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Triggers of Smoking Lapses Over the Course of a Quit Attempt

Published online by Cambridge University Press:  31 August 2016

Stuart G. Ferguson*
Affiliation:
University of Tasmania, Hobart, Australia
Saul Shiffman
Affiliation:
University of Pittsburgh, Pittsburgh, PA
Leigh Blizzard
Affiliation:
University of Tasmania, Hobart, Australia
*
Address for correspondence: Stuart G. Ferguson, Associate Professor, School of Medicine, University of Tasmania, Private Bag 34, Hobart TAS 7001, Australia. E-mail: [email protected]

Abstract

Introduction: Both withdrawal severity and smoking cues can trigger lapses. However, the temporal relationship between these two sets of triggers is unknown.

Aims: To explore the time course of lapse triggers during a quit attempt.

Methods: Across two cessation studies, 186 lapsers monitored their smoking in real-time for up to 7 weeks over the course of a quit attempt. During lapses, participants were asked to report the primary trigger of the event; this, including the time of the event relative to quit day, was logged by an electronic diary. Log multinomial regression was used to estimate the probability that each lapse would be withdrawal-triggered or cue-triggered.

Results: Log multinomial regression showed that the probability of a first lapse being triggered by withdrawal rose in the initial days of a quit attempt before dropping as the quit attempt progressed (P < 0.01). The probability of a cue-triggered lapse rose over the course of a quit attempt (P < 0.05).

Conclusions: The results are consistent both with the time course of withdrawal symptoms and with theoretical predictions about the relationship between nicotine dependence and stimulus control. The results have implications for tailoring smoking-cessation treatments; in particular, for the stepwise provision of smoking-cessation assistance over the course of a quit attempt.

