Why ex-smokers can relapse after quitting for years

By Stephen Beech

Former smokers who relapse may simply be tired of the effort needed to stub out the habit, suggests new research.

The most reliable predictor of an ex-smoker sparking back up the fags wasn’t strong urges to smoke or low confidence in the ability to stay off tobacco – it was weariness of the commitment needed to remain a non-smoker, say scientists.

The study, published in the journal Addiction, found former smokers appear to return to the habit most often because they’re exhausted from the "constant vigilance" needed to remain a non-smoker.

Scientists sat the effect is called "psychological cessation fatigue" - and its influence on ex-smokers is not affected by how long they’ve been an ex-smoker or whether they vape to reduce cravings.

Even after years of not smoking, after withdrawal symptoms and conditioned responses are no longer strong, and even with regular hits of nicotine from vaping, the cumulative mental and emotional cost of sustaining not smoking can become so high that it "overwhelms" coping skills and motivation to stay quit.

This study followed more than 1,900 adult former smokers in England, Australia, Canada and the United States.

Most participants had quit smoking years before the research began.

At the start of the study, each participant expressed how tired he or she was with trying to stay off the fags, how strong the urge to smoke was in the past 24 hours, and how confident he or she was in remaining an ex-smoker.

Two years later, 9.2% of the former smokers had begun smoking again.

The odds of relapse among ex-smokers with high fatigue were 1.64 times higher than those with low fatigue.

Study lead author Professor Hua Yong said: "The ex-smokers who were most tired of trying to sustain not smoking had a 64% higher likelihood of relapse than ex-smokers who expressed no cessation fatigue.

"High urge to smoke and low confidence with remaining an ex-smoker also predicted smoking relapse, but the predictive strength of cessation fatigue was both stronger and at least partly independent of these other two measures."

Yong, of Deakin University in Australia, added: “Smoking is notoriously hard to quit.

"About 95% of unassisted attempts to quit ultimately end in relapse, and even when evidence-based treatments like nicotine patches are used, relapse rates are still high.

"Our research suggests that ‘tiredness with efforts to remain non-smoking’ can be a useful screening tool to catch ex-smokers who are at higher risk of relapse and give them support when they need it.

"We could incorporate assessment of cessation fatigue in routine health checks and be ready to provide relapse prevention interventions where needed.

"Ex-smokers might also be advised to seek more help when they begin to experience fatigue.”