Psychological fatigue poses major risk for returning smokers

The most reliable predictor of an ex-smoker's relapse isn't strong urges to smoke or low confidence in the ability to stay off tobacco – it's weariness with the efforts to remain a non-smoker, according to a new study published today in Addiction. Ex-smokers appear to return to smoking most often because they're exhausted from the constant vigilance needed to remain a non-smoker. 

This effect is called psychological cessation fatigue, and its influence on ex-smokers is not affected by how long you've been an ex-smoker or whether you vape to reduce cravings. Even after years of not smoking, after withdrawal symptoms and conditioned responses are no longer strong, and even with regular hits of nicotine from vaping, the cumulative mental and emotional cost of sustaining not smoking can become so high that it overwhelms your coping skills and motivation to stay quit.

This study followed almost 2,000 adult ex-smokers in Australia, Canada, England, and the United States. Most participants had quit smoking years before the study began. At the start of the study, each participant expressed 1) how tired he or she was with trying to stay quit, 2) how strong the urge to smoke was in the past 24 hours, and 3) how confident he or she was in remaining an ex-smoker. 

Two years later, 9.2% of the ex-smokers had begun smoking again. The odds of relapse among ex-smokers with high fatigue were 1.64 times higher than those with low fatigue. In other words, the ex-smokers who were most tired of trying to sustain not smoking had a 64% higher likelihood of relapse than ex-smokers who expressed no cessation fatigue.

High urge to smoke and low confidence with remaining an ex-smoker also predicted smoking relapse, but the predictive strength of cessation fatigue was both stronger and at least partly independent of these other two measures.

Smoking is notoriously hard to quit. About 95% of unassisted attempts to quit ultimately end in relapse, and even when evidence-based treatments like nicotine patches are used, relapse rates are still high. Our research suggests that 'tiredness with efforts to remain not smoking' can be a useful screening tool to catch ex-smokers who are at higher risk of relapse and give them support when they need it. We could incorporate assessment of cessation fatigue in routine health checks and be ready to provide relapse prevention interventions where needed. Ex-smokers might also be advised to seek more help when they begin to experience fatigue." 

Dr. Hua Yong, Lead Author, Deakin University, Australia