The Psychology of Smoking Relapse

Smoking relapse is one of the most significant challenges that most smoking quitters or stoppers face. Although wide availability of cessation aids and interventions exist, the rate of relapse remains relatively high, with many returning to smoking within the first year after quitting. It is with this in mind that psychological factors involved with smoking relapse have become more important in improving the interventions. This article explores the psychology behind smoking relapse, including the behavioural, cognitive, emotional, and social aspects of the phenomenon of smoking relapse. It will also dive into a few evidence-based strategies for long-term smoking cessation.

Social and environmental factors also form an integral part of the relapse process. Social support as well as social norms and exposure to smoking cues cannot be underestimated in their contribution to relapse. A supportive social network might encourage, account for, and practically support the quit process, whereas an environment that discourages smoking may promote the consolidation of abstinence.

Conversely, an environment where smoking is rampant is likely to foster relapse. Using social support in interventions such as group counselling, peer support programs, and family involvement provides supportive conditions for behaviour change. Additionally, interventions targeting modification or avoidance of high-risk environments can help the individual cope with social situations that may provoke cravings.

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Knowledge of smoking relapse

Smoking relapse is when an individual restarts smoking after a period of quitting. It is not a sudden process but one that takes place over a series of stages. Marlatt and Gordon’s (1985) relapse model focused on the notion of the “abstinence violation effect” (AVE), where an individual experiences a lapse, which might be as minor as smoking a single cigarette, and perceives this as not succeeding. This triggers a full-blown relapse. It is largely a cognitive-behavioural model brought into the limelight by the processes of cognition, emotion, and the situation influencing the process of relapse.

Behavioral Factors

Behavioural factors play a very important role in smoking relapse. Smoking is maintained most of the time by conditioned associations between smoking and some environmental stimuli. For example, smokers associate smoking with the activity of drinking coffee or sitting with friends. Such association may trigger a desire for smoking and may increase the likelihood of relapse.

• Habitual Behavior: Smoking is often a very deeply ingrained habit. Habits are habitual, automatic behaviours. This makes habits very hard to change because they do not require conscious control. Automaticity in smoking may be cued by particular stimuli, such as stress or boredom, which initiates people to smoke without conscious awareness. Thus, breaking the automaticity requires an effortful performance aimed at breaking the linkage between cues and smoking behaviour.
• Behavioural Substitution: Avoidance of relapse can also be brought about by replacing smoking with other behaviours. Behavioural therapies such as engaging in exercise, gum chewing, or maintaining relaxation skills have helped various individuals deal with their desire to smoke. Those interventions that apply contingency management are quite efficient in the prevention of relapse by providing incentives for maintaining abstinence.

Cognitive Factors

Cognitive factors, including beliefs, attitudes, and self-efficacy, are generally salient in relapse to smoking.

• Cognitive Dissonance: The theory of cognitive dissonance (Leon Festinger, 1957) suggests that people experience psychological discomfort when their behaviour and their beliefs or attitudes do not align. The urge to smoke for ex-smokers can activate their state of dissonance, particularly if they have strong beliefs about the risks associated with smoking. Cognitive distortions such as discounting the risks associated with smoking or rationalizing an instance of lapse may, however, lead to relapse.
• Expectancies and Beliefs: Positive expectancies toward smoking, such as that smoking reduces tension or enhances concentration, may facilitate smoking again. Conversely, for an individual with low self-efficacy, the belief that one cannot quit may undermine the ability to quit. Bandura’s self-efficacy theory explains how self-efficacy influences behaviour change. People with high levels of self-efficacy are better at persevering in quitting attempts and countering cues to relapse.
• Cognitive-Behavioral Therapy (CBT): CBT is applied to change the negative cognitions and perceptions toward smoking. In addition, smoking cessation intervention based on CBT includes identifying cognitive distortions, self-efficacy, and ways in which the individual can manage cravings and high-risk situations. Research indicates that CBT-based interventions at the very least can reduce the risk of relapse.

Emotional Factors

Emotions play a highly critical role in the smoking relapse process. Negative feelings that are the very potential triggers for relapse can include, but are not limited to: stress, anxiety, and depression.

• Negative Affect and Coping: Negative affect, or the experience of unpleasant emotions, is a good predictor of relapse during smoking cessation. Indeed, many smokers smoke as a means of coping with aversive effects. Individuals in the quit process may experience an increase in negative affect due to withdrawal symptoms and the loss of their primary coping tool. The lack of alternative strategies may lead individuals to turn to smoking as a strategy for regulating their emotions.
• Stress and Relapse: The effects of stress on smoking relapse have long been documented. According to the stress-relief hypothesis, people smoke as an attempt to reduce stress and handle daily hassles. However, there may be more to this perception, as the relief from smoking could be immediate but only temporary due to withdrawal from nicotine that can perpetuate a cycle of stress and craving. Studies also have established that interventions such as mindfulness-based stress reduction (MBSR), and various relaxation training programs are helpful stress management interventions and, by extension, prevent relapse.
• Emotion Regulation: Coping skills to manage emotions well are good in the prevention of relapse. Mindfulness-based interventions, focusing on a non-judgmental awareness of one’s thoughts and emotions, have been deemed effective for reducing the detrimental effects of negative effects on smoking relapse. Mindfulness can help a person observe cravings and negative emotions without acting on them, and in turn, it increases the chances for less relapse.

Social and Environmental Factors

Social and environmental factors, including social support, social norms, and exposure to smoking cues, influence smoking relapse. Social Support: High on the list of factors that lead to effective smoking quitting is social support. Support from family, friends, and even support groups can
encourage an individual, hold them accountable for quitting, and sometimes provide all necessary help. According to a meta-analysis done by Park et al. (2016), high social support was associated with higher quit rates and fewer likelihoods of relapse.

