Intervention | Technique |
Relapse prevention |
| Every ex-tobacco user undergoing relapse prevention should receive congratulations on any success and strong encouragement to remain abstinent. When encountering a recent quitter, use open-ended questions designed to initiate patient problem-solving (eg, "How has stopping tobacco use helped you?"). |
The clinician should encourage the patient's active discussion of the topics below: |
The benefits, including potential health benefits, that the patient may derive from cessation |
Any success the patient has had in quitting (duration of abstinence, reduction in withdrawal, etc) |
The problems encountered or anticipated threats to maintaining abstinence (eg, depression, weight gain, alcohol, other tobacco users in the household) |
Management of relapse |
Lack of support for cessation | Schedule follow-up visits or telephone calls with the patient |
Help the patient identify sources of support within their environment |
Refer the patient to an appropriate organization that offers cessation counseling or support |
Negative mood or depression | If significant, provide counseling, prescribe appropriate medications, or refer the patient to a specialist |
Strong or prolonged withdrawal symptoms | If the patient reports prolonged craving or other withdrawal symptoms, consider extending the use of an approved pharmacotherapy or adding/combining pharmacologic medication to reduce strong withdrawal symptoms |
Weight gain | Recommend starting or increasing physical activity; discourage strict dieting |
Reassure the patient that some weight gain after quitting is common and appears to be self-limiting |
Emphasize the importance of a healthy diet |
Maintain the patient on pharmacotherapy known to delay weight gain (eg, bupropion sustained release; nicotine-replacement pharmacotherapies, particularly nicotine gum) |
Refer the patient to a specialist or program |
Flagging motivation/feeling deprived | Reassure the patient that these feelings are common |
Recommend rewarding activities |
Probe to ensure that the patient is not engaged in periodic tobacco use |
Emphasize that beginning to smoke (even a puff) will increase urges and make quitting more difficult |