relapse to smoking (Hughes et al. 1992). That study reported smoking cessation results by the use of two measures: one measure that reflected complete abstinence and another measure that reflected some smoking (smoking an average of one cigarette per day or less since the last follow-up and observer verification of no smoking of more than 10 cigarettes on any 2 days). The study findings, which used biochemical verification, indicated that 33 percent of self-quitters were abstinent at 2 days, 24 percent at 7 days, 22 percent at 14 days, 19 percent at 1 month, 11 percent at 3 months, 8 percent at 6 months, and 3 percent at 6 months. By using the more relaxed criteria, 47 percent were abstinent at 2 days, 38 percent at 7 days, 32 percent at 14 days, 27 percent at 1 month, 20 percent at 3 months, and 11 percent at 6 months.

Under a worst case scenario of unsuccessful quitting attempts, Piasecki and colleagues described cessation attempt “fatigue,” or a decrease in motivation and ability to stay abstinent (Piasecki et al. 2002). Cessation attempt fatigue is noted to be associated with lower expectations for cessation success, a reduced ability to cope or to believe in having the capacity to quit or stay abstinent, and fewer resources to exert control over behaviors or actions related to tobacco use. Smoking lapses and relapses to smoking, however, do not necessarily represent total quit failures but, rather, represent learning experiences along the pathway to cessation.

Early on in a cessation attempt, smokers may face a number of circumstances that encourage a smoking lapse, including symptoms associated with nicotine addiction (withdrawal, negative affect, urges, and cravings), the presence of social environmental factors such as smokers in the environment, or easy access to tobacco products (Brauer et al. 1996; Piasecki 2006). Although any smoking behavior after quitting has been identified as a very strong predictor of an eventual relapse (Kenford et al. 1994; Shiffman et al. 2006; Westman et al. 1997), it may not necessarily be a final outcome. Hyland and colleagues (2006) found that quit attempts in the previous year and a longer duration of past quit attempts were important predictors of new quit attempts, suggesting that some smokers will continue to attempt to abstain from smoking, despite past lapses or relapses (Hyland et al. 2006).

Other researchers note that smokers with failed quit attempts may reduce the intensity of smoking and the level of addiction for several months



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