Within-day temporal patterns of smoking, withdrawal symptoms, and craving

University of Pittsburgh, Pittsburgh, PA, USA.
Drug and alcohol dependence (Impact Factor: 3.42). 02/2011; 117(2-3):118-25. DOI: 10.1016/j.drugalcdep.2010.12.027
Source: PubMed


We examined the temporal relationships between smoking frequency and craving and withdrawal. 351 heavy smokers (≥15 cigarettes per day) used ecological momentary assessment and electronic diaries to track smoking, craving, negative affect, arousal, restlessness, and attention disturbance in real time over 16 days. The waking day was divided into 8 2-h "bins" during which cigarette counts and mean levels of craving and withdrawal were computed. Cross-sectional analyses showed no association between restlessness and smoking, and arousal and smoking, but craving (b=0.65, p<0.01) was positively associated, and negative affect (b=-0.20, p<0.01), and attention disturbance (b=-0.24, p<0.01) were inversely associated with smoking. In prospective lagged analyses, higher craving predicted more subsequent smoking and higher smoking predicted lower craving (p's<0.01). Higher restlessness also predicted more subsequent smoking and higher smoking predicted lower restlessness (p's<0.01). Higher negative affect did not predict later smoking, but more smoking preceded lower negative affect (p<0.01). Neither attention disturbance nor arousal predicted, or were predicted by variations in smoking. In short, smoking exhibits time-lagged, reciprocal relationships with craving and restlessness, and a one-way predictive relationship with negative affect. Temporal patterns of craving and restlessness may aid in the design of smoking cessation interventions.

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    • "Those refinements are possible with ecological momentary assessment (EMA), a method in which participants use a handheld computer or smartphone to report on their activities and moods in real time as they go about their daily lives (Preston and Epstein 2011; Shiffman 2005). Recent EMA studies from our clinic and others have shown increases in negative affect, 1 craving, and restlessness preceding lapse to or continued use of cocaine or cigarettes (Chandra et al. 2011; Preston and Epstein 2011; Shiffman 2005). We have also shown with EMA that negative affect and craving increase as stress increases, but, crucially, we have been unable to show a statistically significant relationship between stress and actual drug use (Preston and Epstein 2011). "
    College of Problems on Drug Dependence; 06/2015
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    • "Also, the co-variations between pulmonary functions tested by a spirometer and positive/negative affect in patients with asthma were reported [17]. In addition, some studies demonstrated that addictive behaviors such as smoking [18,19] and alcohol consumption [20,21] are related to the fluctuations in psychological states, e.g., positive/ negative affect and craving. Furthermore, the associations of momentary psychological states with self-reported physical activity were demonstrated [22,23]. "
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    ABSTRACT: Computerized ecological momentary assessment (EMA) is widely accepted as a "gold standard" method for capturing momentary symptoms repeatedly experienced in daily life. Although many studies have addressed the within-individual temporal variations in momentary symptoms compared with simultaneously measured external criteria, their concurrent associations, specifically with continuous physiological measures, have not been rigorously examined. Therefore, in the present study, we first examined the variations in momentary symptoms by validating the associations among self-reported symptoms measured simultaneously (depressive mood, anxious mood, and fatigue) and then investigated covariant properties between the symptoms (especially, depressive mood) and local statistics of locomotor activity as the external objective criteria obtained continuously. Healthy subjects (N = 85) from three different populations (adolescents, undergraduates, and office workers) wore a watch-type computer device equipped with EMA software for recording the momentary symptoms experienced by the subjects. Locomotor activity data were also continuously obtained by using an actigraph built into the device. Multilevel modeling analysis confirmed convergent associations by showing positive correlations among momentary symptoms. The increased intermittency of locomotor activity, characterized by a combination of reduced activity with occasional bursts, appeared concurrently with the worsening of depressive mood. Further, this association remained statistically unchanged across groups regardless of group differences in age, lifestyle, and occupation. These results indicate that the temporal variations in the momentary symptoms are not random but reflect the underlying changes in psychophysiological variables in daily life. In addition, our findings on the concurrent changes in depressive mood and locomotor activity may contribute to the continuous estimation of changes in depressive mood and early detection of depressive disorders.
    PLoS ONE 09/2013; 8(9):e74979. DOI:10.1371/journal.pone.0074979 · 3.23 Impact Factor
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    ABSTRACT: Nearly all smokers who lapse experience a full-blown relapse, but the mediating mechanisms that contribute to this relationship are not well understood. A better understanding of these mechanisms would help to advance more effective relapse prevention treatments for smokers. The purpose of this study is to experimentally evaluate the effects of a programmed smoking lapse on smoking relapse and the effects of postlapse changes in craving on relapse. Adult smokers (n = 63) who quit smoking with a brief cognitive-behavioral intervention and self-help materials were randomly assigned to one of two experimental conditions after 48 h of abstinence: No lapse (a no-smoking control/30-min waiting period) or lapse (smoking two cigarettes of their favored brand during a 30-min period). All participants were then followed daily for 14 days. Craving and biochemically verified self-reported abstinence were assessed on each follow-up day. Time (days) to relapse (7 consecutive days of smoking) was the main dependent measure. Results of Cox regression analysis revealed that participants in the lapse condition relapsed more quickly than participants in the no-lapse condition (hazard ratio [HR] = 2.12, 95% confidence interval [CI] = [1.03, 4.35]). These effects were attributable, in part, to episodic increases in craving among participants in the lapse condition only (HR = 12.42, 95% CI = [2.00, 77.1]). Previously abstinent smokers who lapse are at risk for increased cigarette cravings and consequently, full-blown relapse. These results have implications for both cognitive-behavioral treatments for relapse prevention and for medications designed to help smokers manage cravings.
    Health Psychology 05/2011; 30(5):588-96. DOI:10.1037/a0023445 · 3.59 Impact Factor
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