Triggers of smoking lapses over the course of a quit attempt

Introduction: Both withdrawal severity and smoking cues can trigger lapses. However, the temporal relationship between these two sets of triggers is unknown.

Aims: To explore the time course of lapse triggers during a quit attempt.

Methods: Across two cessation studies, 186 lapsers monitored their smoking in real-time for up to 7 weeks over the course of a quit attempt. During lapses, participants were asked to report the primary trigger of the event; this, including the time of the event relative to quit day, was logged by an electronic diary. Log multinomial regression was used to estimate the probability that each lapse would be withdrawal-triggered or cue-triggered.

Results: Log multinomial regression showed that the probability of a first lapse being triggered by withdrawal rose in the initial days of a quit attempt before dropping as the quit attempt progressed (P < 0.01). The probability of a cue-triggered lapse rose over the course of a quit attempt (P < 0.05).

Conclusions: The results are consistent both with the time course of withdrawal symptoms and with theoretical predictions about the relationship between nicotine dependence and stimulus control. The results have implications for tailoring smoking-cessation treatments; in particular, for the stepwise provision of smoking-cessation assistance over the course of a quit attempt.