Prediction of smoking relapse: Analyses of temptations and transgressions after initial cessation.

Different types of "relapse crises" and associated coping responses were associated with the resumption of smoking using a prospective design. One hundred and two previously heavy smokers (M?=?23.9 cigarettes a day) who achieved initial abstinence through a smoking cessation program were interviewed by telephone at 1, 2, and 3 months posttreatment. At each assessment, subjects described relapse crises, situations in which they were tempted to smoke or actually smoked but resumed abstinence (lapsed). Prospective analyses indicated that any smoking lapse is strongly related to subsequent relapse. Situational characteristics of relapse crises and the number of cognitive and behavioral coping responses reported during crises were only modestly consistent over time and were unrelated to later relapse. Confidence ratings and situational attributions about the relapse crises were also not prospectively associated with eventual relapse. Subanalyses suggested that lapses associated with urges and emotional (guilt) responses and lapses occurring in frequent situations are more likely to result in relapse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relapse crises and coping among dieters.

We examined situational antecedents of dieting relapse crises and dieters' attempts to cope with temptations to overeat. We analyzed postreatment interviews with 57 obese Ss with Type II diabetes, comparing situations in which Ss lapsed with those in which they overcame temptation to overeat. Cluster analysis yielded 3 categories of relapse crises: mealtime, low-arousal, and emotional upset situations. The cluster differed in outcome: Upset situations almost always resulted in overeating; situational factors, especially food-related cues, increased relapse risk; but performance of coping was the strongest correlate of outcome. Cognitive and behavioral coping responses were each equally associated with positive outcomes. When Ss reported combining both types of coping, they were less likely to report overeating. The dynamics of relapse crises among dieters resemble those that govern relapse crises in addictive behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The influence of situation and coping on relapse crisis outcomes after smoking cessation.

Examines the influence of situational characteristics and coping on the outcome of a relapse crisis for 232 Ss followed for 1 month after a self-initiated smoking cessation attempt. Survival of a relapse crisis was most strongly related to the number of coping strategies used. All coping strategies were equally effective; furthermore, combining cognitive and behavioral coping strategies was not more effective than using multiple cognitive or multiple behavioral strategies. During the second half of the follow-up period (Weeks 3 and 4 postcessation), the presence of smokers resulted in a decreased likelihood of coping and an increased likelihood of smoking. In addition, active coping was marginally related to higher baseline levels of motivation to quit. When motivation and the presence of smokers were controlled, however, coping still significantly predicted outcome. Results are discussed with reference to previous relapse studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preventing smoking relapse, using an individually tailored skills-training technique.

The effectiveness of a relapse prevention program was studied in a population of 744 smokers. Subjects first attended an intensive 4-day series of 2-hr meetings in which they were trained to use more than 40 behavioral and cognitive cessation techniques. At the 1-week follow-up session, those abstinent from smoking (79%, carbon monoxide verified) were randomly assigned to one of three follow-up conditions: (a) a three-session skills-training program in which subjects developed and actively rehearsed individually tailored coping strategies for likely relapse situations, (b) a three-session discussion control condition in which subjects discussed maintenance but did not develop or rehearse coping strategies, or (c) a no-treatment control condition. Survival analysis indicated higher abstinence rates for the skills-training group than for the control groups throughout the following year. After 12 months, the biochemically confirmed continuous abstinence rate was higher in the skills-training group (41.3%) than in the discussion and no-treatment groups (34.1% and 33.3%, respectively). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Approach and avoidance coping responses among older problem and nonproblem drinkers.

The Coping Responses Inventory (CRI) was used to study coping among older problem and nonproblem drinkers. The CRI organizes coping efforts according to their focus (approach or avoidance) and method (cognitive or behavioral). Compared with nonproblem drinkers, older problem drinkers were more likely to use cognitive and behavioral avoidance responses to manage life stressors. Problem drinkers who experienced more negative life events and more severe stressors used both more approach and more avoidance coping. Those who had more financial and social resources relied more on approach and less on avoidance coping. Problem drinkers who relied more on avoidance coping tended to have more drinking problems and to report more depression and physical symptoms and less self-confidence. Positive reappraisal was associated with less depression and more self-confidence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping with temptations to smoke.

