Limited evidence for effectiveness of relapse-prevention interventions for smoking cessation

Limited evidence for effectiveness of relapse-prevention interventions for smoking cessation

Brian McAvoy
Clinical question

How effective are specific relapse-prevention interventions for reducing the proportion of recent quitters who return to smoking?

Bottom line

The evidence did not support the use of behavioural treatments to help prevent relapse after quitting smoking (moderate-certainty evidence). This result was the same in all the different groups of people studied. The most promising treatments involved extending treatment with stop‐smoking medicine, in particular varenicline (moderate-certainty evidence). Extending treatment with bupropion did not appear to help (moderate-certainty evidence), and there was not enough evidence on extending treatment with nicotine replacement therapy. Most of the studies used behavioural treatments that tried to teach people skills to cope with the urge to smoke, or followed up with additional leaflets, calls, internet or mobile phone resources, or additional counselling.


Of the 77 studies, 48 included people who had already quit, and 29 helped people to quit and then tested treatments to prevent relapse. Special populations were assessed in 26 studies that focused on people who needed to stop smoking for a limited period of time because they were pregnant (18 studies), in hospital (5 studies) or in military service (3 studies).


Treatments used to help people avoid relapse usually focus on teaching the skills to cope with temptations to smoke, but can also involve extending the length of the treatment that helped them to quit or giving additional treatment, such as follow‐up calls, leaflets or stop‐smoking medicine.

Cochrane Systematic Review

Livingstone-Banks J et al. Relapse prevention interventions for smoking cessation. Cochrane Reviews, 2019, Issue 2. Art. No.: CD003999.DOI: 10.1002/14651858.CD003099.pub5. This review contains 77 studies involving 67,285 participants.