The One-Question Test That Predicts Smoking Relapse Years After Quitting

Study explains why ‘staying quit’ gets harder the longer you’re cigarette-free.

* One quick question predicts relapse: Feeling “tired of staying quit” flags higher relapse odds whether you quit months or years ago.

* Time still helps: The longer you stay smoke-free, the lower your overall risk. Fatigue matters on top of that.

* Vaping shows a protective link: Daily vapers had lower odds of relapse in this study, even after adjustment. The reasons were not tested.

* Make it practical: Ask yourself at checkups, “How tired am I of trying to stay quit?” * High fatigue is a cue to seek extra support, not a failure.

BURWOOD, Australia — Ask anyone who’s quit smoking and they’ll tell you the first few days are brutal. Cravings hit hard, withdrawal symptoms peak, and every moment feels like a battle. But here’s what most people expect: after those initial weeks or months, staying smoke-free should get easier. The body heals, cravings fade, and life as a non-smoker becomes the new normal.

A study of nearly 2,000 former smokers across four countries challenges that assumption. Mental exhaustion from staying cigarette-free doesn’t fade as a predictor over time. When researchers analyzed three measures of quitting difficulty — fatigue, urges to smoke, and confidence — only fatigue remained a significant predictor of relapse when all were examined together. Time since quitting and vaping also showed independent protective effects.

Fatigue predicted relapse regardless of whether someone had been quit for months or years. The finding challenges the belief that relapse risk fades uniformly as quitting gets easier, raising questions about how we support people trying to break free from cigarettes.

Researchers from Deakin University in Australia led the international team that conducted the study. Going into the research, they hypothesized that the predictive power of cessation fatigue would weaken over time as quitters settled into their new habits. The data showed otherwise: exhaustion predicted relapse with similar strength regardless of how long someone had been smoke-free.

Published in Addiction, the study tracked former smokers in Canada, the United States, England, and Australia over six years, with surveys in 2016, 2018, 2020, and 2022. At each baseline wave, scientists asked participants one question: “To what extent are you tired of trying to stay quit?” Follow-ups occurred approximately two years later, when researchers checked who had relapsed.

Those who reported feeling moderately tired had 64% higher odds of relapse. Those who felt very tired faced 81% higher odds. Time since quitting did not moderate the link between fatigue and relapse. The fatigue effect held constant whether someone had been quit for three months or three years.

Common sense says staying quit should get easier as time passes. Physical cravings diminish after the first few weeks as nicotine clears from the body. Situations and places associated with smoking gradually lose their trigger power. Former smokers report feeling healthier, breathing easier, and saving money.

Data confirms part of this story. People who’d been quit for longer did have lower overall relapse rates. Someone smoke-free for two years had 86% lower odds of relapsing compared to someone who’d quit within the past three months.

But here’s the paradox. Long-term quitters had lower overall relapse rates. Yet when someone did report feeling fatigued from staying quit, that fatigue predicted relapse just as strongly after years as after months. A person quit for three years who reported high fatigue showed a similar relative increase in relapse risk as someone quit for three months with the same fatigue level, even though the three-year quitter’s baseline risk was much lower to start.

This pattern shows something important about how behavior change works. Physical challenges of quitting get easier over time. But for some people, the psychological effort required to maintain that change doesn’t necessarily follow the same path.

Researchers tested three different measures: strength of urges to smoke, confidence in staying quit, and cessation fatigue (the mental exhaustion from maintaining abstinence). When analyzed separately, all three predicted relapse. But when examined together, only fatigue remained significant among these task-difficulty measures. Urges to smoke dropped out of the equation entirely. Confidence’s apparent protective effect disappeared. Time since quitting and vaping, however, continued to show independent protective effects.

This hierarchy shows what these measures actually capture. Urges represent the immediate difficulty of wanting a cigarette right now. Confidence reflects someone’s belief about their ability to resist those urges. But fatigue measures something different: the ongoing psychological effort some people expend to stay quit.

