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approximately 40% of patients symptoms can last longer than 1.3 Smoking is a chronic relapsing disease
3-4 weeks. 12
Nicotine withdrawal symptoms represent the sum of all changes
induced by abrupt cessation of nicotine consumption, which is 1.3.1 Relapse patterns
particularly difficult in the first two to six weeks and which must be Nicotine/tobacco dependence is a chronic relapsing condition,
accompanied by qualified medical assistance and psychological which is mostly acquired during adolescence.5 Tobacco
support. Thus the best strategy recommended by all smoking dependence has many characteristics of a chronic disease
cessation guidelines for treating nicotine dependence is to with most smokers persist in consuming tobacco for years or
combine pharmacological treatment with psycho-behavioural decades.
therapy. 13 “Relapse” is considered a return to regular smoking by someone
who has quit. Relapse typically refers to a period of several days
Smoking status or more of continuous smoking after a period of abstinence.
It is recommended that all clinicians appropriately assess of “Failures” or “relapses” mean daily smoking for at least three
current and past tobacco use with patients. days after a period of at least 24 hours without any smoking.
The following definitions are used for the classification of A “lapse” or a “slip” denotes the use of tobacco after a prior
smoking status: period of abstinence that does not result in the return to regular
• Non-smoker is a person who has not smoked more than 100 smoking. This may be the case of quitters and ex-smokers who
cigarettes in his/her life-time (or 100 g of tobacco, in the case smoke less than one cigarette per day in up to three days in one
of pipes, cigars or other tobacco products). week, or smoke any number of cigarettes one day in one week in
• Daily smoker is a person who has smoked on a daily basis the week before any scheduled visit. A lapse may be an isolated
for at least three months. event that is followed by a renewal of abstinence, or it is a strong
• Occasional smoker is a person who has smoked, but not on predictor of relapse.
a daily basis. Among ex-smokers relapse is common. Relapse most
• Ex-smoker is a person who has quit smoking for at least six frequently occurs within the first few days of a quit attempt when
months. withdrawal symptoms are the greatest. Over 75% of unaided
quitters relapse within the first week making this a critical period
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Some standard questions considered helpful in assessing of time. Figure 1.2 depicts the likelihood of relapse within the
smoking status are as follows: first year of quitting.
1. Have you ever smoked cigarettes or used other tobacco Once patients are smoke free for two to three months their risk
products (e.g. pipes, cigars etc.)? of relapse is much lower – but by no means gone. Even among
For current smokers: tobacco users who may have succeeded in quitting for brief or
2. How many cigarettes (or other tobacco products, e.g. pipes, longer periods of time the risk of relapse remains high. Patients
cigars etc.) do you usually smoke per day? who stay smoke free for at least 12-months have a 35% lifetime
3. How many years have you been smoking? probability of relapse (See Figure 1.3). 14
4. How many cigarettes have you smoked in your life? Is it
more or less than 100? 1.3.2 Treatment of tobacco dependence after cessation
5. Do you smoke every day/on certain days/in specific Tobacco dependence may need persistent and repeated
situations? Which situations? therapeutic interventions, as well as long- term follow-up until
For ex-smokers: it is cured. 15
6. How many years/months has it been since you quit smoking? Understanding its chronic nature implies long-term observation,

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