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Tobacco Cravings Linger, Raising Relapse Odds

People Who Quit Smoking May Relapse Because of Cue-Induced Cravings
By
WebMD Health News
Reviewed by Laura J. Martin, MD

Sept. 15, 2010 -- Sights, sounds, smells, and other cues remind people who’ve quit smoking of their former habit and can lead to cigarette cravings. These cravings may actually increase over time, raising the odds of an eventual relapse, even after a long period of abstention, a new study finds.

Gillinder Bedi, DPsych, assistant professor of clinical psychology at Columbia University in New York, tells WebMD that she and colleagues enlisted 86 adults who smoked 10 or more cigarettes a day.

The participants were randomly placed in one of several groups. Some were paid to abstain for seven days, others 14 days, and others 35 days. Researchers verified their abstinence daily.

The Study Design

“For smoking cues, participants viewed 30 smoking-related photographs while holding a lit cigarette,” the authors write. “For neutral cues, participants viewed neutral pictures while holding a pencil cut to cigarette length, and a scented candle provided the neutral olfactory cue.”

After being exposed to cues of either kind, participants filled out a questionnaire to rate their degree of craving. About half of the original enrollees did not remain abstinent for the entire study period.

The smoking cues increased cravings as more time passed, Bedi tells WebMD, the same as in animal experiments.

“Humans have more choice, but it won’t break the habit,” she says. “We found that the longer people had been abstinent, the more their self-reported craving increased on standardized scales.”

Risk of Relapse

Bedi says the study indicates that “the incubation of craving phenomenon is real and robust,” a finding she says might be true for other drugs as well.

The study may surprise people who have quit and assume they are safe from relapse after time passes, she tells WebMD.

“They think everything is fine,” she says. “Then they see something that makes them crave after a prolonged period of not smoking. You remain susceptible. We know that lots of people relapse after long periods of time.”

Clinical Implications of Study

Bedi and her colleagues write that their findings “have significant clinical implications, suggesting that clinicians and users should be aware that risk of relapse precipitated by cue-induced craving may persist or increase with abstinence.”

Because a person’s environment is filled with cues that can trigger cravings, Bedi tells WebMD that the study has important implications for developing treatment strategies to help smokers understand their relapse risk and make them better able to cope with situations that make them want to smoke.

The study is published online in the journal Biological Psychiatry.

“People should be aware that even if they feel completely safe, some cue might trigger a craving,” she says.

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