ATTUD Journal Club Postings

The ugly relapse curve

A while ago I published a paper describing the relapse curve in self-quitters (Addiction 99:29) showing most smokers can not even remain abstinent for the first week. Some thought that the abstinence curve might not be so steep in those in treatment. A recent paper (Addiction 114:787) found this not to be true as, those less than half of those on placebo, NRT or bupropion could remain abstinent for one week. The exception was for varenicline. 

Given this, why do treatment studies, quitlines and behavioral interventions continue to not schedule the first post-abstinence session till 7 days after the quit date? By then, the deed is done. Having sessions at 1,3 and 5 days after the quit date, even if by phone, can also catalyze coping skills. Its hard to sell the importance of coping skills prior to the quit date as the problem is hypothetical and over-confidence is rare. However, when one is battling 24/7 craving, coping skills seem more attractive. Its not like a schedule of 1, 3 and 5 days of interventions is overkill. Doctors see inpatients on days 1, 2, 3, 4, 5, 6, and 7.