A day at a time: Predicting smoking lapse from daily urge.

Abstract

Smokers who recently quit (N = 214) monitored smoking urges for up to 26 days after quitting. Computers administered 4-5 assessments daily at random times; participants rated urges on waking and when they experienced temptation episodes. Urge intensity after cessation did not generally exceed urges reported during baseline ad lib smoking. Urge intensity and temptation frequency consistently declined over the quit period. Controlling for urge intensity at baseline, all daily urge intensity measures predicted lapse the following day in proportional hazards survival analyses. Average duration of temptation episodes also predicted lapses; frequency of temptation did not. To isolate the effect of day-to-day variations in urges, participants' nicotine dependence and urge intensity on quit day were controlled for. Only urge intensity at waking still predicted lapse risk; this was not because of this measured being closer in time to the day's lapses. Among lapsers, urge intensity at waking and in temptations rose preceding a lapse.

Predictors of smoking lapse in a human laboratory paradigm

“…Participants who reported high levels of withdrawal, tension, or craving for the relief of negative affect after 12 h of abstinence were more likely to initiate smoking earlier during the delay period, which may suggest that the primary motivation for initiating smoking was alleviation of the negative symptoms related to acute abstinence. This notion is supported by the findings of several smoking cessation studies which demonstrated that a rapid increase in withdrawal symptoms, negative affect, and craving and the subsequent desire to relieve this aversive symptomatology is the most reliable predictor of a smoking lapse (Shiffman et al, 1996a;Shiffman et al, 1997b;Shiffman et al, 2002;Shiffman and Waters 2004).…”

“…A series of reports by Shiffman and colleagues have identified contextual changes in mood and motivation, proximal to the lapse event itself, that promote a lapse into smoking, such as increases in negative affect, nicotine withdrawal, and urge to smoke (Shiffman et al, 1996a;Shiffman et al, 1997b;Shiffman et al, 2002;Shiffman and Waters 2004). Additionally, individuals who possess certain traits, including high anxiety, low distress tolerance, and a high severity of nicotine dependence, are also more at risk to lapse in early abstinence (Shiffman et al, 1996b;Shiffman et al, 1997a;Brown et al, 2005;Zvolensky et al, 2009).…”

Latent class typology of nicotine withdrawal: genetic contributions and association with failed smoking cessation and psychiatric disorders

“…Evidence from animal studies suggests that nicotine withdrawal results in significant decreases in brain reward function, which is a potential explanation for the physiological basis of smoking relapse (Epping-Jordan et al 1998). In studies with humans, withdrawal symptoms have been identified as a predictor of relapse from smoking cessation (Swan et al 1996;Shiffman et al 1997).…”

Randomized Trial of Telephone-Delivered Acceptance and Commitment Therapy Versus Cognitive Behavioral Therapy for Smoking Cessation: A Pilot Study

“…To balance baseline variables between the two conditions, treatment assignment used an automated algorithm stratifying on these factors empirically known to predict smoking cessation: gender (male/female), quit attempts in past 12 months (yes/no), binge alcohol use in past 30 days (yes/no), and positive screen for depression in past 3 months (yes/no; Hughes & Kalman, 2006;Perkins et al, 2008;Shiffman et al, 1997;Zhu, Sun, Billings, Choi, & Malarcher, 1999). Randomized study arm assignments were computer generated and concealed from participants after eligibility was determined and consent for participation was obtained.…”