Explored the effectiveness of coping responses reported to a hotline by ex-smokers dealing with temptations to smoke. Earlier findings on the effectiveness of cognitive and behavioral responses for 183 smokers were cross-validated on 75 new Ss. The number of coping responses had no effect, but combining cognitive and behavioral responses enhanced effectiveness. Formal smoking cessation treatment resulted in more behavioral coping, especially relaxation and physical activity, but had no effect on coping effectiveness. Seven types of behavioral coping were equally effective: Each was significantly more effective than no coping response and equal to other behavioral responses in preventing relapse. A similar pattern held for 8 types of cognitive coping, except that the use of willpower was significantly inferior to other cognitive responses, and self-punitive thoughts were entirely ineffective. The implications of these findings for the coping skill model of self-control and for clinical practice are discussed. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of depressive symptoms on smoking abstinence and treatment adherence among smokers with a history of alcohol dependence.

This study examined the effect of depressive symptoms on smoking abstinence and treatment adherence among smokers with a past history of alcohol dependence. Participants (24 women, 27 men) were randomly assigned to behavioral counseling (BC) or behavioral counseling plus cognitive-behavioral mood management training (CBT). The Hamilton -Rating Scale for Depression (HRSD; A Hamilton, 1967) was administered to assess baseline depressive symptoms. Participants who received CBT and had higher HRSD scores were more likely to achieve short-term abstinence from smoking and attend more treatment sessions than those with lower depression scores, whereas for BC participants the effect of HRSD scores was the opposite. Smokers with a history of alcohol dependence reporting high levels of depressive symptoms may benefit from a mood management intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lapse-induced surges in craving influence relapse in adult smokers: An experimental investigation.

Objectives: 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. Method: 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. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

An investigation of predictors of nicotine abstinence in a smoking cessation treatment study of smokers with a past history of alcohol dependence.

This study investigated predictors for smoking abstinence at 12-week follow-up among 85 smokers with a past history of alcohol dependence enrolled in a smoking cessation trial. Length of alcohol abstinence at time of enrollment and longest previous period of smoking abstinence were significantly associated with smoking status at follow-up. Multiple logistic regression with these variables entered as predictors suggested that longest previous period of smoking abstinence partially mediated the relationship between length of alcohol abstinence at enrollment and smoking status at follow-up. Additional research is warranted to identify predictors of nicotine abstinence and smoking relapse in this population and to understand the factors that mediate the relationship between length of alcohol abstinence at enrollment and smoking outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A longitudinal analysis of unaided smoking cessation.

A sample of 153 smokers who attempted to quit smoking without treatment was followed for 2 years. Follow-up assessment occurred at 1 month, 4 months, 1 year, and 2 years postquit. A subsample of 69 individuals was also interviewed prior to their quit date. The majority of participants (77%) achieved at least 24 hr of abstinence by the 1-month follow-up. However, subsequent relapse rates were high: Only 13% of the sample was abstinent at 1 year, and 19% reported abstinence at the 2-year follow-up. Variables related to short-term outcome were generally unrelated to long-term outcome. Individuals who succeeded at initial cessation were more likely to be men and to be lighter smokers. Among those who initially quit, abstainers at 1 month were less likely to have participated in prior treatment, to report smokers among their friends, and to live with other smokers. At 2 years, abstainers were younger and had smoked for fewer years. The use of multiple strategies for cessation was associated with abstinence at the 2-year follow-up. A strong motivation to quit was found to be important for both initial success and long-term maintenance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relevance of cue reactivity to understanding alcohol and smoking relapse.

Several learning-based theories have been forwarded to account for the problem of drug relapse, including conditioned withdrawal, conditioned compensatory responding, appetitive motivational models, and social learning models. The various models are compared and evaluated against available evidence from studies with humans pertaining to alcohol and tobacco addiction. Studies that are reviewed focus primarily on the antecedents and consequences of alcohol and smoking relapse, as well as on reactions to cues that have been associated with prior drug ingestion, in an attempt to understand their motivational relevance. Problems in evaluating the various relapse models in humans are discussed. It is concluded that the appetitive model is better supported than the withdrawal model, and the compensatory model is least supported. Reactions to substance use stimuli may play an important role in alcohol and smoking relapse. Concepts drawn from the various theoretical models are linked tentatively in a schematic diagram of a hypothesized sequence of cognitive/affective, physiological, and behavioral events that lead to initial drug use after a period of abstinence (slip) and then to continued use (a relapse). The treatment implications of some of the cue reactivity models are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group counseling versus individualized relapse prevention aftercare following intensive outpatient treatment for cocaine dependence: Initial results.

