Relapse prevention interventions for smoking cessation

 

Abstract

Background

A number of treatments can help smokers make a successful quit attempt, but many initially successful quitters relapse over time. Several interventions were proposed to help prevent relapse.

Objectives

To assess whether specific interventions for relapse prevention reduce the proportion of recent quitters who return to smoking.

Search methods

We searched the Cochrane Tobacco Addiction Group trials register in August 2008 for studies mentioning relapse prevention or maintenance in title, abstracts or keywords.

Selection criteria

Randomized or quasi-randomized controlled trials of relapse prevention interventions with a minimum follow up of six months. We included smokers who quit on their own, or were undergoing enforced abstinence, or who were participating in treatment programmes. We included trials that compared relapse prevention interventions to a no intervention control, or that compared a cessation programme with additional relapse prevention components to a cessation programme alone.

Data collection and analysis

Studies were screened and data extracted by one author and checked by a second. Disagreements were resolved by discussion or referral to a third author.

Main results

Fifty-four studies met inclusion criteria, but were heterogeneous in terms of populations and interventions. We considered 36 studies that randomized abstainers separately from studies that randomized participants prior to their quit date.

Looking at studies of behavioural interventions which randomised abstainers, we detected no benefit of brief and 'skills-based' relapse prevention methods for women who had quit smoking due to pregnancy, or for smokers undergoing a period of enforced abstinence during hospitalisation or military training. We also failed to detect significant effects of behavioural interventions in trials in unselected groups of smokers who had quit on their own or with a formal programme. Amongst trials randomising smokers prior to their quit date and evaluating the effect of additional relapse prevention components we also found no evidence of benefit of behavioural interventions in any subgroup. Overall, providing training in skills thought to be needed for relapse avoidance did not reduce relapse, but most studies did not use experimental designs best suited to the task, and had limited power to detect expected small differences between interventions. For pharmacological interventions, extended treatment with varenicline significantly reduced relapse in one trial (risk ratio 1.18, 95% confidence interval 1.03 to 1.36). Pooling of five studies of extended treatment with bupropion failed to detect a significant effect (risk ratio 1.17; 95% confidence interval 0.99 to 1.39). Two small trials of oral nicotine replacement treatment (NRT) failed to detect an effect but treatment compliance was low and in two other trials of oral NRT randomizing short-term abstainers there was a significant effect of intervention.

Authors' conclusions

At the moment there is insufficient evidence to support the use of any specific behavioural intervention for helping smokers who have successfully quit for a short time to avoid relapse. The verdict is strongest for interventions focusing on identifying and resolving tempting situations, as most studies were concerned with these. There is little research available regarding other behavioural approaches.
Extended treatment with varenicline may prevent relapse. Extended treatment with bupropion is unlikely to have a clinically important effect. Studies of extended treatment with nicotine replacement are needed.

 

Plain language summary

Do any interventions help smokers who have successfully quit for a short time to avoid relapsing

Some people start smoking again shortly after quitting and are said to have 'relapsed'. Interventions used to help people avoid relapse usually focus on teaching the skills to cope with temptations to smoke. This approach and others have not been shown to be helpful, either for people who quit on their own, or with the help of a cessation treatment, or who quit because they were pregnant or in hospital. Many trials conducted so far have not been of a strong enough design to detect possible small effects. Among drug treatments, extended use of varenicline may help some smokers. Studies of extended use of nicotine replacement treatment are urgently needed.

 

摘要

背景

戒菸後的預防復發處遇

有一些的治療確實能幫助吸菸者成功的戒菸，但是隨著時間的流逝，一開始成功戒菸的一些人慢慢的又開始吸菸。有幾個處遇是用來預防復發的。

目標

評估復發預防的特定處遇是否能降低戒菸者再度吸菸的比率。

搜尋策略

我們搜尋2008年8月在Cochrane Tobacco Addiction Group trials 登錄的研究，在標題、摘要或關鍵字有提到預防復發。

選擇標準

預防復發處遇的隨機或半隨機對照實驗，至少追蹤六個月。我們納入那些自己戒菸的吸菸者、被強迫戒菸的吸菸者或加入戒菸計畫的吸菸者。我們納入的研究是接受預防復發處遇和沒有處遇的控制組的比較，或是戒菸計畫合併有預防復發處遇和只有戒菸計畫的比較。

資料收集與分析

由一名作者篩選研究及擷取資料，另一名作者負責檢查。當兩人有不同的意見時，兩人經過討論解決或者由第三名作者決定。

主要結論

54篇研究符合納入的標準，但是在母群及處遇的異質性很高。我們將36篇隨機分派戒菸者的研究和隨機分派尚未就戒菸者的研究加以分開。當回顧那些隨機分派戒菸者的行為處遇的研究，我們發現對那些因為懷孕而戒菸的婦女或是在住院或當兵期間被強迫戒菸的人，短期或以技巧為基礎的'復發的預防方法並沒有好處。我們同樣發現在自願戒菸或經由戒菸計畫而戒菸的人，行為處遇也沒有任何有意義的效果。在那些尚未戒菸前先隨機分派的試驗去評估額外預防復發成效，我們同樣發現在任何組別裡都沒有證據顯示行為處遇有任何的好處。總體而言，提供避免復發所需要的技巧訓練培訓，並沒有辦法降低復發，但是多數研究並沒有使用最適合研究目的的實驗設計，且因為統計考驗力太小而無法偵測出各個處遇間的微小差異。在藥物治療上，一篇有關varenicline的延長治療的研究中發現能顯著降低復發率。(risk ratio 1.18, 95% confidence interval 1.03 to 1.36). 整合五篇bupropion的延長治療的研究，沒有發現顯著效果 (risk ratio 1.17; 95% confidence interval 0.99 to 1.39). 在兩個小型口服尼古丁替代療法的試驗(簡稱 NRT)中沒有檢測到效果，而且治療的遵囑性低，在另外兩個口服尼古丁替代療法試驗，隨機分派短期戒菸者，發現具有顯著的效果。

作者結論

目前沒有足夠的證據支持使用任何特定的行為處遇來幫助在很短的時間戒菸成功的吸菸者避免復發。大家一致認為的重點在於確認和解決誘惑情境，而大部分研究也著重在此。目前很少的研究考慮到其他的行為取向。使用varenicline的延長治療或許可以預防復發。使用bupropion的延長治療似乎沒有重要的臨床效果。我們仍需要使用尼古丁替代療法的研究。

翻譯人

本摘要由彰化基督教醫院胡淑惠翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

有些人在戒菸後不久後又開始吸煙，就是所謂的‘復發’。用來幫助人們避免復發的處遇通常關注在教導一些技巧以應付吸菸的誘惑。這種方法和其他方法並沒有被證明是有幫助的，無論是對於自己戒菸，或在戒菸治療的幫助下戒菸，或者因為懷孕或住院而戒菸的人來說。到目前為主，許多試驗的考驗力並沒有大到可以檢測出可能的些微效果。在藥物治療中，延長使用varenicline可以幫助一些吸菸者。目前我們迫切需要使用尼古丁替代療法的研究。