Prospective analysis of early lapse to drinking and smoking among individuals in concurrent alcohol and tobacco treatment

Abstract

The aims of the current study were to examine, prospectively, (a) dynamic changes in affective state, self-efficacy, and urge in the hours before initial smoking and drinking lapses among individuals in concurrent alcohol and smoking treatment, and (b) the extent to which self-efficacy, urge to use, and/or the use of one substance predicted lapse to the other substance. Ninety-six men and women recruited for a clinical trial of concurrent alcohol and tobacco treatment were eligible for inclusion. Only data from those who experienced an initial lapse to drinking (n=29) or smoking (n=32) were included. Two outpatient substance abuse clinics provided concurrent alcohol and smoking treatment on a weekly basis for three months. Ecological Momentary Assessment (EMA) methods were employed over a 28-day monitoring period to assess antecedents to first drink, and a 14-day monitoring period was examined for initial smoking lapses. Baseline and EMA measures of positive and negative affect, alcohol/smoking urge, alcohol/smoking abstinence self-efficacy, nicotine withdrawal, and quantity/frequency of alcohol and tobacco use were examined as lapse predictors. Analyses of EMA ratings controlled for the corresponding baseline measure. Smoking lapse among individuals in concurrent alcohol and tobacco treatment was foreshadowed by higher urges to smoke, lower positive mood, and lower confidence to resist smoking. Drinking lapse was preceded by lower confidence to resist smoking, but only among individuals who reported recent smoking. Concurrent alcohol and smoking treatment should focus on the enhancement of abstinence self-efficacy, positive mood, and the curbing of urges in order to offset lapse risk.

Figure 1

Weekly timeline for concurrent alcohol and tobacco treatment and assessments. *Additional counseling sessions were provided at weeks 17, 21, and 25.

Figure 2

Relation between aggregated momentary confidence to resist smoking and probability of an initial drinking lapse at the next time point by smoking status. Probability estimates derived from GEE analyses. Among those who reported any smoking in the days prior to their first drinking lapse, lower momentary confidence to resist smoking was associated with a higher probability of initial drinking lapse occurring at the succeeding time point.

Figure 3

Relation between aggregated high activation mood, confidence to resist smoking, and urge to smoke, and probability of an initial smoking lapse at the next time point. Probability estimates derived from GEE analyses. Higher momentary positive-high activation mood and higher momentary confidence to resist smoking were independently associated with lower probability of an initial smoking lapse occurring at the succeeding time point. Higher momentary urge to smoke was associated with a higher probability of an initial smoking lapse occurring at the succeeding time point.