Article

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

ABSTRACT

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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    • "Moreover, they avoid relying on individuals' autobiographical memory (which is the case in retrospective self-reports), which is prone to random error but also fraught with systematic bias[25]. Evidence from other clinical studies, such as smoking cessation, indicates that ambulatory monitoring of subjective states provides greater temporal resolution than can be achieved by laboratory assessments[26,27]. This setting provides rich and detailed information on both the background level of mood and well-being (tonic levels), as well as the frequency and magnitude of acute fluctuations (phasic variation), and identifies specific periods when these occur (for example, early morning). "
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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). "

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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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