Abstract
AimsTemperament and impulsivity are powerful predictors of addiction treatment outcomes. However, a comprehensive assessment of these features has not been examined in relation to smoking cessation outcomes.MethodsNaturalistic prospective study. Treatment-seeking smokers (n = 140) were recruited as they engaged in an occupational health clinic providing smoking cessation treatment between 2009 and 2013. Participants were assessed at baseline with measures of temperament (Temperament and Character Inventory), trait impulsivity (Barratt Impulsivity Scale), and cognitive impulsivity (Go/No Go, Delay Discounting and Iowa Gambling Task). The outcome measure was treatment status, coded as “dropout” versus “relapse” versus “abstinence” at 3, 6, and 12 months endpoints. Participants were telephonically contacted and reminded of follow-up face to face assessments at each endpoint. The participants that failed to answer the phone calls or self-reported discontinuation of treatment and failed to attend the upcoming follow-up session were coded as dropouts. The participants that self-reported continuing treatment, and successfully attended the upcoming follow-up session were coded as either “relapse” or “abstinence”, based on the results of smoking behavior self-reports cross-validated with co-oximetry hemoglobin levels. Multinomial regression models were conducted to test whether temperament and impulsivity measures predicted dropout and relapse relative to abstinence outcomes.ResultsHigher scores on temperament dimensions of novelty seeking and reward dependence predicted poorer retention across endpoints, whereas only higher scores on persistence predicted greater relapse. Higher scores on the trait dimension of non-planning impulsivity but not performance on cognitive impulsivity predicted poorer retention. Higher non-planning impulsivity and poorer performance in the Iowa Gambling Task predicted greater relapse at 3 and 6 months and 6 months respectively.ConclusionTemperament measures, and specifically novelty seeking and reward dependence, predict smoking cessation treatment retention, whereas persistence, non-planning impulsivity and poor decision-making predict smoking relapse.
Highlights
An outstanding challenge for smoking cessation interventions is the detection of individual differences associated with poor treatment outcomes, especially in relation with long-term relapse [1, 2]
At the 3-month follow-up (n5140), 32 participants had dropped out from treatment, 27 participants had relapsed during treatment, and 81 participants had maintained abstinence during treatment
At the 6-month follow-up (n5123), 30 participants had dropped out from treatment, 37 participants had relapsed during treatment, and 56 participants had maintained abstinence during treatment
Summary
An outstanding challenge for smoking cessation interventions is the detection of individual differences associated with poor treatment outcomes, especially in relation with long-term relapse [1, 2]. Higher levels of novelty seeking associate with lower abstinence rates at mid-term (2 to 6 months) and long-term (12 months) follow-ups [6, 7]. This association is at least partly explained by poorer treatment retention in high novelty seekers [7]. Several studies have shown that separate aspects of trait and cognitive impulsivity are significantly associated with smoking cessation outcomes. Higher levels of trait impulsivity associate with short-term and mid-term smoking relapse (i.e., 1 week and 3 months respectively) [12, 13]. No studies to date have thoroughly mapped the link between the multimodal (i.e., trait and cognitive) and multifaceted (i.e., separate dimensions of trait and cognitive) aspects of impulsivity and smoking cessation outcomes
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