Every time someone successfully resists lighting up, it requires mental effort. That effort doesn’t necessarily feel harder over time. The individual moments of resistance may even feel easier as they become routine. But for some former smokers, the sustained vigilance required, day after day, month after month, year after year, continues to exact a psychological toll.

Think of it this way. Holding a five-pound weight at arm’s length feels manageable at first. After a few minutes, the weight hasn’t changed, but the arm begins to shake. After ten minutes, the same weight feels unbearable. The challenge hasn’t intensified; the capacity to meet it has eroded. Cessation fatigue can work similarly. The task of staying quit may not feel harder moment to moment, but the sustained effort can deplete psychological resources over time.

Importantly, this study did not show fatigue increasing with time. Rather, it showed that when fatigue is present, it predicts relapse at any quit length. The research measured whether time-since-quitting changed fatigue’s predictive power and found it did not.

This helps explain one of the most puzzling patterns in smoking relapse: why people who’ve successfully quit for months or years suddenly return to cigarettes after what seems like a minor trigger.

Traditional thinking attributes these relapses to an especially strong craving overpowering someone’s defenses. Maybe they had a stressful day, drank with friends who smoke, or went through a breakup. The trigger seemed unusually powerful.

But one interpretation supported by the fatigue model is different. The trigger might not have been particularly strong. Instead, the person’s psychological resources to resist it had become depleted through sustained effort. Like the arm holding the weight, the system didn’t collapse because the load increased, but because maintaining the same vigilance for an extended period became unsustainable. However, because the study checked in with participants only every two years, researchers couldn’t capture the specific circumstances or immediate triggers that preceded individual relapse moments.

Among study participants, 9.2% relapsed over the two-year follow-up period. Those who reported no fatigue at baseline had a 6.8% relapse rate, while those who reported no urges to smoke had a 6.9% relapse rate. Among fatigued participants, the relapse rate jumped to 14.5% for those moderately fatigued and 18.8% among the highly fatigued group.

About 60% of participants had quit smoking for at least a year when they entered the study. Many had successfully navigated the early weeks and months when physical cravings peak. They’d built new habits, developed coping strategies, and established themselves as non-smokers. Yet fatigue still predicted their relapse risk.

Researchers analyzed data from 1,914 former smokers who participated in the International Tobacco Control Four Country Smoking and Vaping Survey between 2016 and 2022. These participants provided 2,715 observations across multiple survey waves. Participants completed surveys approximately every two years, answering questions about cessation fatigue, urges to smoke, confidence in staying quit, time since quitting, and use of vaping products.

Several factors reduced relapse risk beyond fatigue levels. Time since quitting had a strong protective effect. People quit for four to six months had 38% lower odds of relapse than those who’d quit within the past three months. Those smoke-free for seven months to a year saw their odds drop by 64%. After one to two years, odds fell by 78%, and after two years, by 86%.

Vaping also appeared protective. Daily vapers had 60% lower odds of relapse than non-vapers initially. But after accounting for fatigue levels, that protective effect weakened to 40% lower odds, though it remained statistically significant. The study found that people who vaped reported lower fatigue levels, suggesting vaping may reduce relapse partly by lowering the psychological burden of staying quit, not just by satisfying nicotine cravings. However, the exact mechanisms weren’t tested in this research.

Why doesn’t psychological exhaustion fade as a predictor over time the way physical withdrawal does? The answer lies in different theories about how self-control and behavior change work.

One possibility is that self-control operates like a muscle that can be temporarily depleted. After hours or days of resisting temptation, the capacity to keep resisting diminishes. Eventually the person gives in, not because they suddenly wanted a cigarette more, but because they ran out of mental energy to keep refusing. If this model were correct, fatigue should peak in the early days of quitting when self-control demands are highest, then fade as cravings diminish.

The study found no evidence that fatigue’s predictive effect weakened with longer time since quitting. When researchers tested whether time-since-quit moderated the relationship between fatigue and relapse, they found no significant interaction. This pattern points to a different mechanism.

