title: Longitudinal changes in smoking abstinence symptoms and alternative reinforcers predict long-term smoking cessation outcomes.
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, United States. Electronic address: schnoll@mail.med.upenn.edu.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Schnoll
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680N Lakeshore Drive, Chicago, IL 60611, United States.
authors.forename: Brian
authors.initials: B
authors.lastname: Hitsman
authors.affiliation: Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, United States.
authors.forename: Sonja
authors.initials: S
authors.lastname: Blazekovic
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680N Lakeshore Drive, Chicago, IL 60611, United States.
authors.forename: Anna
authors.initials: A
authors.lastname: Veluz-Wilkins
authors.affiliation: Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, United States.
authors.forename: E Paul
authors.initials: EP
authors.lastname: Wileyto
authors.affiliation: Pulmonary, Allergy, & Critical Care Division, University of Pennsylvania, Presbyterian Medical Center, 51N. 39th Street, 1st Floor Rear, Philadelphia, PA 19104, United States.
authors.forename: Frank T
authors.initials: FT
authors.lastname: Leone
authors.affiliation: Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, United States.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Audrain-McGovern
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D003376:Counseling / Q000379:methods / Q000639:trends; D066249:Craving / Q000187:drug effects; D003863:Depression / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009538:Nicotine / Q000008:administration & dosage; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012907:Smoking / Q000523:psychology / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D061485:Tobacco Use Cessation Devices / Q000639:trends*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D009538:Nicotine
keywords: Alternative reinforcers; Behavioral economics; Craving; Smoking; Withdrawal