Craving in Intermittent and Daily Smokers During Ad Libitum Smoking

Introduction: This study aimed to assess average and peak craving intensity among nondaily intermittent smokers (ITS), in smoking episodes and when not smoking, compared to that of daily smokers (DS).

Methods: Two hundred and twelve ITS and 194 DS monitored their smoking and craving for 3 weeks using Ecological Momentary Assessment methods. Craving was assessed (0–100 scale) when subjects lit a cigarette and at random times when not smoking; 48,469 observations were analyzed using generalized estimating equations.

Results: ITS experienced craving, including intense craving; their 95th percentile intensity averaged 77.7 ± 22.5 out of 100 (higher among DS: 89.1 ± 14.5). ITS reported lower craving than DS, both when smoking and when not smoking. In both groups, craving was less intense when not smoking (DS: 71.1 ± 20.7 vs. 59.83 ± 21.97; ITS: 59.91 ± 23.03 vs. 26.63 ± 19.87), but the difference was significantly greater among ITS. Among ITS, the probability of smoking rose continuously as craving increased over the full range of the scale. In contrast, among DS, the probability of smoking rose until the midpoint of the scale, after which the relationship flattened. Findings were mostly similar for ITS with and without a history of past daily smoking.

Conclusions: ITS do experience craving, including intense craving. The relationship between craving and smoking is stronger among ITS because DS experience moderate craving even between cigarettes. In contrast, ITS appear to experience craving in limited situations associated with smoking, suggesting that their craving and smoking may be driven by transient cues rather than endogenous needs.