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• Social norms and peer influence: There is a big impact of social norms and peer influence on the level of smoking behaviour. People who are around smokers or were part of a social circle that considered smoking a norm are more likely to relapse. If somebody was part of a nonsmoking social network, chances of relapse become low. Interventions that involve groups and peer support programs can prove to be effective for long-term smoking cessation.
• Environmental Cues: Exposure to environments in which smoking is habitual, such as bars or parties, may indeed precipitate craving and relapse. Over time, such environmental cues can become a conditioned stimulus associated with nicotine effects. The most important strategy in relapse prevention is avoidance of, or modification in exposure to, high-risk environments. Though this article focuses on psychological determinants, neurobiological contributions must be identified in smoking addiction and relapse. Nicotine addiction is said to be due to changes in brain circuits associated with reward, motivation, and self-control. These neurobiological changes increase the risk of relapse, mainly through exposure to stressors or cues that bring about smoking.

Read More: Why Is Smoking So Appealing to Youths, Know About the Effects?

Techniques for Preventing Smoking Relapse

Since smoking relapse is a complex behavior, support to individuals that would maintain them abstinent for a longer time period should be multilateral. Some of the evidence-based prevention approaches for smoking relapse are the following:

• Cognitive-Behavioural Interventions: CBT is one of the best approaches used in controlling the distortion of cognitive behaviour and enhancing self-efficacy and coping skills. Relapse prevention programs based on CBT help provide people with the ability to identify high-risk situations, manage their cravings, and inculcate problem-solving skills.
• Mindfulness-Based Interventions: MBIs teach the clients to be observers of their thoughts, emotions, and cravings without reacting to them. The degree of negative affective impact is significantly reduced with mindfulness practices by regulating emotions that ultimately minimize the possibility of relapse.
• Stress management: This consists of relaxation training, progressive muscle relaxation, and deep-breathing exercises, which can assist in helping individuals manage stress and consequently reduce the urge to smoke. Any stress reduction technique incorporated into a cessation program would likely enhance outcomes.
• Behavioural Substitution: It encourages behavioural substitution for smoking cigarettes with healthier behaviours like physical activity. Such exercises have been found to reduce withdrawal symptoms, decrease craving, and improve mood.
• Social Support and Counseling: Social support is also very important for long-term abstinence. Group counselling, peer support programs, and telephone quitlines create a supportive atmosphere wherein individuals can share their experiences, and receive encouragement, and motivation.
• Medication-Assisted Therapy: Pharmacological interventions, such as NRT, bupropion, and varenicline, mitigate withdrawal symptoms and heightened craving. Medication combined with behavioural interventions has been shown to improve outcomes at cessation.

Conclusion

Smoking relapse is a complex phenomenon that is critically associated with a wide interplay of factors, psychological, behavioural, emotional, social, and neurobiological. Understanding the psychological underpinnings of relapse forms an essential aspect of interventions aimed at helping people quit smoking and then remain abstinent from cigarettes. Quitting smoking is, indeed, an important milestone in the pursuit of health and wellness; however, the road to sustained abstinence is frequently fraught with challenges. Relatively high relapse rates exist for smoking, requiring a complex solution based upon the influence of underlying psychological processes that trigger relapse.

Although psychological mechanisms are foundational in uncovering relapse into smoking behaviour, the neurobiological changes resulting from nicotine addiction are also important and enable the notion of reversion. Chronic administration of nicotine causes significant alterations in reward-related circuits within the brain that are both motivational and executive in nature, making the subject more vulnerable to relapse by stress or environmental cues.

Pharmacological interventions, for instance, target NRT, bupropion, and varenicline at the neurobiological level to reduce withdrawal symptoms and cravings. Medication, alongside behavioural and cognitive treatment strategies, is posited to facilitate a more all-inclusive support of smokers to achieve and maintain smoking abstinence. Finally, the process for lasting quitting is best understood as dynamic, thereby recommending quit attempts must persist and change with time as the individual responds to failure, using multiple approaches.

The high recurrence rates among smokers reinforce the view that stop-smoking interventions must be person-centred, flexible, and more specific to the challenges of each individual. Relapse should not be regarded as a failure but rather as a common step in the process. Learning through failure may inspire a person to identify his triggers, improve his ability to cope with difficult situations, and increase his resolve to quit. Healthcare professionals and researchers are players in helping bridge this gap by providing effective smoking cessation strategies.

Further research into the psychosomatic relapse mechanism also needs to be continued so that targeted and innovative interventions can be best designed. The second thing would be public health initiatives that create supportive environments for non-smoking, reduce exposure to smoking cues, and challenge the social norms around smoking to maximize cessation efforts. The motivation of smoking relapse psychology and evidence-based interventions will help individuals benefit, avoid smoking, and obtain long-term freedom, thus fostering excellent results in public health. By creating a holistic understanding of the psychology of smoking relapse and using evidence-based interventions, society can help people for lasting freedom from smoking and positive outcomes concerning public health.

From behavioural habits and cognitive distortion through emotional triggers and social influences, the complexity of relapse requires interventions from different angles. Cognitive-behavioural therapy, mindfulness-based interventions, stress management, behavioural substitution, social support, and medication-assisted treatment provide valuable strategies for reducing the risk of relapse and increasing long-term abstinence. Smoking addiction relates to psychological, social, and neurobiological aspects, which can be overcome by empowering the capability of those individuals to overcome the challenges of relapse and achieve long-term success in their quest for a smoke-free life.