Abstinence effects as predictors of 28-day relapse in smokers.

The present analysis sought to determine the relationship between abstinence effects in 64 ex-smokers (mean age = 41.1 years) and the rate at which they relapsed over 4 weeks of biochemically confirmed follow-up. This analysis focused on six abstinence effects that play a central role in the DSM-III-R and DSM IV definitions of withdrawal from nicotine: anger, depression, craving, appetite, confusion, and tension. Significant increases were observed for all six symptoms following cessation, and, with the exception of craving, substantial intercorrelations among the abstinence effects were noted. Cox proportional hazards survival models identified increases in anger, depressed mood, and craving to be significantly associated with a shorter time to relapse (all p < .03). Stepwise Cox proportional hazards survival analysis identified increases in depressed mood and craving as the most significant combination of abstinence effects in relation to time to relapse. A more stringent test of the potency of the relationship between these abstinence effects and time to relapse was conducted in which two other risk factors in this sample, method of quitting and education level, were also included in the model testing sequence. Even after adjustment for these significant risk factors, the increase in craving remained a significant predictor of a higher rate of relapse. This result suggests a robustness to this particular abstinence effect as a determinant of the speed with which ex-smokers relapse over a 1-month interval after cessation.