title: Lapse-induced surges in craving influence relapse in adult smokers: an experimental investigation.
abstract: OBJECTIVE
  Nearly all smokers who lapse experience a full-blown relapse, but the mediating mechanisms that contribute to this relationship are not well understood. A better understanding of these mechanisms would help to advance more effective relapse prevention treatments for smokers. The purpose of this study is to experimentally evaluate the effects of a programmed smoking lapse on smoking relapse and the effects of postlapse changes in craving on relapse.
  
  
  METHODS
  Adult smokers (n = 63) who quit smoking with a brief cognitive-behavioral intervention and self-help materials were randomly assigned to one of two experimental conditions after 48 h of abstinence: No lapse (a no-smoking control/30-min waiting period) or lapse (smoking two cigarettes of their favored brand during a 30-min period). All participants were then followed daily for 14 days. Craving and biochemically verified self-reported abstinence were assessed on each follow-up day. Time (days) to relapse (7 consecutive days of smoking) was the main dependent measure.
  
  
  RESULTS
  Results of Cox regression analysis revealed that participants in the lapse condition relapsed more quickly than participants in the no-lapse condition (hazard ratio [HR] = 2.12, 95% confidence interval [CI] = [1.03, 4.35]). These effects were attributable, in part, to episodic increases in craving among participants in the lapse condition only (HR = 12.42, 95% CI = [2.00, 77.1]).
  
  
  CONCLUSIONS
  Previously abstinent smokers who lapse are at risk for increased cigarette cravings and consequently, full-blown relapse. These results have implications for both cognitive-behavioral treatments for relapse prevention and for medications designed to help smokers manage cravings.
authors.affiliation: RAND Corporation, Pittsburgh, Pennsylvania 15213, USA. shadel@rand.org
authors.forename: William G
authors.initials: WG
authors.lastname: Shadel
authors.forename: Steven C
authors.initials: SC
authors.lastname: Martino
authors.forename: Claude
authors.initials: C
authors.lastname: Setodji
authors.forename: Daniel
authors.initials: D
authors.lastname: Cervone
authors.forename: Katie
authors.initials: K
authors.lastname: Witkiewitz
authors.forename: Ellen Burke
authors.initials: EB
authors.lastname: Beckjord
authors.forename: Deborah
authors.initials: D
authors.lastname: Scharf
authors.forename: Regina
authors.initials: R
authors.lastname: Shih
mesh_terms: D000328:Adult; D001521:Behavior Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055502:Secondary Prevention; D012907:Smoking / Q000523:psychology*; D016540:Smoking Cessation / Q000379:methods / Q000523:psychology*; D000074606:Smoking Prevention