Ninety-eight male cocaine-dependent patients who completed an intensive outpatient program (IOP) were randomly assigned to either standard group counseling (STND) or individualized relapse prevention (RP) aftercare. Heavier cocaine and alcohol use during IOP and low self-efficacy predicted more cocaine use during the treatment phase of the study, whereas lifetime diagnoses of alcohol dependence, major depression, and any anxiety disorder predicted less cocaine use. Rates of complete abstinence during the 6-month study period were higher in STND than RP, whereas RP was more effective in limiting the extent of cocaine use in those who used during Months 1-3. Matching analyses indicated patients who failed to achieve remission from cocaine dependence during IOP and those with a commitment to absolute abstinence did better in RP than in STND, whereas patients with other abstinence goals did better in STND than RP. Several differences in experiences before cocaine use and "near-miss" episodes were also identified. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Delay discounting predicts postpartum relapse to cigarette smoking among pregnant women.

Delay discounting (DD), a measure of impulsivity, describes the rate at which rewards lose value as the delay to their receipt increases. Greater discounting has been associated with cigarette smoking and various other types of drug abuse in recent research. The present study examined whether DD predicts treatment outcome among cigarette smokers. More specifically, the authors examined whether baseline discounting for hypothetical monetary rewards predicted smoking status at 24 weeks postpartum among women who discontinued smoking during pregnancy. Participants were 48 pregnant women (10.5 = 4.1 weeks gestational age at study entry) who participated in a clinical trial examining the use of incentives to prevent postpartum relapse. Several sociodemographic characteristics (being younger, being less educated, and reporting a history of depression) assessed at study entry were associated with increased baseline DD, but in multivariate analyses only DD predicted smoking status at 24 weeks postpartum. Greater baseline DD was a significant predictor of smoking status at 24 weeks postpartum. DD was reassessed periodically throughout the study and did not significantly change over time among those who eventually resumed smoking or those who sustained abstinence. The results extend the association of DD with risk for substance abuse to pregnant and recently postpartum cigarette smokers and demonstrate a significant relationship between DD and treatment outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of psychosocial and situational variables on substance abuse among homeless adults.

Finding direct and indirect influences of salient psychosocial and situational variables on problem substance use among homeless people is important in designing evidence-based, effective, and relevant interventions for this special population. A stress-coping paradigm in conjunction with situational items specialized for homeless people was used to explore predictive relationships in a sample of homeless adults (N = 664) among (a) psychosocial variables of self-esteem, social support, positive and negative coping, and emotional distress, (b) situational variables of homelessness history and quality of recent housing, and (c) outcomes of alcohol use, injection drug use (IDU), and non-IDU. Lower self-esteem predicted greater emotional distress, lower positive coping, greater negative coping, and more alcohol use. Social support predicted less emotional distress and more positive coping. Chronic homelessness predicted more emotional distress, less positive coping, greater alcohol use, and IDU. Poor housing was associated with more alcohol use and IDU. Substance abuse interventions among the homeless should have a dual focus that includes attention to psychological issues and negative coping patterns while also addressing situational, environmental factors, including encouraging provision of permanent supportive housing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Approach and avoidance coping responses among older problem and nonproblem drinkers": Clarification.

Reports a clarification in the article by R. H. Moos et al (Psychology and Aging, 1990[Mar], Vol 5[1], 31–40). The authors wish to note that research reported in the article by P. L. Brennan and R. H. Moos (see record 1991-10154-001) was based on the sample used in the research reported by Moos et al and that this information was inadvertently deleted in the Brennan and Moos article. (The following abstract of the article by Moos et al originally appeared in PA, Vol 77:14961.) The Coping Responses Inventory (CRI) was used to study coping among older problem and nonproblem drinkers. The CRI organizes coping efforts according to their focus (approach or avoidance) and method (cognitive or behavioral). Compared with nonproblem drinkers, older problem drinkers were more likely to use cognitive and behavioral avoidance responses to manage life stressors. Problem drinkers who experienced more negative life events and more severe stressors used both more approach and more avoidance coping. Those who had more financial and social resources relied more on approach and less on avoidance coping. Problem drinkers who relied more on avoidance coping tended to have more drinking problems and to report more depression and physical symptoms and less self-confidence. Positive reappraisal was associated with less depression and more self-confidence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personal and psychosocial risk factors for physical and mental health outcomes and course of depression among depressed patients.

