Examining Bi-directional links between distinct affect states and tobacco lapse during a cessation attempt.

Abstract

Theoretical models of addiction highlight the bi-directional links of certain distinct affect states and tobacco lapse, but to date, few studies have examined bi-directional associations, instead examining associations with global affect measures (e.g., negative affect versus feelings of guilt). The present study examines bi-directional associations among 23 distinct affect states with individuals who tobacco lapse among use attempting to quit in an observational study. Participants (N288, 49 = 288, 49 % female, aged 19-73, 51 % White, 14 % Black, 10 % Hispanic) were provided tobacco quit support and nicotine replacement therapy. Participants completed ecological momentary assessments (EMA) 4x a day for 10 days post-quit. EMAs assessed affect and lapse in near real-time. Multilevel models tested affect at time t predicting lapse between time t and t + 1, and lapse reported at time t predicting affect at time t + 1. Adjusting for covariates, results suggested that at the between-person level, pride was associated with lower odds of lapse, whereas guilt was associated with higher odds of lapse. At the within-person level, disgust and shame were associated with higher odds of lapse. Results also suggested that lapsing was associated with increased feelings of guilt, shame, and enthusiasm, and decreased feelings of sadness. Results are generally consistent with the abstinence violation effects, suggesting that addiction to tobacco is facilitated by cycles of guilt and shame. Results further this line of research by suggesting that alleviation of sadness and promotion of enthusiasm may serve to maintain addiction, and that pride may be a promising avenue to promote resilience against lapse.