Tobacco withdrawal components and their relations with cessation success

Abstract

Rationale Tobacco withdrawal is a key factor in smoking relapse, but important questions about the withdrawal phenomenon remain. Objectives This research was intended to provide information about two core components of withdrawal (negative affect and craving): 1) how various withdrawal symptom profile dimensions (e.g., mean level, volatility, extreme values) differ between negative affect and craving; and 2) how these dimensions relate to cessation outcome. Methods Adult smokers (N=1504) in a double-blind randomized placebo-controlled smoking cessation trial provided real-time withdrawal symptom data four times per day for 4 weeks (2 weeks pre-quit and 2 weeks post-quit) via palmtop computers. Cessation outcome was biochemically confirmed 8-week point-prevalence abstinence. Results Examination of craving and negative affect dimensions following a cessation attempt revealed that craving symptoms differed from negative affect symptoms, with higher means, greater variability, and a greater incidence of extreme peaks. Regression analyses revealed that abstinence was associated with lower mean levels of both craving and negative affect and fewer incidences of extreme craving peaks. In a multivariate model, the increase in mean craving and negative affect scores each uniquely predicted relapse. Conclusions Real-time reports revealed different patterns of abstinence-related negative affect and craving and that dimensions of both predict cessation outcome, suggesting that negative affect and craving dimensions each has motivational significance. This underscores the complexity of withdrawal as a determinant of relapse and the need to measure its distinct components and dimensions.

Smoking and Opioid Detoxification: Behavioral Changes and Response to Treatment

“…Smokers frequently report intense craving even without nicotine deprivation (Hughes, 1992), and many endorse more severe urges than during abstinence (Cox et al, 2001;Piper et al, 2011). In this regard, clonidine has shown to reduce craving following smoking cessation and it seems less effective in attenuating smoking-induced craving (Knott et al, 2005).…”

Expectancies for Cigarettes, E-Cigarettes, and Nicotine Replacement Therapies Among E-Cigarette Users (aka Vapers)

“…Given that these enthusiastic users of e-cigarettes still considered their product inferior to cigarettes in these areas suggests that they may be at risk of smoking relapse. In particular, affect regulation may be a prepotent motivator of tobacco use 60,61 , whereas weight gain has been cited as a primary reason for putting off quit attempts, especially in women. [62][63][64] Thus, these expectancies may represent targets for relapse-prevention efforts directed at e-cigarette users, as may be the development of relevant coping skills to prevent cigarette smoking relapse.…”

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

“…First, we examine withdrawal and baseline dependence to understand the processes involved in smoking after a quit attempt. Prior research has demonstrated that withdrawal is a key factor involved in lapse and relapse (Javitz, Brigham, Lessov-Schlaggar, Krasnow, & Swan, 2009;Piasecki, Jorenby, Smith, Fiore, & Baker, 2003;Piper et al, 2011). Two primary withdrawal factors have been identified, which are strongly related to relapse or later smoking status: smoking urges and negative affect (Piasecki et al, 2000;Piper et al, 2011;Zhou et al, 2009).…”

“…Prior research has demonstrated that withdrawal is a key factor involved in lapse and relapse (Javitz, Brigham, Lessov-Schlaggar, Krasnow, & Swan, 2009;Piasecki, Jorenby, Smith, Fiore, & Baker, 2003;Piper et al, 2011). Two primary withdrawal factors have been identified, which are strongly related to relapse or later smoking status: smoking urges and negative affect (Piasecki et al, 2000;Piper et al, 2011;Zhou et al, 2009). In addition to predicting longer term relapse, increases in smoking urges or cravings and negative affect are associated with immediate smoking lapses (Berkman et al, 2011;Shiffman & Waters, 2004).…”

“…intrOduCtiOn An increasing number of smoking studies have included collection of ecological momentary assessment (EMA) data to uncover processes associated with addiction, quitting, withdrawal, lapse, and relapse (Colvin & Mermelstein, 2010;Piasecki et al, 2011;Piper et al, 2011;Shiffman et al, 2007). Collecting this kind of data is an important step in understanding addiction processes, as it gives ecologically valid assessments of process-related measures, such as individuals' current mood and context as well as substance use (Shiffman, 2009).…”