Does extinction of responses to cigarette cues occur during smoking cessation?
OBJECTIVE
This study investigated whether Pavlovian extinction occurs during smoking cessation by determining whether experience abstaining from smoking in the presence of cigarette cues leads to decreased probability of lapsing and whether this effect is mediated by craving.


METHODS
Secondary analyses were carried out with data sets from two studies with correlational/observational designs.


METHODS
Data were collected in smokers' natural environments using ecological momentary assessment techniques.


METHODS
Sixty-one and 207 smokers who were attempting cessation participated.


METHODS
Multi-level path models were used to examine effects of prior experience abstaining in the presence of available cigarettes and while others were smoking on subsequent craving intensity and the probability of lapsing. Control variables included current cigarette availability, current exposure to others smoking, number of prior lapses and time in the study.


RESULTS
Both currently available cigarettes [odds ratios (OR) = 36.60, 11.59] and the current presence of other smoking (OR = 5.00, 1.52) were powerful predictors of smoking lapse. Repeated exposure to available cigarettes without smoking was associated with a significantly lower probability of lapse in subsequent episodes (OR = 0.44, 0.52). However, exposure to others smoking was not a reliable predictor, being significant only in the smaller study (OR = 0.30). Craving functioned as a mediator between extinction of available cigarettes and lapsing only in the smaller study and was not a mediator for extinction of others smoking in either study.


CONCLUSIONS
This study showed that exposure to available cigarettes is a large risk factor for lapsing, but that this risk can also be reduced over time by repeated exposures without smoking. Smoking cessation interventions should attempt to reduce cigarette exposure (by training cigarette avoidance) but recognize the potential advantage of unreinforced exposure to available cigarettes.
Department of Health and Behavior Studies, Teachers College Columbia University, New York, NY 10027, USA. oconnell@tc.columbia.edu
Kathleen A
KA
O'Connell
Saul
S
Shiffman
Lawrence T
LT
Decarlo
D000328:Adult; D003213:Conditioning, Psychological; D003463:Cues; D005108:Extinction, Psychological; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D015233:Models, Statistical; D012307:Risk Factors; D055502:Secondary Prevention; D057566:Self Report; D012907:Smoking / Q000523:psychology*; D016540:Smoking Cessation / Q000523:psychology* / Q000706:statistics & numerical data; D013375:Substance Withdrawal Syndrome / Q000523:psychology