A new bi-directional model connecting smoking, quitting and relapse: Implications for spontaneous quitting?

Author and presenter:
Lynn Larabie
Physician, Ontario, Canada

Abstract
Smoking is the single most important preventable cause of death in the world. Despite the dismal statistics quoted for smoking cessation outcomes in research studies, millions of people do quit smoking successfully without assistance. Initially conceptualised as a circle and later modified to a spiral shape, the Stages of Change (SOC) model postulates that smokers who quit on their own move forward through a series of stages that describe their readiness to quit. However, many smokers who quit spontaneously demonstrate that step-by-step progression through discrete stages is not necessary for success.

In addition, cessation and maintenance are fluid processes with many people moving randomly in and out of abstinence in a ‘back and forth’ motion not allowed in the SOC spiral. A new bi-directional model is presented which captures the underlying connection between smoking, quitting and relapsing that is the dance of nicotine addiction. Like opposite sides of the same coin, quitting and relapse are equally weighted, integral parts of smoking behaviour. The bi-directional model is a better fit for spontaneous quit attempts. Even though it does not address the question of when or why these occur, the graphic representation of smoking behaviour can be used to illustrate and so simplify the current treatment of nicotine dependency.

Source of funding: nil

Declaration of interest: none

About the presenter
Physician with special interest in smoking cessation and aviation medicine.