The below new study followed 63 quitters assigned to two different groups for 14 days but only examined relapses which occurred within the first 9 days . One group was encouraged to not lapse while the other was told to smoke two of their own brand of cigarettes at 48 hours. In that it only looked at the first nine days of quitting, the study's most important finding was the effect of smoking those two cigarettes on changes in craving. The study found that although lapse initially diminished cravings (as would be expected following nicotine replenishment) that thereafter episode craving within the lapse group esclated :
"Among participants in the lapse condition, the hazard of relapse was estimated to be 12 times higher (12.42, 95% CI [2.00, 77.1] .007) after experiencing an increase in craving than it was among participants in the control condition who experienced stable craving."
Here's two more quotes from the full text of the study:
[P]eriods of abstinence following a lapse are typically short-lived: nearly every smoker who lapses eventually relapses (Brandon, Tiffany, Obremski, & Baker, 1990; Chornock, Stitzer, Gross, & Leischow, 1992; Garvey, Bliss, Hitchcock, Heinold, & Rosner, 1992).
From the Discussion portion of the paper:
The results of the current study, in combination with the results of other experimental studies (Chornock et al., 1992; Juliano et al., 2006), firmly establish that lapse has a causal relationship to relapse in smokers. The current study goes beyond these previous studies in that it provides new information about mediating mechanisms that link smoking lapses to relapses. Compared with participants in the no-lapse condition, participants who were assigned to lapse experienced an initial acute decrease in craving followed by a significant surge in craving. The surges in craving experienced by those in the lapse condition, which were observed after controlling for their baseline craving levels, explained their faster rate of relapse relative to participants in the control condition.
The field of tobacco control has long struggled to understand why smoking lapses nearly always lead to relapses. As a result, cognitive– behavioral and pharmacological interventions have had little success in helping smokers to avoid relapse.
The final point above suggests the importance of treating lapse as relapse, versus conventional quitting wisdom which invites lapse/relapse by teaching quitters, "Don't be discouraged if you slip up and smoke one or two cigarettes. It's not a lost cause," "One cigarette is better than an entire pack, " "Understand that you've had a slip. You've had a small setback. This doesn't make you a smoker again, " and "Don't be too hard on yourself. One slip up doesn't make you a failure."
As Joel says, it's like telling an alcoholic not to let a sip now and then put you back to drinking or a heroin addict not to allow shooting up put you back to using. That's horrible advice. What this study adds to the knowledge base is what most of us already knew. That while most who lapse walk away from it thinking that they've gotten away with using just once, that their brain will soon be begging for more. There was always only one rule ... no nicotine today, never take another puff, dip or chew!
Breathe deep, hug hard, live long,
John - Gold x12
Lapse-induced surges in craving influence relapse in adult smokers: An experimental investigation
Health Psychology, 2011 May 16. [Epub ahead of print]
Shadel WG, Martino SC, Setodji C, Cervone D, Witkiewitz K, Beckjord EB, Scharf D, Shih R.
Abstract 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
= 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]).
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. [/size][/font]
PubMed Link: http://www.ncbi.nlm.nih.gov/pubmed/21574708