The Importance of the First Week of Quitting Smoking

Just one week of being smoke-free increases your patients’ chances of quitting smoking by 9x.

What are the challenges of the first week?

As their physician, you can help patients get through this crucial time period by:

Offering Quick Counselling to your patients
Using different strategies to support your patients

Referring patients to smoking cessation resources

Why is the first week so critical?

icon of a person thinking about cigarettes

Withdrawal symptoms and cravings are at their strongest during the first week^1,2

The risk of relapse is shown to be highest during the first 8 days after a quit attempt³

Getting patients through the first week increases their chances of quitting by 9X⁴

What makes the first week so difficult?

Difficulty quitting may be due to nicotinic receptor upregulation. Using SPECT imaging, Cosgrove et al. showed that abstinent smokers (vs. non-smokers) had significant β2-nicotinic acetylcholine receptor (β2-nAChR) upregulation in multiple brain regions that persisted 1 month after abstinence. This was correlated with a greater urge to smoke. Receptor levels only returned to normal by 6-12 weeks.⁵

Availability of the nicotinic acetylcholine receptor containing the β2 subunit: nonsmokers vs. tobacco smokers

Image of brain regions using SPECT imaging

From Cosgrove KP, et al.

Strategies to support your patients during the crucial first week and beyond

REDUCE TO QUIT^®	Consider REDUCE TO QUIT^® for patients who want to quit, but are not ready to quit entirely Produced similar quit rates to abrupt cessation NRT increases the chances of success by helping to manage cravings and withdrawal symptoms
NRT	Offer NRT to all patients - even those not ready to quit: Most smokers want to quit and are looking to their HCP for advice⁶ The offer of NRT has been shown to spur a quit attempt^7,8 A review of 12 clinical studies showed that oral NRT, like Nicorette^®, significantly reduced withdrawal symptoms, such as irritability, anxiety and withdrawal discomfort² Remind patients that NRT needs to be used beyond the first week for at least 10 or 12 weeks to be effective
Proven Strategies	Offer proven strategies to prevent and manage relapse during the first week The highest dose patch available in the NICODERM^® range is 21 mg⁹ Continuing NRT patch treatment during a relapse was shown to significantly increase the likelihood of recovery at 6 and 10 weeks¹⁰
Practical Tips	Provide practical tips to help them get through the first week: Remind them that cravings are temporary. A 5-minute distraction (e.g., playing a game on their phone) is often enough to get past it. Have them write a list of reasons for quitting and keep it visible. Looking at it can help them get through challenging times. Explain that their brain will try to rationalize having a cigarette (e.g., “It’s OK to smoke when I drink”). Have a plan to manage this. Suggest drinking water when a craving hits to keep the mouth busy. Advise changing up their routine, which can be tied to smoking (e.g., a new route to work; avoiding certain people/places for a few days).

Remember: your role is vital
NRT + strategic advice from an HCP was shown to increase a smoker’s quitting success by 4X vs. going cold turkey.¹¹

Download these strategies to support your patients during the crucial first week

Download

Learn about counselling techniques

See the benefits of combination therapy

References

1. Shiffman, S., Ferguson, S. G., Gwaltney, C. J., Balabanis, M. H., & Shadel, W. G. (2005). Reduction of abstinence-induced withdrawal and craving using high-dose nicotine replacement therapy. Psychopharmacology, 184(3-4), 637–644.

2. West, R., & Shiffman, S. (2001). Effect of oral nicotine dosing forms on cigarette withdrawal symptoms and craving: a systematic review. Psychopharmacology, 155(2), 115–122.

3. Hughes JR, et al. Shape of the Relapse Curve and Long-term Abstinence Among Untreated Smokers. Addiction 2004;99:29-38.

4. Tùnnesen P, Paoletti P, Gustavsson G, et al. Higher dosage nicotine patches increase one-year smoking cessation rates: results from the European CEASE trial. Eur Respir J 1999;13:238-246.

5. Cosgrove KP, et al. Beta2-Nicotinic Acetylcholine Receptor Availability During Acute and Prolonged Abstinence from Tobacco Smoking. Archives of General Psychiatry 2009:66(6):666-676.

6. Reid JL, Hammond D, Tariq U, Burkhalter R, Rynard VL, Douglas O. Tobacco Use in Canada: Patterns and Trends, 2019 Edition. Waterloo, ON: Propel Centre for Population Health Impact, University of Waterloo.

7. Burris JL et al. A Mechanistic Test of Nicotine Replacement Therapy Sampling for Smoking Cessation Induction. Psychol Addict Behav 2015 Jun;29(2):392-399.

8. Shiffman S. Nicotine Replacement Therapy Increases Quit Attempts Among Unmotivated Smokers When Added to Encouragement to Practice Quitting. Evidence-Based Medicine 2012;17(6):187-188.

9. NICODERM^® Product Insert. November 7, 2022.

10. Ferguson SG, Gitchell JG, Shiffman S. Continuing to wear nicotine patches after smoking lapses promotes recovery of abstinence. Addiction. 2012 Jul;107(7):1349-53.

11. Sutherland G. Smoking: Can We Really Make a Difference? Heart 2003;89:ii25-7.