Quitting Tobacco Use is a Process

Stages of Quitting

The stages of tobacco cessation are: Contented user, Thinking about quitting, Deciding to quit, Quitting, Trying to stay quit, Relapsing, and Staying quit. This is a process that may repeat before becoming permanent.

Stage of Tobacco Cessation Definition
Contented User A stage of pre-contemplation. No intention of taking action within the next 6 months. May be uninformed or underinformed of health consequences or may have attempted change many times and lost confidence that quitting is possible. Appears unmotivated or resistant to change.
Thinking About Quitting A stage of contemplation. Intends to change in the next 6 months. Aware of pros and cons of changes. Profound ambivalence or behavioral procrastination can develop as the person balances the pros and cons.
Deciding to Quit A stage of preparation. Intends to take action soon, usually within 30 days. May have a plan, such as buying a book, joining a class, or talking to a counselor. Very interested in changing and has already decided to do so. Setting a quit date or signing up for a smoking cessation class are 2 types of preparation. Taking varenicline (Chantix®) or bupropion (Zyban®) and setting a quit date is another example.
Quitting A stage of action. A person has made behavior modifications within the last 6 months. With smoking, this step is equated with total abstinence.
Trying to Stay Quit A stage of maintenance. Working to prevent relapse, although fewer urges than someone in the action stage. Maintenance may last from 6 months to 5 years; however, some smokers remain in maintenance permanently.
Relapsing Not actually a stage but an event: the moment a patient first returns to smoking. It is quickly followed by return to one of the other stages of tobacco cessation. As a clinician, you can help motivate the patient to progress toward the action stage of quitting.
Staying Quit A stage of termination. No urge to do the behavior that is being avoided (e.g., no temptation to smoke), and 100% self-efficacy in managing it. Will never return to old habit regardless of the situation. About 20% of ex-smokers reach termination.