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Randomized Controlled Trial
. 2016 Aug 1:165:245-52.
doi: 10.1016/j.drugalcdep.2016.06.017. Epub 2016 Jun 25.

Longitudinal changes in smoking abstinence symptoms and alternative reinforcers predict long-term smoking cessation outcomes

Robert A Schnoll  1 , Brian Hitsman  2 , Sonja Blazekovic  3 , Anna Veluz-Wilkins  2 , E Paul Wileyto  3 , Frank T Leone  4 , Janet E Audrain-McGovern  3
Affiliations
Randomized Controlled Trial

Longitudinal changes in smoking abstinence symptoms and alternative reinforcers predict long-term smoking cessation outcomes

Robert A Schnoll et al. Drug Alcohol Depend. .

Abstract

Background: Transdermal nicotine, with behavioral counseling, is among the most popular approaches used to quit smoking. Yet, 6-month cessation rates rarely exceed 20-25%. Identifying factors associated with cessation success may help researchers and clinicians develop enhanced interventions that can improve quit rates. This study examined longitudinal changes in withdrawal, craving, depression and anxiety symptoms, and alternative reinforcers, from a baseline assessment to a 6-month outcome, as predictors of 6-month smoking cessation outcomes following 8 weeks of nicotine patch treatment and counseling.

Methods: A sample of 180 smokers, who completed an effectiveness trial that provided counseling and 8 weeks of 21mg nicotine patches, was analyzed. Generalized estimating equations evaluated changes in withdrawal and craving, depression and anxiety symptoms, and alternative reinforcers over time, between participants who were smoking at 6-months and participants who were abstinent (confirmed with carbon monoxide) at 6-months. Multiple logistic regression assessed changes in these variables as predictors of relapse.

Results: Controlling for covariates associated with cessation (i.e., nicotine dependence, patch adherence, and rate of nicotine metabolism), participants who were abstinent at 6 months showed significantly lower craving and withdrawal and significantly higher substitute reinforcers from baseline to 6 months, vs. those who were smoking at 6 months (p<0.001). An increase in craving predicted relapse to smoking (p<0.05).

Conclusions: These results support continued efforts to strengthen interventions that reduce withdrawal and craving and the development of interventions to address alternative reinforcers in order to promote long-term smoking abstinence following nicotine patch treatment.

Keywords: Alternative reinforcers; Behavioral economics; Craving; Smoking; Withdrawal.

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Conflict of interest statement

Conflict of Interest

Dr. Schnoll and Dr. Hitsman receive medication and placebo free of charge from Pfizer and have provided consultation to Pfizer. Dr. Schnoll has also consulted with GlaxoSmithKline. These companies had no involvement in this study.

Figures

Figure 1
Figure 1
Changes in Withdrawal and Craving among 6 Month Smokers and Abstainers Note. FTND score, NMR, and patch adherence were controlled for in GEE analyses.
Figure 2
Figure 2
Changes in Depression and Anxiety Symptoms among 6 Month Smokers and Abstainers Note. FTND score, NMR, and patch adherence were controlled for in GEE analyses.
Figure 3
Figure 3
Changes in Substitute and Complementary Reinforcers among 6 Month Smokers and Abstainers Note. FTND score, NMR, and patch adherence were controlled for in GEE analyses.
See this image and copyright information in PMC

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