Predictors and Reasons for Relapse in Smoking Cessation with Nicotine and Placebo Patches

Nørregaard, Jesper; Tønnesen, Philip; Petersen, L. J.

doi:10.1006/pmed.1993.1021

Cited by 111 publications

(81 citation statements)

References 14 publications

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“…We have examined predictors of and reasons for relapse in the original patch study comprising 289 smokers, and found that previous attempts to quit smoking and low smoking saliva cotinine levels were associated with 6 weeks abstinence [23]. Also, "slips" was a significant predictor of relapse, and we focused on how to prevent slips in our group sessions.…”

Section: Discussionmentioning

confidence: 99%

Recycling of hard-core smokers with nicotine nasal spray

Tønnesen¹,

Mikkelsen²,

Nørregaard³

et al. 1996

Eur Respir J

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The primary aim of this smoking cessation study was to evaluate the effect of long-term treatment with nicotine nasal spray in a group of hard-core smokers. A further aim was to compare the effect of ad libitum with fixed dosage of nasal nicotine spray.Eighty nine smokers, failures from two earlier studies with nicotine patches, were enrolled in an open smoking cessation study with nicotine nasal sprays, to be used ad libitum (n=45) or on a fixed schedule of 1 mg·h -1 during the day (n= 44).Carbon monoxide-verified continuous abstinence from smoking beyond Week 2, was 39% at 3 weeks, 12% at 3 months, 10% at 6 months and 6% after 1 yr, with no significant difference in success rate between ad libitum and fixed dosing. Mean daily nicotine dose was 15-16 mg during the first 3 months (range 2-65 mg). Tolerance to local irritating side-effects of nicotine developed during the first weeks of use.Although short-term outcome was promising, the long-term success rate in this group of hard-core smokers was low. Other recycling set-ups are warranted, which might include more aggressive nicotine dosing. Eur Respir J., 1996Respir J., , 9, 1619 To attain an acceptable long-term success rate in smoking cessation, some basic principles have to be followed. The most important is that from the target quit day the smokers have to quit cigarettes completely; even a single cigarette on a few occasions ("slips") will probably lead to relapse.The role of nicotine replacement with nicotine chewing gum and transdermal patches in smoking cessation has been established through several placebo-controlled clinical trials [1,2], and a doubling of the success rate can be expected [3,4]. The dose and the duration of nicotine replacement therapy has not been fully evaluated, though a duration of 6-12 weeks is recommended in most studies, and dose-response effects have been found for nicotine gum and patch [3]. The easiest nicotine product to use is the patch; when applied to the skin it releases about 1 mg of nicotine per hour, i.e. a fixed dosing system. Nicotine nasal spray (NNS), inhaler and gum have to be used ad libitum or prescribed to be taken every hour or so, with the possibility of self-regulating the dose when needed.Trials comparing the four different nicotine formulations have not been performed. In a meta-analysis, comprising 17,703 subjects and 42 gum studies, nine patch studies, one NNS and one inhaler study, the odds rates of nicotine therapy compared with controls were 1.61 for gum, 2.07 for patch, 2.92 for NNS and 3.05 for inhaler [5]. The possible role of nasal aerosols in smoking cessation have been sparsely examined [6][7][8][9]. The NNS is the nicotine delivery system most closely like smoking cigarettes, due to the fast nicotine absorption from the nasal mucosa.In two well-designed, controlled trials of NNS, comprising 227 and 248 smokers, the 1 year outcomes were 26 and 27% in the active group compared with 10 and 15% in the placebo groups [10,11]. In one study, a nicotine substitution of 40% of the smoking l...

