Course and Natural History - Nicotine Dependence

Course and Natural History

The National Health Interview Survey found that 70% of smokers interviewed reported they wanted to quit smoking at some point in their lifetime, and about 33% of smokers try to quit each year. Only about 3% of quit attempts without formal treatment are suc-cessful, and in recent years about 30% of smokers who want to quit are seeking treatment. Outcomes for nicotine dependence treatment vary by the type of treatment and the intensity of treat-ment with specific reports ranging from about 15 to 45% 1-year abstinence rates following treatment. Cessation attempts result in high relapse rates, with the relapse curve for smoking cessation paralleling that for opiates. Most individuals relapse during the first 3 days of withdrawal and most others will relapse within the first 3 months. Withdrawal symptoms are most severe within the first 1 to 3 days of abstinence, often continue for 3 to 4 weeks, and in some persons last for up to 6 months or longer. Current de-pressive symptoms and a history of depression are predictors of relapse. Weight gain may also contribute to relapse, particularly in women. In contrast, several factors have been found to predict worse outcomes at smoking cessation. Predictors include indi-vidual factors, manifestations of the addiction such as severity of withdrawal, and social and environmental circumstances.

Nicotine dependence, like other substance use disorders, can be thought of as a chronic relapsing illness with a course of intermittent episodes alternating with periods of remission for most smokers. About 65% of those who stop smoking relapse in 3 months and another 10% relapse in 3 to 6 months, and with treatment the overall relapse rate is still about 75 to 80% by 1 year. However, these reported lower outcome rates do not consider the additive effects over time related to multiple quit attempts, since about 40 to 50% of smokers in the USA have been able to quit smoking in their lifetime. Less than 25% of the individuals who have quit smoking are successful on their first attempt. Repeated failures are common before successful abstinence, with the aver-age smoker attempting to quit five or six times before success.

Recent prior attempts at quitting do increase the odds that indi-viduals will be able to quit smoking on a future attempt. Relapse can occur even after a long time of abstinence, with about 33% of former smokers who are abstinent for 1 year eventually relapsing 5 to 10 years after cessation.