Type
Original Articles
Copyright
Copyright © The Author(s) 2016 

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References

Blizzard, L., & Hosmer, D. W. (2007). The log multinomial regression model for nominal outcomes with more than two attributes. Biometrical Journal, 49 (6), 889902. doi:10.1002/bimj.200610377.Google Scholar
Carter, B. L., & Tiffany, S. T. (1999). Cue-reactivity and the future of addiction research. Addiction, 94 (3), 349351. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10605863.Google Scholar
Ferguson, S. G., Frandsen, M., Dunbar, M. S., & Shiffman, S. (2015). Gender and stimulus control of smoking behavior. Nicotine Tobacco Research, 17 (4), 431437. doi:10.1093/ntr/ntu195.Google Scholar
Ferguson, S. G., Gitchell, J. G., Shiffman, S., & Sembower, M. A. (2009). Prediction of abstinence at 10 weeks based on smoking status at 2 weeks during a quit attempt: secondary analysis of two parallel, 10-week, randomized, double-blind, placebo-controlled clinical trials of 21-mg nicotine patch in adult smokers. Clinical Therapeutics, 31 (9), 19571965. doi:10.1016/j.clinthera.2009.08.029.CrossRefGoogle ScholarPubMed
Ferguson, S. G., & Shiffman, S. (2009). The relevance and treatment of cue-induced cravings in tobacco dependence. Journal of Substance Abuse Treatment, 36 (3), 235243. doi:10.1016/j.jsat.2008.06.005.CrossRefGoogle ScholarPubMed
Ferguson, S. G., & Shiffman, S. (2010). Effect of high-dose nicotine patch on the characteristics of lapse episodes. Health Psychology, 29 (4), 358366. doi:10.1037/a0019367.Google Scholar
Ferguson, S. G., & Shiffman, S. (2014). Effect of high-dose nicotine patch on craving and negative affect leading up to lapse episodes. Psychopharmacology. doi:10.1007/s00213-013-3429-6.Google Scholar
Ferguson, S. G., Shiffman, S., & Gwaltney, C. J. (2006). Does reducing withdrawal severity mediate nicotine patch efficacy? A randomized clinical trial. Journal of Consulting and Clinical Psychology, 74 (6), 11531161. doi:10.1037/0022-006x.74.6.1153.CrossRefGoogle ScholarPubMed
Fiore, M., & United States. Tobacco Use and Dependence Guideline Panel. (2008). Treating tobacco use and dependence : 2008 update (2008 update ed.). Rockville, Md.: U.S. Dept. of Health and Human Services, Public Health Service.Google Scholar
Freeman, T. J., & Lattal, K. A. (1992). Stimulus control of behavioral history. Journal of the Experimental Analysis of Behavior, 57 (1), 515. doi:10.1901/jeab.1992.57-5.Google Scholar
Heatherton, T. F., Kozlowski, L. T., Frecker, R. C., & Fagerstrom, K. O. (1991). The fagerstrom test for nicotine dependence: A revision of the fagerstrom tolerance questionnaire. British Journal of Addiction, 86 (9), 11191127. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/1932883.Google Scholar
Hughes, J. R., & Hatsukami, D. (1986). Signs and symptoms of tobacco withdrawal. Archives of General Psychiatry, 43 (3), 289294. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/3954551.Google Scholar
Hughes, J. R., Keely, J., & Naud, S. (2004). Shape of the relapse curve and long-term abstinence among untreated smokers. Addiction, 99 (1), 2938. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/14678060.Google Scholar
Kenford, S. L., Fiore, M. C., Jorenby, D. E., Smith, S. S., Wetter, D., & Baker, T. B. (1994). Predicting smoking cessation. Who will quit with and without the nicotine patch. Journal of the American Medical Association, 271 (8), 589594. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8301790.Google Scholar
Kirchner, T. R., Shiffman, S., & Wileyto, E. P. (2012). Relapse dynamics during smoking cessation: Recurrent abstinence violation effects and lapse-relapse progression. Journal of Abnormal Psychology, 121 (1), 187197. doi:10.1037/a0024451.Google Scholar
Niaura, R. S., Rohsenow, D. J., Binkoff, J. A., Monti, P. M., Pedraza, M., & Abrams, D. B. (1988). Relevance of cue reactivity to understanding alcohol and smoking relapse. Journal of Abnormal Psychology, 97 (2), 133152. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/3290304.Google Scholar
Piasecki, T. M., Niaura, R., Shadel, W. G., Abrams, D., Goldstein, M., Fiore, M. C. et al. (2000). Smoking withdrawal dynamics in unaided quitters. Journal of Abnormal Psychology, 109 (1), 7486. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10740938.CrossRefGoogle ScholarPubMed
Piper, M. E., Schlam, T. R., Cook, J. W., Sheffer, M. A., Smith, S. S., Loh, W. Y. et al. (2011). Tobacco withdrawal components and their relations with cessation success. Psychopharmacology, 216 (4), 569578. doi:10.1007/s00213-011-2250-3.Google Scholar
Russell, M. A. (1971). Cigarette smoking: Natural history of a dependence disorder. British Journal of Medical Psychology, 44 (1), 116. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/5101052.Google Scholar
Shaham, Y., Shalev, U., Lu, L., De Wit, H., & Stewart, J. (2003). The reinstatement model of drug relapse: History, methodology and major findings. Psychopharmacology, 168 (1–2), 320. doi:10.1007/s00213-002-1224-x.Google Scholar
Shiffman, S., Dunbar, M. S., & Ferguson, S. G. (2015). Stimulus control in intermittent and daily smokers. Psychology of Addictive Behaviors. doi:10.1037/adb0000052.CrossRefGoogle Scholar
Shiffman, S., Dunbar, M. S., Li, X., Scholl, S. M., Tindle, H. A., Anderson, S. J. et al. (2014). Smoking patterns and stimulus control in intermittent and daily smokers. PloS One, 9 (3), e89911. doi:10.1371/journal.pone.0089911.Google Scholar
Shiffman, S., Ferguson, S. G., Gwaltney, C. J., Balabanis, M. H., & Shadel, W. G. (2006). Reduction of abstinence-induced withdrawal and craving using high-dose nicotine replacement therapy. Psychopharmacology, 184 (3–4), 637644. doi:10.1007/s00213-005-0184-3.Google Scholar
Shiffman, S., Hickcox, M., Paty, J. A., Gnys, M., Richards, T., & Kassel, J. D. (1997). Individual differences in the context of smoking lapse episodes. Addictive Behaviors, 22 (6), 797811.CrossRefGoogle ScholarPubMed
Shiffman, S., Kassel, J. D., Paty, J., Gnys, M., & Zettler-Segal, M. (1994). Smoking typology profiles of chippers and regular smokers. Journal of Substance Abuse, 6 (1), 2135. Retrieved from http://ac.els-cdn.com/S0899328994900523/1-s2.0-S0899328994900523-main.pdf?_tid=2fee56fa-ae48-11e3-ade1-00000aab0f26&acdnat=1395111261_e055c0aa72163bdfacfe6c7412013f1c.Google Scholar
Shiffman, S., Patten, C., Gwaltney, C., Paty, J., Gnys, M., Kassel, J. et al. (2006). Natural history of nicotine withdrawal. Addiction, 101 (12), 18221832. doi:10.1111/j.1360-0443.2006.01635.x.CrossRefGoogle ScholarPubMed
Shiffman, S., Paty, J. A., Gnys, M., Kassel, J. A., & Hickcox, M. (1996). First lapses to smoking: Within-subjects analysis of real-time reports. Journal of Consulting and Clinical Psychology, 64 (2), 366379. Retrieved from http://psycnet.apa.org/journals/ccp/64/2/366/.Google Scholar
Shiffman, S., & Paty, J. (2006). Smoking patterns and dependence: Contrasting chippers and heavy smokers. Journal of Abnormal Psychology, 115 (3), 509523. doi:10.1037/0021-843x.115.3.509.CrossRefGoogle ScholarPubMed
Shiffman, S., Scharf, D. M., Shadel, W. G., Gwaltney, C. J., Dang, Q., Paton, S. M. et al. (2006). Analyzing milestones in smoking cessation: Illustration in a nicotine patch trial in adult smokers. Journal of Consulting and Clinical Psychology, 74 (2), 276285. doi:10.1037/0022-006x.74.2.276.Google Scholar
Shiffman, S., Stone, A. A., & Hufford, M. R. (2008). Ecological momentary assessment. Annual Review of Clinical Psychology, 4, 132.Google Scholar
Shiffman, S., Waters, A., & Hickcox, M. (2004). The nicotine dependence syndrome scale: A multidimensional measure of nicotine dependence. Nicotine Tobacco Research, 6 (2), 327348. doi:10.1080/1462220042000202481.Google Scholar
West, R. J., Hajek, P., & Belcher, M. (1987). Time course of cigarette withdrawal symptoms during four weeks of treatment with nicotine chewing gum. Addictive Behaviors, 12 (2), 199203. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/3630807.Google Scholar