Ecological momentary assessment (EMA; Stone & Shiffman, 1994) was used to characterize and quantify a dynamic process--affective instability in borderline personality disorder (BPD). Sixty outpatients (34 with BPD and affective instability; 26 with current depressive disorder but not with BPD or affective instability) carried electronic diaries for approximately 1 month and were randomly prompted to rate their mood state up to 6 times a day. Results indicated that BPD patients (a) did not report significantly different mean levels of positive or negative affect; (b) displayed significantly more variability over time in their positive and negative affect scores; (c) demonstrated significantly more instability on successive scores (i.e., large changes) for hostility, fear, and sadness than did patients with depressive disorders; and (d) were more likely to report extreme changes across successive occasions (>or=90th percentile of change scores across participants) for hostility scores. Results illustrate different analytic approaches to quantifying variability and instability of affect based on intensive longitudinal data. Further, results suggest the promise of electronic diaries for collecting data from individuals in their natural environment for purposes of clinical research and assessment.

The dependence construct fills an important explanatory role in motivational accounts of smoking and relapse. Frequently used measures of dependence are either atheoretical or grounded in a unidimensional model of physical dependence. This research creates a multidimensional measure of dependence that is based on theoretically grounded motives for drug use and is intended to reflect mechanisms underlying dependence. Data collected from a large sample of smokers (N = 775) indicated that all 13 subscales of the Wisconsin Inventory of Smoking Dependence Motives (WISDM-68) have acceptable internal consistency, are differentially present across levels of smoking heaviness, and have a multidimensional structure. Validity analyses indicated the WISDM-68 subscales are significantly related to dependence criteria such as smoking heaviness and to 4th edition Diagnostic and Statistical Manual of Mental Disorders symptoms of dependence and relapse.

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Considerable research shows that withdrawal severity is inconsistently related to smoking cessation outcomes. This may result from measurement problems or failure to scrutinize important dimensions of the withdrawal experience. Two recent studies demonstrated that withdrawal elevation and variations in the time course of withdrawal were related to relapse in smokers treated with the nicotine patch (T. M. Piasecki, M. C. Fiore, & T. B. Baker, 1998). This article reports a conceptual replication and extension of those findings in unaided quitters. Evidence for temporal heterogeneity was found across different types of withdrawal symptoms. Patterns or slopes of affect and urge reports over time predicted smoking status at follow-up, as did mean elevation in withdrawal symptoms. These results suggest that affect and urge withdrawal symptoms make independent contributions to relapse and that relapse is related to both symptom severity and trajectory.

This article describes a multidimensional, multivariate, and multilevel approach to the assessment of nicotine withdrawal. In this prospective study, 70 adult smokers assigned to an active or placebo nicotine patch condition completed multiple daily assessments using an electronic diary. Average and individual growth curves were estimated for affective and nonaffective withdrawal symptoms. All symptoms but hunger increased significantly on the quit day and remained elevated for three weeks. Variability in symptom experiences across individuals increased from pre- to post-quit. Relations between symptom reports (e.g., negative affect or craving) and episodic events (e.g., stressful events or seeing someone smoke) changed from pre-quit to post-quit. Pre-quit increases in negative affect and quit-day increases in craving were inversely related to abstinence three months after the quit day, suggesting that anticipatory and immediate reactions to quitting influence success.

Research has suggested that the time course of the smoking withdrawal syndrome is fairly invariant across smokers and that smoking withdrawal symptoms are weakly related to relapse. Withdrawal data from 2 clinical trials of the nicotine patch were analyzed to evaluate these characterizations. In both studies, patients were clustered according to the shapes of their withdrawal profiles across 8 weeks of treatment. In each study, 3 clusters with distinct temporal patterns of withdrawal symptomatology emerged. Clusters included both abstinent and lapsing patients, and patch dose was unrelated to cluster membership. Patients with "atypical" patterns of smoking withdrawal (e.g., late symptomatic elevations) were more likely to relapse than patients who showed a gradual elimination of withdrawal. Withdrawal shape, duration, and severity all contributed significantly to the prediction of relapse. Measures of negative affect closely tracked withdrawal symptoms over time within clusters. Topics for future smoking withdrawal research are discussed.

Smoking withdrawal reports from a clinical trial (n = 893) were submitted to hierarchical linear modeling as a cross-method replication of a heterogeneity approach to withdrawal measurement and to clarify the influence of postcessation smoking on symptom reports. Five individual difference parameters tapping distinct facets of withdrawal were derived: intercepts (mean severity), linear slope (direction and rate of change), quadratic trend (curvature), volatility (scatter) and, among lapsers, a cigarette coefficent (smoking-related deflections of symptoms). All parameters were highly variable across persons. Lapsers had more aversive symptom patterns than abstainers, and symptoms tended to be higherthan otherwise predicted on lapse days. These results reinforce the conclusion that withdrawal symptoms are highly variable and argue against discarding withdrawal data from participants who lapse.

Alcohol and tobacco use covary at multiple levels of analysis, and co-use of the two substances may have profound health consequences. In order to characterize the motivationally relevant processes contributing to co-use, the current study used Ecological Momentary Assessment (EMA) to examine the subjective consequences of naturally occurring simultaneous use of alcohol and tobacco. Current smokers who reported frequently drinking alcohol (N = 259) monitored their daily experiences for 21 days using electronic diaries. Participants responded to prompted assessments and also initiated recordings when they smoked a cigarette or completed the first drink in a drinking episode. Momentary reports of smoking and alcohol consumption were associated with one another, and these effects remained after adjustment for occasion-and personlevel covariates. When participants consumed alcohol, they reported increased pleasure and decreased punishment from the last cigarette. Smoking was associated with small increases in pleasure from the last drink. Ratings of "buzzed" and "dizzy" were synergistically affected by couse of alcohol and tobacco. Co-use was also followed by higher levels of craving for both alcohol and tobacco. Results point to the importance of reward and incentive processes in ongoing drug use and suggest that alcohol intensifies real-time reports of the motivational consequences of smoking more strongly than smoking affects corresponding appraisals of alcohol effects. Keywordsalcohol; cigarettes; electronic diary; craving; reward; reinforcement Alcohol drinkers are more likely to smoke cigarettes than teetotalers and smokers are more likely to report drinking alcohol than nonsmokers (Falk, Yi & Hiller-Sturmhofel, 2006; Shiffman & Balabanis, 1995). Moreover, heavy drinkers are likely to be heavy smokers and vice versa (Shiffman & Balabanis, 1995). In psychiatric epidemiology, alcohol use disorders show substantial comorbidity with tobacco dependence (Falk, et al., 2006;Jackson, Sher, Wood, & Bucholz, 2003). The probability of smoking is strongly related to the number of alcohol dependence criteria endorsed (Madden, Bucholz, Martin & Heath, 2000). Indeed, this overlap is so robust that it could be argued alcoholism is most often a disorder involving problematic use of alcohol and tobacco. The covariation of the two substances is practically and clinically important. For instance, abuse of both alcohol and tobacco confers synergistic risk for some forms of cancer (e.g., Castellsague, et al., 1999). Even though alcoholism is associated with devastating medical consequences, a follow-up study of treated alcoholics found they were even more likely to die of tobacco-related disease (Hurt, et al., 1996).Alcohol and tobacco not only tend to be used by the same individuals, but also tend to be used at the same time. In the laboratory, alcohol administration spurs tobacco use (e.g., Mello, Mendelson, & Palmieri, 1987;Mintz, Boyd, Rose, Charuvastra, & Jarvik, 1985). Some evidence suggests nicotine administration i...