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Cited by 184Smoking Behavior and CessationSubstance Abuse Treatment and OutcomesBehavioral Health and Interventions

Craving, withdrawal, and smoking urges on days immediately prior to smoking relapse

Allen, Sharon, Bade, Tracy, Hatsukami, Dorothy, Center, Bruce·2008·Nicotine & Tobacco Research
DOI 10.1080/14622200701705076
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Abstract

Rates of smoking relapse remain high, despite the wide availability of cessation aids. Presumably factors such as craving, withdrawal symptoms, and smoking urges are key contributors to relapse, but empirical support for this presumption is not conclusive and is complicated by the high variability in symptoms across individuals and time, as well as by the lack of an absolute symptom threshold for response. Data were analyzed from 137 female smokers, aged 18-40 years, who completed 30 days of a protocol for a longitudinal smoking cessation trial. Subjects were assigned a quit date and followed regardless of subsequent smoking status. At baseline, subjects completed written measures of nicotine craving, withdrawal symptoms, and smoking urges. They also completed these measures daily for 30 days, beginning on their quit date, Scores were standardized within subjects and graphed to identify temporal symptom patterns. A total of 26 women quit smoking and 111 relapsed (at least one cigarette puff). The intensity of subjects' craving, withdrawal, and smoking urges Factors 1 and 2 peaked on the day of relapse by an average of 1.4, 1.1, 1.2, and 1.1 standard deviations, respectively, with symptoms rising during the previous 2-5 days and dropping precipitously over the 2 days subsequent to relapse. Additionally, women who relapsed had higher absolute (unstandardized) symptom scores on their quit day than those who were abstinent for 30 days. These findings imply that escalation of withdrawal symptoms, craving, and smoking urges during a quit attempt may contribute to smoking relapse. Frequent symptom monitoring might be clinically important for relapse prevention.

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  • Negative affective symptoms of withdrawal act as negative reinforcers that sustain addiction.

    “The emergence of negative affective symptoms, such as dysphoria, anxiety and irritability and, to a lesser extent, the somatic manifestations of withdrawal, serve as negative reinforcers that sustain the vicious cycle of addiction [23, 121, 132–134].”

    From Mechanistic insights into nicotine withdrawal (2011) · cites this paper as [134]

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Authors
Allen, S., Bade, T., Hatsukami, D., & Center, B.
Affiliations
University of Minnesota (US)
Corresponding author
Allen, Sharon
ORCID
Allen, Sharon
Venue
Nicotine & Tobacco Research
Publisher
Oxford University Press (OUP)
Published
2008
Volume
10
Issue
1
Pages
35-45
ISSN
1462-2203 (ISSN-L)
DOI
10.1080/14622200701705076
OpenAlex
W2085579642
Cited by
184
References
0
Citations by year
2026: 2 · 2025: 6 · 2024: 5 · 2023: 8 · 2022: 8 · 2021: 12 · 2020: 8 · 2019: 10 · 2018: 14 · 2017: 9 · 2016: 15 · 2015: 12 · 2014: 14 · 2013: 14 · 2012: 12
FWCI
7.67
Type
journal article
Language
en
Open access
closed
Locations
  • Nicotine & Tobacco Research (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (4r01da008075-19)
  • National Institute on Drug Abuse (2 R01 DA08075)
Topics
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
Keywords
smoking relapse, nicotine craving, withdrawal symptoms, smoking urges, smoking cessation, women smokers, relapse prevention, symptom monitoring
MeSH terms
Adult, Female, Humans, Disruptive, Impulse Control, and Conduct Disorders, Longitudinal Studies, Patient Dropouts, Surveys and Questionnaires, Research Design, Smoking, Substance Withdrawal Syndrome, Tobacco Use Disorder, Reproducibility of Results, Smoking Cessation, Secondary Prevention

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