Smoking relapse, preventing

Hays JT, Hurt RD, Rigotti NA, et al Sustained-release bupropion for pharmacologic relapse prevention after smoking cessation. Ann Intern Med 135 423 33, 2001 Henningfleld JE Nicotine medications for smoking cessation. N Engl J Med 333 1196-1203, 1995... 

Of the more recently introduced methods for smoking cessation, bupropion (an antidepressant with dopaminomimetic properties) has recently been introduced. Clinical trial data, in which the nicotine patch, bupropion at 300 mg, and a combination of the two drugs were compared with placebo treatment, have shown cessation of smoking rates of 36% for the patch, 49% for bupropion and 58% for the combined treatments following 7 weeks of treatment. The placebo response rate was 23%. All subjects received relapse prevention therapy. Thus bupropion appears to be a reasonably safe and effective treatment for nicotine dependence. It is however contraindicated in those subject to epilepsy its main side effects are dry mouth and insomnia. 

In addition, different factors may be involved in ex-smokers who relapse after several months or years of abstinence. Relapse may result from encountering social pressure to smoke, an unaccustomed stressor such as a personal loss, or an unexpected situation that leads to a return to smoking. A key concept in preventing relapses is the distinction between a lapse, which is a brief use of cigarets, and a relapse, which is a full return to smoking in the pattern previously followed by the smoker. One of the main goals of relapse prevention is to keep a lapse from turning into a relapse. 

The following recommendations for an outpatient medical clinic-based smoking cessation protocol follow current US Public Health Service recommendations (58), with additional suggestions to specifically distinguish and address both nicotine withdrawd symptoms, conditioned cravings for cigarets, and relapse prevention. 

Relapse prevention involves anticipating potential difficulties that may lead to resumption of smoking and addressing them in advance as much as possible. Issues to be dealt with may include ... 

Bupropion A drug that inhibits the presynaptic neuronal reuptake of both dopamine and noradrenaline which is used as an antidepressant and to prevent relapse following smoking cessation. 

Varenicline increases smoking cessation rates in smoking cessation trials and appear to prevent relapse. 

Brigham, Janet. Dying to Quit Why We Smoke and Haw We Stop. Washington, D.C. National Academy Press, 1998. This accessible account explains the dynamics of tobacco addiction to both medical professionals and general readers. In addition to motivating smokers through a careful explanation of the horrendous health effects of smoking, the author explains how smokers can deal with withdrawal symptoms and how involvement in a social network can help prevent relapses in ex-smokers. 

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