Modeling naturalistic craving, withdrawal, and affect during early nicotine abstinence: A pilot ecological momentary assessment study.

Abstract

Despite the critical role of withdrawal, craving, and positive (PA) and negative affect (NA) in smoking relapse, relatively little is known about the temporal and predictive relationship between these constructs within the first day of abstinence. This pilot study aims to characterize dynamic changes in withdrawal, craving and affect over the course of early abstinence using ecological momentary assessment. Beginning immediately after smoking, moderate and heavy smoking participants (n = 15 per group) responded to hourly surveys assessing craving, withdrawal, NA, and PA. Univariate and multivariate multilevel random coefficient modeling was used to describe the progression of craving, withdrawal/NA and PA and to test correlations between these constructs at the subject-level over the course of early abstinence. Heavy smokers reported greater craving from 1–4 hours of abstinence and greater withdrawal/NA after 3 or more hours as compared to moderate smokers. Level of withdrawal/NA was strongly positively associated with craving, and PA was negatively correlated with craving, however the temporal dynamics of these correlations differed substantially. The association between withdrawal/NA and craving decreased over early abstinence, whereas the reverse was observed for PA. These findings can inform experimental studies of nicotine abstinence as well as their clinical applications to smoking cessation efforts. In particular, these results help to elucidate the role of PA in nicotine abstinence by demonstrating its independent association with nicotine craving over and above withdrawal/NA. If supported by future studies, these findings can refine experimental methods and clinical approaches for smoking cessation.

Ecological momentary assessment of affect and craving in patients in treatment for prescription opioid dependence

“…To our knowledge, this study is the first to use EMA to examine the relationship between low positive affect and craving in PODPs. The finding that low daily levels of positive affect are associated with greater same day cravings, but only for individuals with lower general levels of positive affect, provides a nuanced extension of findings from several studies that have used questionnaire measures of low positive affect in alcohol-dependent outpatients (McHugh et al, 2012), as well as EMA studies of nicotine-dependent patients (Bujarski, et al, 2015; Cook et al, 2004; Dunbar et al, 2010; Shiffman et al, 2014; Shiffman & Paty, 2006; Versace et al, 2011); although reports have been mixed in studies of nicotine-dependence (Shiffman et al, 2002; Shiffman & Waters, 2004). …”

“…Short term increases in PA have also been associated with a decreased risk for smoking lapse, suggesting PA may play a protective role in early nicotine abstinence (Ferguson, Shiffman, & Gwaltney, 2006). Bujarski et al (2015) also found that PA was negatively correlated with craving, whereas the level of withdrawal/NA was positively associated with craving. However, the temporal dynamics were different, demonstrating the independent role of PA in nicotine abstinence over and above that of NA.…”

“…One reason that low PA may have been overlooked is that many investigators (tacitly) ascribe to a circumplex model of affective space; within this model PA and NA are conceptualized as opposite ends of a continuum, rather than as independent neural systems with separate neurophysiological underpinnings (Ameringer & Leventhal, 2010; Bujarski, et al, 2015). As such, many investigators focus on NA and stress response systems to the exclusion of the PA system.…”

Smoking-induced affect modulation in nonwithdrawn smokers with posttraumatic stress disorder, depression, and in those with no psychiatric disorder.

“…Participants then underwent the mood induction while smoking an experimental cigarette (either NIC+ or NIC−) or holding a pen (minute 0 on Figure 1b timeline: 27 minutes after finishing own-brand cigarette). We designed the experiment so that the latency between own-brand smoking at the beginning of each trial and the smoking manipulation would be less than 30 minutes, a time period too brief to produce, on average, significant increases in withdrawal symptoms (Bujarski et al, 2015; Hendricks, Ditre, Drobes, & Brandon, 2006). Mood was assessed immediately after mood induction (Time 1), and then again at 7 minutes (Time 2, immediately after smoking NIC+, NIC− or holding a pen) and at 18 minutes after the start of mood induction (Time 3: see Figure 1b).…”

Daily sleep quality affects drug craving, partially through indirect associations with positive affect, in patients in treatment for nonmedical use of prescription drugs

“…Low PA has been associated with greater craving (Huhn et al, 2016; McHugh et al, 2013), and high levels of PA have been associated with both higher and lower levels of craving in the laboratory (Mason et al, 2008; Maude-Griffin & Tiffany, 1996; Schlauch et al, 2013; Tiffany & Drobes, 1990) and in the EMA (Bujarski et al, 2015; Epstein & Preston, 2010) literature. Emotional states that produce high PA might place individuals in a celebratory mood, encouraging drug use for hedonic reasons (Baker, Morse, & Sherman, 1987; Robinson & Berridge, 1993).…”