Have we lost our way? The need for dynamic formulations of smoking relapse proneness

Abstract

Current smoking cessation treatments seem to differ from one another in the proportion of ex-smokers who survive the first few days of the quit attempt. After this initial effect, parallel relapse processes appear to unfold in all treatment groups; no available treatments seem to alter the nature of this late relapse process. True relapse prevention will require that we obtain a better understanding of the forces contributing to relapse across the span of the cessation attempt. A working model of dynamic relapse processes may be necessary before treatments can be improved. In this paper, we suggest that the conceptual model of relapse proneness (RP) described originally by the National Working Conference on Smoking Relapse can serve as an ecumenical organizational framework that may be used to integrate and conceptualize relapse data in ways that could generate new strategies for relapse research and inform treatment design. As an illustration, we sketch a preliminary model of RP which postulates that physical withdrawal, stressors/temptations, and cessation fatigue each make independent, time-shifted contributions to relapse risk. A new round of descriptive research focused on relapse proneness processes may be a prerequisite for improving existing smoking cessation interventions.

Heaviness of Smoking Predicts Smoking Relapse Only in the First Weeks of a Quit Attempt: Findings From the International Tobacco Control Four-Country Survey

“…For example, Piasecki, Fiore, McCarthy, and Baker (2002) theorized three sets of forces, namely, withdrawal, self-control, and the exhaustion of self-control, as co-determinants of relapse. These authors postulate that in an early period of a quit attempt, self-control is critical for preventing relapse, but later in the period, relapse is more under the influence of the residual strength of cue-specific factors.…”

“…Others have suggested a more prominent role for the strength of urges to smoke on typical smoking days (Baker, Breslau, Covey, & Shiffman, 2012), but we do not know when might measuring this indicate a propensity to remain quit long term. If Piasecki et al (2002) are correct, then measures that focus on cue-specific cravings might provide useful information, in particular, cues that are associated with negative affect, as negative affect can be both a specific trigger and a reason for smoking (Borland, 2014). Residual beliefs about the value of smoking have also been associated with long-term relapse (Dijkstra & Borland, 2003).…”

Time-Varying Processes Involved in Smoking Lapse in a Randomized Trial of Smoking Cessation Therapies

“…Despite this increased attention to the dynamic nature of smoking cessation and attempts to hypothesize time-varying processes involved in smoking cessation (Piasecki et al, 2002), little is known about time-varying associations between smoking outcomes and their potential covariates (Shiyko, Lanza, Tan, Li, & Shiffman, 2012). For example, although smoking urges and negative affect have been shown to predict smoking lapse after a quit attempt (Berkman, Dickenson, Falk, & Lieberman, 2011;Shiffman & Waters, 2004), it is not known whether these factors play a stronger role in smoking lapse during certain periods.…”

“…Smoking cessation therapies, such as pharmacotherapy or counseling, can more than double abstinence rates, but even with such aids, only 15%-30% of individuals are successful in a given quit attempt (Fiore, Bailey, & Cohen, 2000). Piasecki, Fiore, McCarthy, and Baker (2002) have suggested that this lack of treatment success may result from a poor understanding of addiction processes and that basic research on smoking and cessation dynamics is essential.…”

The effect of five smoking cessation pharmacotherapies on smoking cessation milestones.

“…In addition, many studies do not separate out those smokers who lapsed and then returned to abstinence from those who lapsed and then reverted to regular smoking (i.e., relapsed). Thus, long-term abstinence, as it has been measured, may be an insensitive outcome by which to measure relations between cessation treatments and cessation processes (Piasecki et al, 2002;Piasecki, 2006;Shiffman et al, 2006). …”