This article focuses on personal and psychosocial factors to identify those that predict change in functioning and well-being and clinical course of depression in depressed outpatients over time. Data from 604 depressed patients in The Medical Outcomes Study showed improvements in measures of functioning and well-being associated with patients who were employed, drank less alcohol, and had active coping styles. Better clinical course of depression was associated with patients who had high levels of social support, who had more active and less avoidant coping styles, who were physically active, and who had fewer comorbid chronic conditions. Findings provide some guidance as to what can be done to improve depressed patients' levels of physical and mental health and affect the clinical course of depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive–behavioral treatment for depression in smoking cessation.

Cigarette smokers with past major depressive disorder (MDD) received 8 group sessions of standard, cognitive–behavioral smoking cessation treatment (ST; n?=?93) or standard, cognitive–behavioral smoking cessation treatment (ST) plus cognitive–behavioral treatment for depression (CBT-D; n?=?86). Although abstinence rates were high in both conditions (ST, 24.7%; CBT-D, 32.5%, at 1 year) for these nonpharmacological treatments, no main effect of treatment was found. However, secondary analyses revealed significant interactions between treatment condition and both recurrent depression history and heavy smoking (≥25 cigarettes a day) at baseline. Smokers with recurrent MDD and heavy smokers who received CBT-D were significantly more likely to be abstinent than those receiving ST (odds ratios?=?2.3 and 2.6, respectively). Results suggest that CBT-D provides specific benefits for some, but not all, smokers with a history of MDD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An Ecological Momentary Assessment of Relapse Crises in Dieting.

Much of the research on relapse crises in dieting has focused on isolated lapse events and relied heavily on retrospective self-report data. The present study sought to overcome these limitations by using ecological momentary assessment (EMA) techniques to examine situations of dietary temptation and lapse with a sample of obese, formerly sedentary, postmenopausal women (N = 37) during the final week of a weight-loss intervention. Mood was associated with reports of dietary lapse. Abstinence-violation effects were more strongly associated with dietary lapses than temptations. Finally, coping responses distinguished dietary temptations from lapses. Education on the factors associated with relapse crises in dieting may be imperative for weight loss success and maintenance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Which relapse criteria best predict the mortality risk of treated alcoholics?

We examined which relapse criteria best predict the mortality risk of treated male alcoholics. The subjects were 172 male alcoholics who had previously been hospitalized. Using three criteria which defined relapse as failure to maintain abstinence from alcohol, alcohol abuse, or dependence, the relapse of each subject had been evaluated during a previous 3-year outcome study. Relative mortality risks in the next 3 years classified by the three relapse criteria were compared. The follow-up rate was 93.6% and 31 subjects died. The age-corrected relative mortality risk for subjects failing to maintain abstinence compared with abstainers was 5.32, while the relative mortality risks for the group abusing alcohol and for the group suffering alcohol dependence were 2.23 and 2.56, respectively. These results suggest that relapse defined as failure to maintain abstinence predicts a higher relative mortality risk than do criteria defining in terms of alcohol abuse and alcohol dependence.     

Programmed therapeutic messages as a smoking treatment adjunct: Reducing the impact of negative affect.

Maintaining treatment gains remains a challenge to smoking cessation programs. Smokers prone to negative affect are most likely to relapse. In an effort to improve maintenance, a standard cognitive behavioral treatment was supplemented with the provision of computer-controlled audiotape players containing personalized therapeutic messages. Either the standard treatment alone or the standard treatment plus 2 months use of the tape player were provided to 41 smokers. No outcome difference was found between the 2 conditions during the 1-year follow-up. (The combined 1-year abstinence rate was 61%, with 34% continuously abstinent.) The frequency with which participants used the device predicted both posttreatment coping skill use and smoking rate. Most notable was an interaction between treatment condition and negative affect. Provision of the devices negated or reversed the usual association between negative affect and poorer outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)