ATTUD Journal Club Postings

Do Ex-smokers Return to Normal?

We all have been at cocktail parties and heard innumerable stories of how smokers quit. Often we will hear former smokers say they can’t believe they ever smoked and have no desire at all to return to smoking; others say they have to remain vigilant because they still have desires to smoke at times. I recently published what is, I think, the first paper to try to quantify this. In an internet survey of 403 smokers who had been abstinent for 1-10 years (Hughes, NTR 12:459-462, 2010), 59% said they had a desire to smoke in the last year and 42% of these (or 25% of all former smokers) had a desire in the last week. Overall 9% of smokers said they had a craving that came very close or did cause them to have a puff of a cigarette. No one described a craving that lasted for longer than day.  As expected, those who were more nicotine dependent when they smoked were more likely to have prolonged cravings. We could not determine if these late cravings caused relapse because all of our subjects were former smokers.

Prolonged cravings have been described for alcoholics in recovery, and alcohol treatments often emphasize that many in recovery will never be able to have a “normal relationship” to alcohol. Is this because prolonged use of alcohol and nicotine cause brain changes? Some brain imaging studies show never and former smokers differ, but perhaps they differed even before they took up smoking. Also, formerly obese persons also report they have to constantly monitor their eating and no drug is involved here. And finally, animal studies are more and more finding that we never forget emotional events, we only suppress their memories that are always there ready to come back. These studies are trying to find why some come back so easily in some people but not others.

So what does this all mean? I think it means we need to be upfront with some smokers and say, yes you may have intense cravings from time to time and these can occur for years. And some of you will have them weekly. But you need to be vigilant about not giving into them. So have a plan of action for them (have a smoking buddy to call when they occur, have some leftover nicotine lozenge to use, etc). And remember you lasted through the semi-hell of tobacco withdrawal for many days and devised ways to not give in, so overcoming a few hours of craving should be much easier.