Ex-smokers on their own in fending off a relapse

There's no evidence that behavioral approaches help smokers who have recently quit to remain smoke-free, conclude the authors of a review of relapse prevention strategies.

Furthermore, while the drug varenicline (sold as Chantix) seemed to help some people avoid relapse, long-term treatment with bupropion (sold as Zyban) "is unlikely to have a clinically important effect," Dr. Peter Hajek of the University of London and his colleagues write in The Cochrane Library.

Hajek and his team looked at 54 studies to see what help is available to ex-smokers for preventing a relapse.

The behavioral therapy approach that "holds a virtual monopoly in this field" involves teaching ex-smokers how to spot situations where they might be tempted to smoke, and how to cope with these situations. The review found no evidence that this works.

The few studies that looked at a different approach, following up with people by phone or in person after they had quit, also had negative results.

"But most ex-smokers did not continue to visit clinics or phone help lines," Hayek noted in a press release accompanying the study from the Center for the Advancement of Health. "It is possible that ongoing support that is more convenient, such as texting or messaging, or support that accompanies ongoing medication, would be more effective."

Extended nicotine replacement therapy was only examined in small studies, "in paradigms likely to generate low treatment compliance," so Hayek and his colleagues call for more research on this approach.

Another review in the jounral, of strategies for preventing people from gaining weight after smoking, found non-tailored behavioral interventions weren't effective, and might even be associated with a reduction in abstinence.

After giving up smoking, most people gain weight, Dr. Amanda C. Parsons of the University of Birmingham in the UK and her colleagues note in their review, with an average post-quit increase of 7 kilograms (15.4 pounds).

While bupropion, fluoxetine (Prozac), nicotine replacement therapy and varenicline all prevented weight gain while patients were using them, they had no effect on weight after patients stopped the medications or had been using them long-term, Parsons and her team found.

The best approach seemed to be individually tailored cognitive behavioral therapy, which helped people remain abstinent and also helped them control their weight, according to the researchers. There was also evidence that exercise was helpful. "More studies are needed to confirm this effect," they conclude.

SOURCE: Cochrane Database of Systematic Reviews 2009, Issue 1.