Impulsivity and smoking relapse

Abstract

Previous research has shown that elevated trait-impulsivity heightens the risk for initiating tobacco use and indicates that nicotine may be disproportionately rewarding for more impulsive persons. However, the influence of impulsivity on the ability to maintain nicotine abstinence has not been studied. The present study tested the hypothesis that a higher level of trait-impulsivity would predict a more rapid relapse to smoking following 48 hr of nicotine abstinence. Participants were euthymic, regular smokers (N~45), with a history of at least one major depressive episode, who participated in a paid smoking cessation study with biological challenge (tryptophan depletion). Treatment involved a 1-day skills training workshop followed by 48 hr of bioverified abstinence and weekly follow-up for 1 month. Regression analyses indicated that elevated impulsivity predicted shorter time to relapse following the workshop after controlling for treatment condition, baseline nicotine dependence, and age (b~2.39, R 2 change~.147, p~.011). Greater impulsivity predicted more rapid relapse to smoking, which mediational analyses indicated could not be explained by positive affect, negative affect, or craving. Findings suggest a need to identify alternative mechanisms to explain impulsive smokers' increased difficulty in maintaining abstinence and to develop targeted treatments that address the special needs of smokers high in impulsivity.

Relapse to smoking during unaided cessation: clinical, cognitive and motivational predictors

“…Gurpegui et al, 2007;Mitchell, 1999), but only two previous studies have investigated its relevance to smoking cessation. Both used the Barratt Impulsivity Scale: Doran et al (2004) found it to be positively correlated with rapidity of relapse in 45 adult smokers with a history of depression, but Krishnan-Sarin et al (2007) found no association with one-month cessation rates in 30 adolescents. The present sample was larger and more representative of adult smokers, and the use of multiple questionnaires enabled the potential impact of several different conceptualisations of impulsivity to be investigated.…”

“…Lejuez et al, 2003;Mitchell, 1999). Whilst Doran et al (2004) found one widely used measure of trait impulsivity to predict speed of relapse in adult smokers, Krishnan-Sarins et al (2007) found no such relationship in adolescents; interestingly, however, in this group relapse was predicted by two behavioural indices of impulsiveness (delay discounting and commission errors on a Continuous Performance Task). There has been little other research directly investigating the relationship between impulsivity and relapse, and thus several tasks and trait measures have been employed here to provide at least a preliminary indication of whether some facets of the construct have more utility than others in predicting the ability to quit smoking.…”

Behavioral impulsivity predicts treatment outcome in a smoking cessation program for adolescent smokers

“…No significant differences were observed between abstinent (A) and non-abstinent (NA) smokers on demographics [age in years: A=16.7 (SD=0.24), NA=16. 4 Non-abstinent participants as compared to abstinent ones discounted more significantly on the EDT (p<0.05) and had higher commission-error scores on the CPT (p<0.05; Table 1). No significant differences were observed on other impulsivity measures.…”

“…In contrast, Audrain-McGovern and colleagues (2004) demonstrated that impulsivity, assessed using a self-report delay discounting measure, was higher in adolescent smokers compared with never smokers and that its influence on smoking progression was mediated through other complementary reinforcers like peer smoking. Furthermore, although impulsivity has been associated with relapse in adult smokers (Doran et al, 2004), its relationship to cessation outcome in adolescents has not been systematically examined.…”

The role of self-reported impulsivity and reward sensitivity versus neurocognitive measures of disinhibition and decision-making in the prediction of relapse in pathological gamblers

“…Several studies reported that a higher severity of dependence was predictive of relapse (Babor et al 1987 ;Langenbucher et al 1996 ;Simpson et al 1999 ; but see : Allsop et al 2000 ;Bottlender & Soyka, 2005). Higher levels of selfreported impulsivity are also found to be predictive of relapse and early treatment drop-out in substance dependence (Moeller et al 2001 ;Doran et al 2004). Other studies in substance-dependent populations indicate that deficiencies in neurocognitive functions have a negative effect on the outcome of interventions such as early drop-out (Teichner et al 2002 ;Aharonovich et al 2003), shorter length of treatment adherence (Fals-Stewart & Schafer, 1992 ;Fals-Stewart, 1993), smaller benefits of treatment interventions (Smith & McCrady, 1991 ;Teichner et al 2001), and higher relapse rates (Tapert et al 1999 ;Allsop et al 2000 ;Bowden-Jones et al 2005).…”