An alternative explanation focuses on psychological rather than cognitive exhaustion. Most daily activities become automatic over time. People don’t consciously think about brushing their teeth or locking the car. But for a former smoker, not smoking often remains a conscious choice repeated throughout each day, month, and year. That sustained requirement for active attention and effort may create weariness that persists as long as the vigilance continues.

Smoking was woven into the fabric of daily life for most people who smoked: the morning cigarette with coffee, the smoke break at work, the cigarette after dinner or while driving. Quitting doesn’t just mean stopping one behavior. It means restructuring dozens of daily moments that were previously organized around smoking. That restructuring requires ongoing attention long after the physical withdrawal fades.

For someone five years into a quit attempt, lighting a cigarette might still feel like it could easily happen in a moment of distraction or stress. Vigilance required to prevent that moment may not feel burdensome day to day, but over years, the cumulative psychological cost builds.

Study results showed that 44% of former smokers were using vaping products, and these individuals showed lower fatigue levels and reduced relapse risk. After accounting for their lower fatigue, vaping retained some independent protective effect, though it was weaker than initially observed.

Vaping may reduce fatigue by providing nicotine without requiring complete abstinence from the physical ritual of inhaling. The hand-to-mouth motion, the visible vapor, the throat sensation: these elements might preserve enough of the behavioral pattern that staying smoke-free requires less active effort. But vaping also appears to prevent relapse in ways unrelated to fatigue reduction, possibly by satisfying nicotine cravings directly or providing a behavioral substitute for smoking. The specific mechanisms weren’t directly tested in this study.

Most smoking cessation programs concentrate support in the first weeks or months of a quit attempt, then taper off as people stabilize. Physical withdrawal peaks early, so maximum support when it’s most needed makes sense.

But if psychological exhaustion accumulates over time rather than dissipating, that support model misses a crucial risk period. Someone who’s been cigarette-free for two years might need periodic check-ins to assess fatigue levels and provide support before exhaustion leads to relapse.

The simplicity of the fatigue measure makes screening practical in routine healthcare settings: a single question about how tired someone feels from trying to stay quit. A doctor could ask during annual checkups for former smokers. Those reporting high fatigue could receive targeted interventions focused on managing the psychological burden rather than just resisting cravings.

What would such interventions look like? Though this research doesn’t directly test specific approaches, the fatigue concept points toward several promising directions for future studies. Mindfulness approaches might reduce the sense of constant effort required to stay quit. Repeating a daily mantra to remind oneself of their ability to avoid the urge can be quite helpfu.

Cognitive strategies could help reframe not-smoking from an active choice requiring continual willpower into an integrated identity as a non-smoker. Support groups might help people recognize that sustained vigilance is normal rather than a sign of weakness. Experimental studies are needed to confirm whether targeting fatigue actually reduces relapse rates.

Acknowledging that staying quit remains psychologically demanding even after the early challenges fade becomes key. Former smokers who’ve successfully quit for years still face real challenges, just different ones than newcomers encounter.

For the 34 million American adults who currently smoke and the millions trying to quit, this research offers both warning and insight. Don’t assume that successfully navigating the first months means the psychological challenge is completely over. For some people, the mental effort of sustained vigilance can remain demanding even after the early challenges fade, making relapse feel sudden even when the underlying vulnerability developed gradually.

At the same time, fatigue serves as a measurable warning sign, not a personal failing. Feeling tired of trying to stay quit doesn’t mean someone lacks willpower or commitment. It means they’ve been sustaining a demanding psychological effort, and that effort has accumulated costs.

Recognizing exhaustion as a legitimate risk factor might help former smokers seek support before it leads to relapse. Just as runners recognize muscle fatigue as a signal to rest or adjust training, former smokers could recognize cessation fatigue as a signal that their current approach needs adjustment or additional support.

