First lapses to smoking: Within-subjects analysis of real-time reports.

Abstract

Studies of smoking relapse and temptation episodes have relied on retrospective recall and confounded between- and within-subject variability. Real-time data on temptations and lapses to smoke were gathered using palm-top computers. We made within-subject comparisons of the initial lapse, a temptation episode, and base rate data obtained through randomly scheduled assessments. Negative affect discriminated all three situations, with lapses worse than temptations, and temptations worse than random situations. Participants attributed lapses to negative mood and smoking cues, whereas temptations were more often attributed to behavioral transitions. Participants were 12 times more likely to report coping in temptations than in lapses. However, only cognitive (vs. behavioral) coping strategies were effective. Lapses (vs. the other situations) were more likely to occur when smoking was permitted, when cigarettes were easily available, and in the presence of other smokers. The results have clinical implications, and the computerized monitoring methods may be applicable to an array of clinical research problems.

The reinstatement model and relapse prevention: a clinical perspective

“…These discrepancies cannot be reliably correlated with patient characteristics, episode characteristics, or degree of confidence in recall accuracy (Shiffman et al 1997). Reassuringly, EMA data in smokers tend to confirm that lapses and relapses are associated with smoking-associated cues and with negative mood (Shiffman et al 1996), supporting assertions often made in support of the reinstatement model (if negative mood can be considered roughly homologous to stress). Similar, though less direct, findings were reported in an EMA study of alcoholics: negative mood predicted urge to drink, which, in turn, predicted drinking (Litt et al 2000).…”

“…Human descriptive studies of relapse in real time Yes; some support for stress-induced relapse (Litt et al 2000) Yes: some support for cue-induced relapse and stress-induced relapse (Shiffman et al 1996) No data Fluoxetine: no effect, but outcome measures did not specifically include stress-induced relapse (Kranzler et al 1995) Naltrexone: fewer relapses; fewer patients relapsed (Streeton and Whelan 2001, meta-analysis of 7 trials) Nalrexone: fewer relapses; fewer patients relapsed (Latt et al 2002) Using interventions not tested in the reinstatement model Yes:…”

“…In studies of tobacco smokers, a technique called Ecological Momentary Assessment (EMA) has been used to enable outpatients to report their activities and moods before a lapse or relapse, 1 prospectively and in real time, using handheld data-collection devices (Shiffman et al 1996). When EMA data are compared with retrospective reports gathered 12 weeks later from the same patients, large discrepancies emerge in reported triggers, activities, and moods during lapses (Shiffman et al 1997).…”

Association between smoking and alcohol‐related behaviours: a time–series analysis of population trends in England

“…personality characteristics and psychiatric conditions) 17, 18, 19, 20, 21, 22. Mechanisms proposed for the negative impact of alcohol on smoking cessation include reduced inhibitory control and an increase in the salience of smoking cues 23, 24.…”

The DRD2 TaqI-B polymorphism and its relationship to smoking abstinence and withdrawal symptoms

“…[22][23][24][25] Also, analyses of withdrawal and abstinence data gathered daily, rather than retrospectively, may yield more information about the circumstances in which some genes may exert their influence on smoking behaviors, given that the closer in time the assessment of smoking and withdrawal is to their actual occurrence, the greater the sensitivity at discerning the relationships between the two. 26 The current study used previously unpublished daily diary data from a recent study in our laboratory 27 investigating the role of the DRD2 TaqI-A polymorphism in smoking cessation. In that trial all smokers were provided with the nicotine patch plus brief counseling and were randomized to receive either placebo or venlafaxine, a non-selective serotonin reuptake inhibitor that inhibits the reuptake of serotonin and norepinephrine.…”