Redefining smoking relapse

Posted 16th July 2018 by Dave Cross
Many smokers attempt to quit the habit each year, although the spectre of relapsing looms large in numerous incidences. Researchers at the University of East Anglia discovered a tale of pleasure, guilt and shame that accompanies returning to tobacco, and indicates that cigarette and cigar users lose a sense of identity when they can no longer refer to themselves as “smokers”.

Caitlin Notley spoke about the need for sound research back in 2016. In particular, she touched on the nonsense about flavours and kids vaping being spread at the time: “They’re not really supported by research evidence and it’s important that we have [it] there rather than pay too much heed to possible scare stories.”

And sound research is precisely what she has engaged in since that point. She presented her research looking at tobacco smoking relapse prevention to the Global Forum on Nicotine in 2017. In it she identified the perceived “benefits” of smoking and highlighted that these play a strong role in relapse.

What aids Notley in her work is an encyclopaedic knowledge of vaping, something that is all-too often absent from work produced by tobacco-control activists. Only last month, she released a paper on how vaping can be key in preventing smoking cessation relapse.

Now, with the support of Rory Collins, Notley has produced a paper that seeks to redefine “smoking relapse as recovered social identity”.

Setting out the state of play:

  • Smoking cessation is the primary modifiable health behaviour that will have the greatest impact on mortality
  • Many smokers are able to initially quit
  • UK smoking prevalence is at an all-time low
  • Most quit attempts ultimately result in relapse to smoking. Approximately 75% of quit attempts are not maintained beyond four weeks
  • Long-term relapse following abstinence is common
  • Most smokers will experience multiple relapses before achieving abstinence

The paper talks about things like ‘macro and meso level social interactions and societal influences to negotiate and rehearse individual identity, which boils down to how smokers see themselves – and how they lose that sense of self when they no longer smoke.

“Smoking becomes integral to identity: physically, through addiction to nicotine; psychologically through craving repeated behavioural actions and the ritual of smoking; and socially, as the individual comes to identify as a “smoker.” Crucially, the smoker identity is not fixed, but rather uniquely experienced and interpreted by individuals within specific circumstances.”

The explosion in people proud to declare themselves vapers was noticed over a four-year period on the Planet of the Vapes forum. Ex-smokers redefined themselves as vapers – and then subdivided themselves depending on their preferred form of vaping.

So, the pair argue, at a certain level, failure in a quit attempt can be seen a hitting problem aside from that of addiction, “loss of the smoker identity may mean giving up previous social groups or inhabiting different social spaces.”

The strong sense of community, and the supportive individuals therein, that vaping has created could offer up a further reason why vaping works so well as a disruptive tool when used for tobacco cessation.

Source: Caitlin Notley & Rory Collins (2018): Redefining smoking relapse as recovered social identity secondary qualitative analysis of relapse narratives, Journal of Substance Use, DOI: 10.1080/14659891.2018.1489009

 Dave Cross
Article by Dave Cross
Freelance writer, physicist, karateka, dog walker