Evaluating the temporal relationships between withdrawal symptoms and smoking relapse

Abstract

Smokers attempting to quit often attribute smoking relapse to negative affect, craving, and other nicotine withdrawal symptoms. In addition, there is evidence that smoking relapse can increase these symptoms, particularly negative affect. To address this issue, we analyzed data from an 11-week smoking cessation clinical trial in which smokers (n = 1,246) were randomized to receive either nicotine replacement therapy (NRT), varenicline, or placebo, combined with behavioral counseling. Using cross-lagged analyses, we examined the temporal bidirectional relationships between self-reported measures of affect, craving, and composite withdrawal symptoms and biochemically verified smoking abstinence. The relative strength of these temporal relationships was examined by comparing the explained variances of the models. The results showed that higher negative affect, craving, and composite withdrawal symptoms increased the likelihood of subsequent smoking relapse, and that smoking relapse led to subsequent increases in these same symptoms. A comparison of the explained variances found symptom predicting subsequent relapse models to be stronger than those where relapse predicted subsequent symptoms. Although the explained variance findings generally support a negative reinforcement conceptualization of nicotine dependence, the bidirectional relationship between symptoms and smoking relapse suggests that struggling with quitting smoking leads to significant negative affect, craving, and other withdrawal symptoms that do not quickly resolve. These findings highlight the importance of addressing specific symptoms within the context of smoking cessation. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Trial registration: ClinicalTrials.gov NCT01314001.

Figure 1.

A graphical illustration of the longitudinal structure of the cross-lagged analyses. The four nicotine withdrawal symptom scores (PANAS NA, PANAS PA, MNWS-R, QSU-B) were measured at the end of weeks 1, 4, 8, 11, 24, and 52, and are denoted by X1-X6. Abstinence status (non-, partial, and complete abstinence) during each of the five time periods (between weeks 1 and 4, between weeks 5 and 8, between weeks 9 and 11, between weeks 12 and 24, and between weeks 25 and 52) are denoted by Y1 through Y5. The temporal order of the data was: X1, Y1, X2, Y2, X3, Y3, X4, Y4, X5, Y5, X6.