Effect of high-dose nicotine patch on the characteristics of lapse episodes.
OBJECTIVE
Nicotine patch improves treatment outcomes, but lapses are still common. To understand the process of relapse on patch, we investigated differences in the antecedents (withdrawal, setting, triggers) of lapse episodes experienced on high-dose (35 mg) nicotine patches versus placebo.


METHODS
Participants were smokers who lapsed during a randomized, double-blind trial of active patches (n = 100) versus placebo (n = 85). Participants used electronic diaries to monitor their smoking, affect, and activities in real time for 5 weeks during their cessation attempt.


RESULTS
We analyzed 490 lapse episodes (active: 266; placebo: 224). Lapses on nicotine patch were characterized by significantly lower positive affect and higher negative affect than placebo lapses. Participants treated with high-dose patch were also significantly more likely to lapse in situations involving little or no craving. Situational antecedents of lapses on patch resembled those on placebo.


CONCLUSIONS
The results suggest that treatment with patch may set a higher threshold for affective stimuli to provoke lapses, but does not change the proximal cues that trigger lapses. This suggests that behavioral relapse-prevention strategies developed for unmedicated smokers should also apply to those treated with nicotine patch.
Ferguson
Stuart G
SG
School of Pharmacy and Menzies Research Institute,University of Tasmania, Hobart, Tasmania 7001, Australia. stuart.ferguson@utas.edu.au
Shiffman
Saul
S
D000279:Administration, Cutaneous; D000328:Adult; D000368:Aged; D016739:Behavior, Addictive / Q000523:psychology; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000008:administration & dosage*; D018722:Nicotinic Agonists / Q000008:administration & dosage*; D012008:Recurrence; D012907:Smoking / Q000523:psychology*; D016540:Smoking Cessation / Q000379:methods / Q000523:psychology*; D000074606:Smoking Prevention; D014029:Tobacco Use Disorder / Q000188:drug therapy*; D016896:Treatment Outcome; D055815:Young Adult
D018722:Nicotinic Agonists; D009538:Nicotine