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Relapse prevention
Peter Hajek
Abstract
Relapse is the key unresolved issue in smoking cessation.
We have effective methods to help at least half of dependent
smokers to overcome the initial withdrawal discomfort
and achieve one month abstinence. Most patients feel at
that stage that they are over the worst, and many consider
the problem solved. Yet some 2/3 of initially successful
quitters return to smoking within a year.
There is an extensive observational literature on relapse,
but only limited effort has been devoted to developing
and evaluating relapse prevention interventions. A Cochrane
review of such trials has been published recently and
the presentation will report on the findings of the meta-analysis.
Although there were 40 studies with some relevance for
relapse prevention, only 3 studies randomised participants
at the end of the initial several-weeks treatment period,
with two of these testing the efficacy of Zyban, and one
looking at a behavioural intervention. There were two
types of behavioural relapse prevention interventions
tested across most of the 40 studies, i.e. teaching smokers
to identify risky situations and to cope with them, and
extending treatment contact. The results were resoundingly
negative, but most studies allowed too much experimental
'noise', usually related to methodological problems such
as randomisation prior to quitting smoking, lack of validation,
and lack of reporting of continuous abstinence rates.
We shall try to derive some lessons from the available
evidence for possible directions for future research and
for current practice.
Biography
Peter Hajek is Professor of Clinical Psychology, Head
of Psychology, and Director of Tobacco Dependence Research
Unit at Barts and The London, Queen Mary's School of Medicine
and Dentistry, University of London. His research is concerned
primarily with understanding smoking behaviour, and developing
and evaluating smoking cessation treatments.
Peter Hajek
Head of Psychology and Director,
Tobacco Dependence Research Centre,
Barts and The London School of Medicine and Dentistry,
Queen Mary University of London
p.hajek@qmul.ac.uk
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