3.2.2 What Happens When You Stop

Set realistic withdrawal expectations to reduce early attrition

Unrealistic expectations about withdrawal difficulty are a leading cause of early quit-attempt abandonment.¹ The acute phase (weeks 1–4) includes irritability, insomnia, depressed mood, difficulty concentrating, and restlessness. The extended phase (weeks 4–10) primarily features increased appetite and episodic cravings. Providing this timeline in the preparation stage - before symptoms appear - allows patients to develop specific coping plans for each phase. Consider a written 'withdrawal roadmap' as a clinical tool: what to expect in week 1, week 2, week 4, and week 10.

Introduce NRT options during the preparation stage for maximum adherence

NRT initiation in the preparation stage, before the quit date, improves adherence and reduces early relapse.¹ Pre-quit NRT (particularly patch-based) has emerging evidence of efficacy and is included in several national guidelines. The clinical conversation should cover: product selection based on Fagerström score, realistic expectation-setting for NRT (reduces withdrawal severity by ~50%, does not eliminate cravings entirely), and combination therapy (patch + acute form) for highly dependent patients. Ensure the patient leaves the preparation stage with NRT in hand, not just a plan to obtain it.

Prescribe pre-use diary completion as a self-monitoring intervention during gradual reduction

Pre-use self-monitoring introduces a cognitive interruption between cue and response, disrupting the automaticity of the habit loop.¹ McFall & Hammen (1971) demonstrated that structured self-monitoring alone produces modest reductions in smoking frequency, even without explicit reduction goals. During gradual reduction, prescribing diary completion before each use increases patient awareness of low-salience triggers and provides data for collaborative session review.²