Rich Dietman: Welcome to Mayo Clinic podcast. Our topic today is smoking relapse and how to get back on track with your goal to quit smoking for good. I'm your host, Rich Dietman.

Rich Dietman: Unfortunately, many people who quit smoking find it hard to resist the tobacco urge, and it's not uncommon to have a smoking relapse, or several. But the good news is that when you learn more about smoking relapse, you can also learn about how to prevent another one. In today's podcast, we're talking with Dr. Richard Hurt, professor of medicine and director of the Nicotine Dependence Center at Mayo Clinic in Rochester, Minn. Dr. Hurt, thanks for being with us.

Dr. Hurt: Good morning.

Rich Dietman: To begin with, Dr. Hurt, just exactly what's meant by the term "smoking relapse?"

Dr. Hurt: Classically, we think of a smoking relapse as smoking for seven consecutive days — even a puff a day counts. Anything short of that we consider a lapse, which is much less severe than a relapse.

Rich Dietman: How long after someone quits smoking is he or she at risk of a smoking relapse?

Dr. Hurt: Well, the highest risk is immediately after stopping smoking, and that risk is highest in the first couple of weeks and certainly within the first month after stopping smoking. After that, the risk of relapse goes down, and once a person makes it to six months, the risk of relapse is relatively small. And this all has to do with the neurobiology of this. And by that, I mean when people who are smokers who are addicted to smoking, they have an increase in the number of receptors in the brain that accept nicotine, and therefore this increased number produces urges to smoke and cravings to smoke, and it takes time for those receptors to get back to normal. So we need to get people to understand this is a long process and sometimes it takes several months before they're at low risk for relapse.

Rich Dietman: So it's an actual physical change that takes place over time.

Dr. Hurt: It is. And when we discuss this with patients, they're greatly relieved to hear that because the stigma and the shame that people have — they think they just don't have enough willpower to overcome this.

Rich Dietman: A lot of people say they smoke to cope with stress. How can a person prevent stress from triggering a relapse?

Dr. Hurt: Well, that's actually true. When a person stops smoking, the same brain receptors that want to have another dose of nicotine kind of gnaw at you a little bit, and they can produce stress. But a lot of the stress comes from the outside world. So the triggers and the cues to smoke that a person would usually have smoked under become stressful. So just recognizing those situations is a very important part of this, and only the smoker knows what those situations are. So we teach and talk to patients about things that can relieve stress. One really good thing to do is exercise, even just moderate exercise. Getting up and taking a brisk walk will reduce the stress. Deep-breathing exercises also will reduce stress. So there are some really concrete things that people can do, but the key is to recognize the situations that provoke it.

Rich Dietman: What other situations or circumstances besides stress are most likely to trigger a smoking relapse?

Dr. Hurt: Probably the most common situation we have for relapse is when a person has some alcohol. Drinking and smoking go together. And so when a person is in an alcohol situation, where they've been drinking at a party and someone says, "Let's go outside and have a cigarette," and the person says, "Well, I think I'll do that and I can just have one," that's a bad setup, and that happens fairly frequently. So that probably is the most common thing we hear when people say that they have stopped smoking for six or eight months and then they relapse.

Rich Dietman: And again, you teach people and help people recognize those triggers, those cues.

Dr. Hurt: Absolutely, and so we've talked to them about the more common ones, but then we tell them that they have to really kind of make a list and have a plan. It's like having a plan if you had a fire in your house. No one expects to have a fire in their house, but they need to have a plan in case there is one. So for relapse situations, the smoker needs to plan out, "What am I going to do when I find myself at the Kwik Trip and I have a gallon of milk on the counter and a loaf of bread," and the thought comes to mind, "I'll have a pack of ... " So if you've already paid for the gas, then leave the milk, leave the bread and leave the place. So having a plan in advance is really something that people can do. And sometimes we tell people to write it down and have it in your pocket.

Rich Dietman: What should someone do when they've had a smoking relapse?

Dr. Hurt: Well, they need to get back on track really quickly, and they shouldn't be embarrassed by this. There's enough shame and guilt already in people who are smokers, so if they have a problem with a lapse or a relapse, they need to get back in touch with their provider, whether it be a counselor or a physician, and the sooner they do that the better. So getting back engaged in the treatment process is what we recommend for people to do.

Rich Dietman: If someone's had a relapse, could it mean that he or she is just not ready to quit yet and that they should just stop trying to quit for now?

Dr. Hurt: No, we don't think so. We think that really this is a process. Stopping smoking is a process. It doesn't happen instantaneously all at one time, and so having some experience with a lapse or relapse is something they can learn from, and then they need to take that and move forward. So we want to have people come back and get re-engaged in the treatment process anywhere along the way. Even if they've had some serious urges and cravings to smoke and haven't lapsed or relapsed, we encourage them to come back and talk to us, and sometimes they even go back on medication in those situations.

Rich Dietman: Dr. Hurt, if you've had a relapse and you haven't, for whatever reason, gotten yourself into a quit-smoking treatment program, what are some things that a person can do?

Dr. Hurt: Well first of all, talk with a friend, and if you have a friend who's an ex-smoker, to kind of help you through this, if you have a support person who has really been helpful for you before, talk to them about this because, again, the self-esteem is part of the issue and so being able to talk with someone else about it — there are telephone quit lines in every state in the country. So if you call 1-800-QUITNOW, they'll direct you to your state telephone quit line. You can go to the Internet and find resources on the Internet. One in particular is becomeanex.org. And you shouldn't feel ashamed about that. Stopping smoking is a process and relapse is a common problem. In fact, most people have tried five to seven times to stop smoking before they are able to have sustained absence from smoking.

Rich Dietman: Thanks very much, Dr. Hurt. We've been talking about smoking relapse with Dr. Richard Hurt, professor of medicine and director of the Nicotine Dependence Center at Mayo Clinic. You've been listening to Mayo Clinic podcast. I'm Rich Dietman.

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