Longitudinal changes in smoking abstinence symptoms and alternative reinforcers predict long-term smoking cessation outcomes

Robert A. Schnoll*, Brian Hitsman, Sonja Blazekovic, Anna Veluz-Wilkins, E. Paul Wileyto, Frank T. Leone, Janet E. Audrain-McGovern

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Background Transdermal nicotine, with behavioral counseling, is among the most popular approaches used to quit smoking. Yet, 6-month cessation rates rarely exceed 20–25%. Identifying factors associated with cessation success may help researchers and clinicians develop enhanced interventions that can improve quit rates. This study examined longitudinal changes in withdrawal, craving, depression and anxiety symptoms, and alternative reinforcers, from a baseline assessment to a 6-month outcome, as predictors of 6-month smoking cessation outcomes following 8 weeks of nicotine patch treatment and counseling. Methods A sample of 180 smokers, who completed an effectiveness trial that provided counseling and 8 weeks of 21 mg nicotine patches, was analyzed. Generalized estimating equations evaluated changes in withdrawal and craving, depression and anxiety symptoms, and alternative reinforcers over time, between participants who were smoking at 6-months and participants who were abstinent (confirmed with carbon monoxide) at 6-months. Multiple logistic regression assessed changes in these variables as predictors of relapse. Results Controlling for covariates associated with cessation (i.e., nicotine dependence, patch adherence, and rate of nicotine metabolism), participants who were abstinent at 6 months showed significantly lower craving and withdrawal and significantly higher substitute reinforcers from baseline to 6 months, vs. those who were smoking at 6 months (p < 0.001). An increase in craving predicted relapse to smoking (p < 0.05). Conclusions These results support continued efforts to strengthen interventions that reduce withdrawal and craving and the development of interventions to address alternative reinforcers in order to promote long-term smoking abstinence following nicotine patch treatment.

Original languageEnglish (US)
Pages (from-to)245-252
Number of pages8
JournalDrug and Alcohol Dependence
StatePublished - Aug 1 2016


  • Alternative reinforcers
  • Behavioral economics
  • Craving
  • Smoking
  • Withdrawal

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Pharmacology (medical)
  • Toxicology
  • Pharmacology


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