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Section: Discussionmentioning

confidence: 99%

Recycling of hard-core smokers with nicotine nasal spray

Tønnesen¹,

Mikkelsen²,

Nørregaard³

et al. 1996

Eur Respir J

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show abstract

“…One clinical study revealed an association between postcessation weight gain and relapse among abstainers (Borrelli & Mermelstein, 1998), whereas other studies have observed postcessation weight gain to predict higher abstinence rates (Hall, Ginsberg, & Jones, 1986; Advance Access publication April 1, 2013 Norregaard, Tonnesen, & Petersen, 1993;Swan & Carmelli, 1995).…”

Section: Introductionmentioning

confidence: 99%

Weight Concerns Among Finnish Ever-Smokers: A Population-Based Study

Luostarinen

Tuovinen

Saarni

et al. 2013

Nicotine & Tobacco Research

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“…Moreover, it is known that the first instance of smoking after the initiation of a quit attempt is one of the best predictors of relapse (Brandon et al, 1990;Garvey et al, 1992;Kenford et al, 1994;Marlatt et al, 1988;Nides et al, 1995;Norregaard et al, 1993). Lapses typically occur soon after quitting, and are usually defined as any smoking, even one puff (e.g., Brandon et al, 1990;Shiffman et al, 1996).…”

mentioning

confidence: 99%

Modeling the effect of alcohol on smoking lapse behavior

et al. 2006

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The primary aim of this project was to examine the role of alcohol use in smoking lapse behavior, as alcohol consumption is a known risk factor for poor smoking cessation outcomes. We have developed a novel human laboratory model to examine two primary aspects of alcohol-mediated tobacco relapse: 1) Does alcohol facilitate the initiation of the first cigarette? 2) Once the first cigarette is initiated, does alcohol facilitate subsequent smoking? Using a within-subject design, 16 daily smokers who were also heavy social drinkers received a priming drink (0.03 g/dl or taste masked placebo) and then had the option of initiating a tobacco self-administration session or delaying initiation by five minute increments for up to 50 minutes in exchange for monetary reinforcement. Subsequently, the tobacco self-administration session consisted of a one-hour period, in which subjects could choose to smoke their preferred brand of cigarettes using a smoking topography system or receive monetary reinforcement for cigarettes not smoked. Alcohol craving, tobacco craving, subjective reactivity to alcohol, and nicotine withdrawal were assessed as secondary outcomes. Results demonstrated that after consuming the alcohol beverage, subjects were less able to resist the first cigarette and initiated their smoking sessions sooner, and smoked more cigarettes compared to the placebo beverage. These findings have implications for smoking cessation in alcohol drinkers and model development to assess smoking lapse behavior. Keywordssmoking; lapse behavior; alcohol; craving; human laboratory; monetary reinforcement It is well established that alcohol consumption and tobacco use are highly correlated in both clinical and non-clinical samples. Among alcoholics, 80% to 95% are smokers (DiFranza & Guerrera, 1990;Hughes, 1993;Kalman et al., 2005;Patten et al., 1996;Sobell et al., 1990), as compared to 23% in the general population (CDC, 2003 (DiFranza & Guerrera, 1990;Grant et al., 2004;Hurt et al., 1994) and the severity of alcohol and tobacco dependence is positively correlated (Ellingstad et al., 1999;Gulliver et al., 1995). Smoking is also highly correlated with drinking in nonalcoholic individuals (Carmody et al., 1985;Istvan & Matarazza, 1984), particularly among those who are heavy drinkers. Both laboratory studies and naturalistic observations have demonstrated that alcohol consumption is strongly associated with increased rates of smoking (Glautier et al., 1996;Mitchell et al., 1995;Shiffman et al., 1994). Additionally, there is evidence for cross-substance craving from both clinical and non-clinical samples (Drobes et al., 2000;Tiffany, 1995). Given the high co-occurrence of alcohol and tobacco use, it is not surprising that alcohol has been identified as a risk factor for poor smoking cessation outcomes (Baer & Lichenstein, 1988;Shiffman 1986;Zimmerman et al., 1990). For example, Shiffman (1986) found that 20% of all relapse episodes in smokers involved alcohol consumption. In a real-time examination of first lapse episodes, ...

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Predictors and Reasons for Relapse in Smoking Cessation with Nicotine and Placebo Patches

Cited by 111 publications

References 14 publications

Recycling of hard-core smokers with nicotine nasal spray

Recycling of hard-core smokers with nicotine nasal spray

Weight Concerns Among Finnish Ever-Smokers: A Population-Based Study

Modeling the effect of alcohol on smoking lapse behavior

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