Majority of tobacco users cycle through multiple periods of relapse and remission.

As we can see in the

Readiness to Change Model, after a person quits, they can stay quit, or go back into relapse. If the user
relapses, they will fall back into thinking about quitting or the ready to quit phase, meaning we have to
reuse the skills we learned in the previous modules.

Figure 5.1. Readiness to Change Model

Relapse should not be viewed as a failure, either on the part of the tobacco user or on the provider. We
should only consider is as a temporary setback since tobacco dependence has many features typical of
a chronic disease. The majority of tobacco users cycle through multiple periods of relapse and remis-
sion. Only 7% of smokers achieve long-term success quitting on their own, meaning relapses are very
common (Fiore et al., 2000); and that 93% would need our help.

COMMON CAUSES OF RELAPSE

Nicotine withdrawal discomfort. Because of the neurochemical effects of nicotine, it is expected that the
person attempting to quit will experience manifestations of discomfort after stopping tobacco use. This
happens early in the quitting process and may last several months.

BTI: Module 5. Staying Quit or Relapse 1

Negative emotions (anger, frustration, sadness, interpersonal conflict). The manifestations of discom-
fort take a toll on the person who has recently quit tobacco use. Negative emotions may magnify these
feelings of discomfort.

Stressful situations at home, work, or school/traumatic events. Just like negative emotions, it is likely
that the person has developed lighting up as automatic response to stressful situations at home, work,
or at school. Hence, we need to be aware of these potential triggers for relapse.

Social and environmental pressures. A significant number of smokers have started their habit because of
social and environmental pressures. These same pressures also often make it difficult for them to quit.

Loneliness/depression. Similar to stressful situations and negative emotions, smokers may have deve-
loped their smoking habit as a way to counteract loneliness or depression.

Weight gain. Smoking works as an appetite suppressant in some people, and after quitting, they would
often experience weight gain. This sudden weight gain is often noticeable for smokers, and in some
instances may trigger relapse.

Lack of support. As mentioned earlier, the majority of tobacco users who try to quit on their own and
without outside help, will encounter difficulty in avoiding relapse.

RELAPSE PREVENTION

Eventhough relapse is common for former tobacco users, there are several key tips that would help pre-
vent relapse (Fiore et. al., 2000):
 Congratulate success, no matter how brief.
 Review the benefits of quitting.
 Offer encouragement to remain tobacco free.
 Assist individuals with problems by referring them to treatment providers with whom you are
familiar in your area.

RELAPSE INTERVENTIONS

The Five A’s

What should we do when the person we are assisting relapses and start so use tobacco again?
Guided by the Readiness to Change Model, we will guide/ assist the person to transcend from relapse to

BTI: Module 5. Staying Quit or Relapse 2

thinking about quitting or ready to quit. We would again have to use the method we consistently used in
the previous modules: The Five A’s.

 Ask about their tobacco use.

 Advise the person to begin a new quit attempt. Acknowledge any period spent tobacco free.
“Quitting even for a day, is a real victory”. Some tobacco users need a period of time before begin-
ning a new quit attempt.
 Assess the person’s willingness to make another quit attempt within the next 30 days.
 Assist by referring them to other tobacco cessation services or encouraging them to think about
quitting again.
 Arrange to follow-up with the person at your next encounter.

Follow-ups

 Keep it brief. Conducting a follow-up contact should take no more than two to three minutes.
 Stick to the topic. Mention who you are and that your purpose is to make a BRIEF contact to see
how the person is doing.
 Avoid getting into problem-solving discussions. Use referrals to other services to help persons who
have additional concerns or questions.
 Follow ups may be done through telephone or mobile phone or other means.
 Use practical methods. Here are some ways you can initiate a follow-up:
 Tobacco user comes back at the health care facility for follow-up
 Telephone call/cellphone call/text message
 Home visit

Important Points about Relapse

 Most relapses occur early in the quitting (Fiore et al., 2000). So, time the follow-up in relation to the
tobacco user’s quit date. Follow-up contact should be arranged to occur soon before and after the
Quit Date, preferably during the first week. A second follow-up contact is recommended within the
first month (Fiore et al., 1996) and then follow up monthly until six months to seven months. More
frequent follow ups may be necessary depending on the client (refer to the Tobacco Cessation Al-
gorithm).
 Use reminder tools to ensure contact is made. Help the person to put up a system to remind them
of their scheduled follow-ups. Be proactive in reminding the person of their incoming follow-ups.
 Whenever you need assistance, always keep in mind that there are tobacco cessation services
available for your utilization (e.g., Quitline).

BTI: Module 5. Staying Quit or Relapse 3

STAYING QUIT AND RELAPSE
Watch the video role-plays of brief tobacco interventions during follow-up contacts.

KEY POINTS TO REMEMBER

 Only about 7% of smokers achieve long-term success when trying to quit on their own.
 Relapses are common and should not be viewed as failure.
 In case of relapse, apply again the “FIVE A’S”: ASK, ADVISE, ASSESS, ASSIST, ARRANGE
 To do effective follow-ups:
 Keep it brief.
 Stick to the topic.
 Avoid getting into problem-solving discussions.
 Use practical method for contacting individuals for follow-ups.

 What a BTI provider can do to prevent relapse:

 Congratulate success, no matter how brief.
 Review the benefits of quitting.
 Offer encouragement to remain tobacco free.
 Assist individuals with problems by referring them to treatment providers with whom you are
familiar in your area
 Keep in mind, that it will not always be successful and that it is okay.
 If an individual is into other substance addictions, do not attempt to go beyond what you are certi-
fied to do.
 Be conscious and be sensitive in dealing with individuals. Avoid intimidating gestures and lan-
guages when talking to them.
 Be aware of the physical and psychological environment that is framing the message you want to
send.
 Explore and seek the support of other similar providers or clinics in your area.

BTI: Module 5. Staying Quit or Relapse 4

 This e-book and related documents are intended for use
by a broad range of healthcare and non-healthcare
professionals (private or government). It is based on the
Brief Tobacco Intervention training curriculum developed by
Health Partners Limited Liability Corporation in Guam, USA,
and is customized based on the Philippine context.

All rights reserved.

The mention (if any) of specific companies or of certain

manufacturer’s product does not imply that they are endorsed or
recommended by the Department of Health (DOH) in reference over
others of a similar nature. Reproduction in full or in part of this e-
book for educational or other non-commercial purposes are
authorized without any prior written permission from the copyright
holder, provided the source is fully acknowledged as indicated
below. Reproduction for profit or for commercial purposes is
prohibited without written permission from the copyright holder.

Suggested citation: Department of Health (2019). Philippine Brief

Tobacco Intervention Course E-book. Manila, Philippines:
Department of Health.