Shape of the relapse curve and long‐term abstinence among untreated smokers

Hughes, John R.; Keely, Josue P.; Naud, Shelly

doi:10.1111/j.1360-0443.2004.00540.x

Cited by 1,228 publications

(962 citation statements)

References 48 publications

(54 reference statements)

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“…These high rates of relapse early on after an attempt in the current study are similar to that observed with other drug dependencies (Hughes et al, 2004) and suggest cannabis may be as dependence producing as other drugs. As importantly, such early relapse also suggests treatment programs need to schedule sessions very early on in any attempt to maintain marijuana abstinence.…”

Section: Success Of Abstinence and Reduction Attemptssupporting

confidence: 87%

Attempts to stop or reduce marijuana use in non-treatment seekers

Hughes

Peters

Callas

et al. 2008

Drug and Alcohol Dependence

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Daily marijuana smokers (n=19) who intended to quit or reduce in the next month on their own called a phone each night for 28 nights to report marijuana use and reported intentions to change at the end of each week. Outcomes did not differ between those who initially planned to reduce vs. quit in the next month. Participants averaged three attempts to reduce and one attempt to quit during the 28 days. Participants reduced on 11% and abstained on 14% of days. Most participants were successful in reducing or abstaining on half or more of the days they attempted; however, only four participants (21%) reduced ≥ 50% for ≥ 7 consecutive days and only two (10%) abstained for that long. Abstinence or reduction did not appear to change alcohol or caffeine use. We conclude a) initial intentions are poor predictors of outcomes, b) most users make multiple, short-lived attempts to change, c) reduction was as common as abstinence, d) many attempts to change are initially successful but few persist, and e) other drug use does not appear to worsen with marijuana reduction or abstinence.

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Section: Success Of Abstinence and Reduction Attemptssupporting

confidence: 87%

Attempts to stop or reduce marijuana use in non-treatment seekers

Hughes

Peters

Callas

et al. 2008

Drug and Alcohol Dependence

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“…Despite several FDA approved treatments, the majority of smokers who attempt to quit will ultimately relapse and return to regular smoking behavior within the first year following a quit attempt (Hughes et al, 2004;Wileyto et al, 2004;Jorenby et al, 2006). Numerous risk factors for relapse have been identified (e.g., see Garvey et al, 1992;Doherty et al, 1995;Shiffman et al, 1996b;Ockene et al, 2000;Piasecki et al, 2000;Piasecki et al, 2003), and developing treatments to effectively target these many factors remain a high research priority.…”

Section: Introductionmentioning

confidence: 99%

Predictors of smoking lapse in a human laboratory paradigm

et al. 2014

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Rationale During a smoking quit attempt, a single smoking lapse is highly predictive of future relapse. While several risk factors for a smoking lapse have been identified during clinical trials, a laboratory model of lapse was until recently unavailable and, therefore, it is unclear whether these characteristics also convey risk for lapse in a laboratory environment. Objectives The primary study goal was to examine whether real-world risk factors of lapse are also predictive of smoking behavior in a laboratory model of smoking lapse. Methods After overnight abstinence, 77 smokers completed the McKee smoking lapse task, in which they were presented with the choice of smoking or delaying in exchange for monetary reinforcement. Primary outcome measures were the latency to initiate smoking behavior and the number of cigarettes smoked during the lapse. Several baseline measures of smoking behavior, mood, and individual traits were examined as predictive factors. Results Craving to relieve the discomfort of withdrawal, withdrawal severity, and tension level were negatively predictive of latency to smoke. In contrast, average number of cigarettes smoked per day, withdrawal severity, level of nicotine dependence, craving for the positive effects of smoking, and craving to relieve the discomfort of withdrawal were positively predictive of number of cigarettes smoked. Conclusions The results suggest that real-world risk factors for smoking lapse are also predictive of smoking behavior in a laboratory model of lapse. Future studies using the McKee lapse task should account for between subject differences in the unique factors that independently predict each outcome measure.

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“…First, it is possible that the benefits of medications decline, even in the context of RCTs. Many smokers who quit relapse 14, 15, 16, 17, leading to declines in quit rates over time 18, 19, 20, 21. This is well illustrated by a recent study ( n = 1086), which found initial quit rates of at least 24 hours’ duration to be 70–80%, with declines over time to approximately 20% for varenicline, nicotine patch and combination nicotine groups by 1 year 22.…”

Section: Introductionmentioning

confidence: 85%

Diminishing benefit of smoking cessation medications during the first year: a meta‐analysis of randomized controlled trials

et al. 2018

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Background and aimsAlthough smoking cessation medications have shown effectiveness in increasing abstinence in randomized controlled trials (RCTs), it is unclear to what extent benefits persist over time. This paper assesses whether the benefits of smoking cessation medications decline over the first year.MethodsWe selected studies from three systematic reviews published by the Cochrane Collaboration. RCTs of first‐line smoking cessation medications, with 6‐ and 12‐month follow‐up, were eligible for inclusion. Meta‐analysis was used to synthesize information on sustained abstinence (SA) at 6 versus 12 months and 3 versus 6 months, using the risk difference (RD) (‘net benefit’) between intervention and control group quit rates, the relative risk (RR) and the odds ratio (OR).ResultsSixty‐one studies (27 647 participants) were included. Fewer than 40% of intervention group participants were sustained abstinent at 3 months (bupropion: 37.1%; nicotine replacement therapy (NRT): 34.8%; varenicline: 39.3%); approximately a quarter were sustained abstinent at 6 months (bupropion: 25.9%; NRT: 26.6%; varenicline: 25.4%), and approximately a fifth were sustained abstinent at 12 months (bupropion: 19.9%; NRT: 19.8%%; varenicline: 18.7%). There was only a small decline in RR (3 months: 1.95 [95% confidence interval (CI) = 1.74–2.18, P < 0.0001]; 6 months: 1.87 (95% CI = 1.67–2.08 P < 0.0001); 12 months: 1.75 (95% CI = 1.56–1.95, P < 0.0001) between intervention and control groups over time, but a substantial decline in net benefit [3 months: RD = 17.3% (14.5–20.1%); 6 months: RD = 11.8% (10.0–13.7%); 12 months: RD = 8.2% (6.8–9.6%)]. The decline in net benefit was statistically significant between 3 and 6 [RD = 4.95% (95% CI = 3.49–6.41%), P < 0.0001] and 6 and 12 months [RD = 3.00% (95% CI = 2.36%–3.64%), P < 0.0001)] for medications combined and individual medications.ConclusionsThe proportion of smokers who use smoking cessation medications who benefit from doing so decreases during the course of the first year, but a net benefit still remains at 12 months.

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Shape of the relapse curve and long‐term abstinence among untreated smokers

Abstract: More reports of relapse curves of self-quitters are needed. Smoking cessation interventions should focus on the first week of abstinence. Interventions that produce abstinence rates of 5-10% may be effective. Cessation studies should report relapse curves.

Cited by 1,228 publications

References 48 publications

Attempts to stop or reduce marijuana use in non-treatment seekers

Attempts to stop or reduce marijuana use in non-treatment seekers

Predictors of smoking lapse in a human laboratory paradigm

Diminishing benefit of smoking cessation medications during the first year: a meta‐analysis of randomized controlled trials

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