Limitations exist in this research. Two-year gaps between surveys meant researchers couldn’t determine exactly when relapses occurred or what immediate triggers preceded them. High dropout rates (61% lost to follow-up) raised questions about whether results apply to all former smokers or just those who remained in the study, with retained participants being older, less likely to be from England, more likely to be from an identified majority group, and having lower education compared to those lost to follow-up. Measuring fatigue with a single question, while practical, might miss aspects of the experience. The sample skewed toward longer-term quitters, with only 14% having been quit less than three months, resulting in a lower overall relapse rate and potentially making nicotine withdrawal less relevant than it would be in samples of more recent quitters.

Future research needs to test whether interventions targeting fatigue can actually reduce relapse rates. Proving that connection requires experimental studies that manipulate fatigue levels and measure subsequent success. For now, an important finding stands: Time heals the physical damage of smoking and reduces acute cravings. But for those who experience it, the psychological challenge of staying quit can remain a persistent predictor of relapse risk, regardless of how long they’ve been smoke-free.

Researchers analyzed survey data from 1,914 former smokers who participated in the International Tobacco Control Four Country Smoking and Vaping Survey conducted between 2016 and 2022 in Canada, the United States, England, and Australia. Participants who had quit smoking at one survey wave completed follow-up surveys approximately two years later. At baseline, researchers measured cessation fatigue using the question “To what extent are you tired of trying to stay quit?” with responses from 1 (not at all tired) to 5 (extremely tired), which were grouped into three categories for analysis: not tired, moderately tired, and very tired. They also measured strength of urges to smoke, abstinence self-efficacy, time since quitting, and current vaping status. At follow-up, researchers determined who had relapsed to smoking. Statistical analysis used generalized estimating equations logistic regression models to account for repeated observations from the same individuals across multiple survey waves while controlling for demographic factors including age, gender, ethnicity, income, education, and country.

Among the 1,914 participants providing 2,715 observations across three wave-pairs, 9.2% had relapsed by follow-up. Baseline cessation fatigue strongly predicted relapse risk. Compared to those reporting no fatigue, moderately fatigued participants had 64% higher odds of relapse (odds ratio = 1.64, 95% confidence interval = 1.21–2.23), while highly fatigued participants had 81% higher odds (odds ratio = 1.81, 95% CI = 1.07–3.07). When analyzed separately, strength of urges to smoke and abstinence self-efficacy also predicted relapse, but when all three measures were included together, only cessation fatigue remained statistically significant. Longer time since quitting reduced relapse risk substantially. Those quit for two or more years had 86% lower odds of relapse compared to those quit less than three months. Current vaping was associated with lower relapse risk, with daily vapers showing 60% lower odds than non-vapers. The predictive effect of cessation fatigue did not vary by time since quitting, indicating fatigue predicted relapse equally well whether someone had been quit for months or years.

Several important limitations affected this study. The high attrition rate of 61% at follow-up created a non-representative sample that may limit generalizability, with retained participants being older, less likely to be from England, more likely to be from an identified majority group, and having lower education compared to those lost to follow-up. The long two-year interval between surveys prevented precise determination of when relapses occurred or what immediate triggers preceded them. Cessation fatigue was measured with only a single item, which may not adequately capture all aspects of this construct. The sample skewed toward longer-term quitters, with only 14% having been quit less than three months, resulting in a lower overall relapse rate and potentially making nicotine withdrawal less relevant than it would be in samples of more recent quitters. The study design did not allow for determination of precise causal relationships or examination of potential mediating pathways between cessation fatigue and the other task difficulty measures.

The International Tobacco Control Four Country Smoking and Vaping Survey received support from grants from the United States National Cancer Institute (P01 CA200512), the Canadian Institutes of Health Research (FDN-148477), and the National Health and Medical Research Council of Australia (GTN1106451; GTN1198301). Dr. Kenneth Michael Cummings has served as a paid witness in litigation filed against cigarette manufacturers. The other authors declared no conflicts of interest. Deakin University facilitated open access publishing as part of the Wiley-Deakin University agreement via the Council of Australian University Librarians.

