Schedule a follow-up contact.

Implementation:The follow-up should occur within the first week after the cessation date. A second follow-up is recommended within the first month of the cessation date. During this follow-up, be certain to congratulate any success/progress in the client's cessation attempt. If tobacco use has occurred since the last conversation review circumstances surrounding the tobacco use that led to the client's relapse. Address any concerns and discuss anticipated future challenges to maintaining a smoke free lifestyle.

Relapse is a normal occurrence. It is important for a client to look at the circumstances around her relapse and make a plan to prevent similar circumstances from tempting her to relapse in the future. The client must learn to anticipate high-risk situations if she is going to sustain a smoke free lifestyle. The client must also learn how to handle unexpected episodes of stress without smoking. This is where the essential relapse prevention skills will be useful.

Preventing Relapse: Because of the chronic relapsing nature of tobacco dependence, clinicians should provide brief effective relapse prevention treatment. Relapse prevention interventions are especially important soon after quitting and can be delivered by means of either scheduled clinic visits, or any time the clinician encounters an ex-tobacco user. Relapse interventions can be divided into two categories: minimal practice and prescriptive interventions.

Components of minimal practice relapse prevention:

These interventions should be part of every encounter with a patient who has recently quit:

Every ex-tobacco user undergoing relapse prevention should receive congratulations on any success and strong encouragement to remain abstinent.

When encountering a recent quitter, use open-ended questions designed to initiate patient problem solving.

• How has stopping tobacco use helped you?

The clinician should encourage the patients' active discussion of the topics below:

• Potential health benefits the patient and her baby will receive from cessation
  • Gives you more energy and helps you breathe easier.
  • Saves you money you can spend on other things.
  • Lets you feel good about what you've done for yourself and your baby.

• Any success the patient has had in quitting.
  • Duration of abstinence, reduction in withdrawal, etc.

• The problems encountered or anticipated threats to maintaining abstinence (e.g., depression, weight gain, alcohol, other tobacco users in the household).

Components of prescriptive relapse intervention:

During prescriptive relapse prevention, a patient might identify a problem that threatens his or her abstinence. Specific problems likely to be reported by patients and potential responses follow:

Problems Responses Lack of support for cessation Schedule follow-ups or telephone calls with the patient. Help the patient identify sources of support within her environment. Refer the patient to an appropriate organization that offers cessation counseling or support. Negative mood or depression If significant, provide counseling, prescribe appropriate medications, or refer the patient to a specialist. Strong or prolonged withdrawal symptoms If the patient reports prolonged craving or other withdrawal symptoms, consider extending the use of an approved pharmacology or adding/combining pharmacologic medications to reduce strong withdrawal symptoms. Weight gain Recommend starting or increasing physical activity after a physician's clearance. Emphasize the importance of a healthy diet. Reassure the patient that weight gain in normal during pregnancy. Flagging motivation/feeling deprived Reassure the patient that these feelings are common. Recommend rewarding activities. Probe to ensure that the patient is not engaged in periodic tobacco use. Emphasize that beginning to smoke (even a puff) will increase urges and make quitting more difficult.

Activity:
As the Health Care Provider you will want to address these areas with your client:

• Congratulations for maintaining a smoke free lifestyle thus far.
• Triggers for relapse.
• When did the relapse happen?
• What were was going on in your life at the time of relapse?
• Did you have a support person there?
• What techniques did you try to assist you in working through the craving?
• Would you like to set another cessation date at this time?
• What can I teach you to assist in maintaining a smoke free lifestyle?

Supplemental Handout Materials

All handout materials are available at our Handouts Resources Section	in PDF [Get Help]	in MS Word
Coping Tips to Stay a Non-smoker For Life	copetips.pdf (66k)	copetips.doc (25k)
Coping with Quitting Smoking	copequit.pdf (201k)	copequit.doc (22k)
Sample Follow-up Call	fllwcall.pdf (63k)	fllwcall.doc (21k)
Sample Follow-up Letter	fllwletr.pdf (80k)	fllwletr.doc (21k)

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