Yong, H.-H., Borland, R., Le Grande, M., Hu, C. C.-Y., Gartner, C., Hyland, A., & Cummings, K. M. (2025). Understanding the role of cessation fatigue in smoking relapse: Findings from the International Tobacco Control Four Country Smoking and Vaping Survey. Addiction.

I smoked cigs for about 15 years. I don’t miss it. Quit about 35 years ago. I could smoke a cigar and not relapse.

Circumstances forced me to go about 12 hours without a cigarette, years ago. I had no choice. The next morning, I bought a pack, and kept it in my pocket. I had a choice, and I chose not to smoke. About a week later, someone asked if I had a cigarette, and I gave them the unopened pack.

I quit smoking for over a year. Every day was a battle. After work I had to talk myself from stopping at a gas station to pick up a pack. I finally grew tired and went back to smoking. Then vapes were invented. It was still hard to give up the cigarettes. It took me three months just to be on the vape.

35 yrs tobacco free here, although I still enjoy an occasional cigar with a nice Cognac or scotch. I can’t imagine myself ever going back to cigarettes and I was a heavy smoker from an early age.

I quit many years ago and haven’t thought about having a smoke for a long time. That is until I read the article.

You have to think differently about it.
Once you commit to quit, it takes a while to get past it.
After a while, you are no longer quitting, you simply don’t smoke anymore. It is not a part of your life.
The nicotine addiction clears out after a couple of months. The hand to mouth bit is the part that lingers. I wondered what I would do instead of a smoke break. For a while I would sit there and not smoke. After a while I just went about my business. I used Commit lozenges for nicotine replacement while fighting the hand to mouth habit. Remained happily smoke free for years. Started smoking cigars a while back and wish I hadn’t. At least I don’t freak out if I can’t have one.

Its been about 45 years now, the first months were not easy. My experience was that the more time that went by the less urges to smoke I had and the more disgust I had of the thought of smoking,especially found others smoke disgusting. Unlike those in the study, my energy increased.

Having quit 3 times cold turkey before it finally took I can say that nicotine is definitely as addictive as any narcotic.

I have not smoked a cigarette for 27 years and can’t imagine ever wanting to again. But I’d be afraid to smoke even one because you can get hooked again in a week or two.

30 posted on 10/21/2025 9:08:04 AM PDT by Georgia Girl 2 (The only purpose of a pistol is to fight your way back to the rifle you should never have dropped)

I’ve been smoking cigarettes for 50+ years... When you smoke daily you don’t notice that constant high... But go without... I Tried quitting a few times in the past and going a day or two without smoking, and then you smoke that first cigarette and you are immediately catching a nicotine buzz.

I began smoking at 18, after HS, “Benson&Hedges Menthold 100s” - the longest cig available
Carton was $2.89 (10 packs).
After 5 years, increased to 2 packs a day.
Tried quitting a gazillion times.
After another 5 years, quit cold turkey - totally painless - and never looked back.
Now smoke-free since I was 28...and never again had an urge.
I’ve had 2-3 cigars but it’s been decades since the last one.

Yes, its a drug high not psychological. Nicotine is a strong drug. When you are frantically rummaging through trash cans at 9:00 AM looking for a cigarette butt that you can maybe get a couple of puffs off of because you ran out of cigarettes you’re an addict.

I have always said that I don’t have an addictive personality and the only thing I have ever been addicted to is nicotine.

33 posted on 10/21/2025 9:30:04 AM PDT by Georgia Girl 2 (The only purpose of a pistol is to fight your way back to the rifle you should never have dropped)

I did the vape thingy for a week. Then quit everything................

I did it for a day. I didn’t like the vape. I kept it nearby the first couple of weeks after cold-turkey quitting cigarettes (using the taper-down method) and then tossed it.

They needed a study for this? Lou Reed said of all the things he quit smoking was the one he never stopped craving.

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