, Volume 226, Issue 1, pp 83–89 | Cite as

Urge to smoke over 52 weeks of abstinence

  • Michael UssherEmail author
  • Emma Beard
  • Gboyega Abikoye
  • Peter Hajek
  • Robert West
Original Investigation



Cigarette cravings are well documented during the first weeks of smoking abstinence. Treatments focus on helping smokers reduce these acute cravings. Cravings experienced later on are less well understood and may be important when considering treatment duration.


We conducted a longitudinal study of cravings over 52 weeks of smoking abstinence.


Cravings were operationalised as strength of, and time spent with, urges to smoke. These were assessed among 452 smokers quitting with behavioural support but without pharmacotherapies. Individuals maintaining abstinence were assessed at 1, 2, 3, 4, 26 and 52 weeks after quitting (n = 197, 156, 139, 131, 66 and 38, respectively). Abstinence was validated at each assessment by expired carbon monoxide. Time courses were plotted for those abstinent for 52 weeks and for those abstinent up to earlier time points. Correlations were examined between ratings of urges at consecutive time points.


Ratings of strength of urges to smoke followed an exponential decline over 52 weeks of abstinence, but 6 months after quitting 13 % of ex-smokers still reported strong urges. At 12 months, no ex-smokers reported strong urges, although 34 % reported some urges. Strength of urges to smoke after 1, 2, 3 and 4 weeks of abstinence predicted strength of urges at 6 months.


Strength of urges to smoke decline exponentially over time following smoking cessation, though some smokers report strong urges after 6 months of abstinence, and urges are still reported by a third of smokers after 12 months. Relapse prevention treatments may need to target prolonged craving.


Urges to smoke Cravings Time course Smoking abstinence 



This study was funded by the Wellcome Trust and Cancer Research UK. Dr. Ussher and Professors West and Hajek are members of the UK Centre for Tobacco Control Studies.

Conflict of interest

Professors West and Hajek undertake research and consultancy for companies that develop and manufacture smoking cessation medications. Professor West has a share of a patent in a novel nicotine delivery device. Dr. Beard has received conference funding from Pfizer. The remaining authors declare no conflict of interest.


  1. Baker TB, Breslau N, Covey L, Shiffman S (2012) DSM criteria for tobacco use disorder and tobacco withdrawal: a critique and proposed revisions for DSM-5. Addiction 107:263–275PubMedCrossRefGoogle Scholar
  2. Daughton DM, Fortmann SP, Glover ED, Hatsukami DK, Heatley SA, Lichtenstein E, Repsher L, Millatmal T, Killen JD, Nowak RT, Ullrich F, Patil KD, Rennard SI (1999) The smoking cessation efficacy of varying doses of nicotine patch delivery systems 4 to 5 years post-quit day. Prev Med 28:113–118PubMedCrossRefGoogle Scholar
  3. Fagerström K (2012) Determinants of tobacco use and renaming the FTND to the Fagerstrom Test for Cigarette Dependence. Nicotine Tob Res 14:75–78PubMedCrossRefGoogle Scholar
  4. Fletcher PD, Doll R (1969) A survey of doctors’ attitudes to smoking. Br J Prev Soc Med 23:145–153PubMedGoogle Scholar
  5. Gritz ER, Carr CR, Marcus AC (1991) The tobacco withdrawal syndrome in unaided quitters. Br J Addict 86:57–69PubMedCrossRefGoogle Scholar
  6. Heatherton TF, Kozlowski LT, Frecker RC, Fagerström KO (1991) The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire. Br J Addict 86:1119–1127PubMedCrossRefGoogle Scholar
  7. Hendricks PS, Ditre JW, Drobes DJ, Brandon TH (2006) The early time course of smoking withdrawal effects. Psychopharmacology 187:385–396PubMedCrossRefGoogle Scholar
  8. Henningfield JE, Shiffman S, Ferguson SG, Gritz ER (2009) Tobacco dependence and withdrawal: science base, challenges and opportunities for pharmacotherapy. Pharmacol Ther 123:1–16PubMedCrossRefGoogle Scholar
  9. Herd N, Borland R, Hyland A (2009) Predictors of smoking relapse by duration of abstinence: findings from the International Tobacco Control (ITC) Four Country Survey. Addiction 104:2088–2099PubMedCrossRefGoogle Scholar
  10. Hughes JR (1992) Tobacco withdrawal in self-quitters. J Consult Clin Psychol 60:689–697PubMedCrossRefGoogle Scholar
  11. Hughes JR (2007) Effects of abstinence from tobacco: valid symptoms and time course. Nicotine Tob Res 9:315–327PubMedCrossRefGoogle Scholar
  12. Hughes JR (2010) Craving among long-abstinent smokers: an Internet survey. Nicotine Tob Res 12:459–462PubMedCrossRefGoogle Scholar
  13. Hughes JR, Gust SW, Skoog K, Keenan R, Fenwick JW (1991) Symptoms of tobacco withdrawal: a replication and extension. Arch Gen Psychiatry 48:52–59PubMedCrossRefGoogle Scholar
  14. Hughes JR, Keely J, Naud S (2004) Shape of the relapse curve and long-term abstinence among untreated smokers. Addiction 99:29–38PubMedCrossRefGoogle Scholar
  15. Killen JD, Fortmann SP (1997) Craving is associated with smoking relapse: findings from three prospective studies. Exp Clin Psychopharmacol 5:137–142PubMedCrossRefGoogle Scholar
  16. McCarthy DE, Piasecki TM, Fiore MC, Baker TB (2006) Life before and after quitting smoking: an electronic diary study. J Abnorm Psychol 115:454–466PubMedCrossRefGoogle Scholar
  17. Piasecki TM, Fiore MC, Baker TB (1998) Profiles in discouragement: two studies of variability in the time course of smoking withdrawal symptoms. J Abnorm Psychol 107:238–251PubMedCrossRefGoogle Scholar
  18. Piasecki TM, Niaura R, Shadel WG, Abrams D, Goldstein M, Fiore MC, Baker TB (2000) Smoking withdrawal dynamics in unaided quitters. J Abnorm Psychol 109:74–86PubMedCrossRefGoogle Scholar
  19. Piasecki TM, Jorenby DE, Smith SS, Fiore MC, Baker TB (2003) Smoking withdrawal dynamics: II. Improved tests of withdrawal–relapse relations. J Abnorm Psychol 112:14–27PubMedCrossRefGoogle Scholar
  20. Sayette MA, Shiffman S, Tiffany ST, Niaura RS, Martin CS, Shadel WG (2000) The measurement of drug craving. Addiction 95(Suppl 2):S189–S210PubMedGoogle Scholar
  21. Shiffman S, Hickcox M, Paty JA, Gnys M, Kassel JD, Richards TJ (1996) Progression from a smoking lapse to relapse: prediction from abstinence violation effects, nicotine dependence, and lapse characteristics. J Consult Clin Psychol 64:993–1002PubMedCrossRefGoogle Scholar
  22. Shiffman S, Engberg JB, Paty JA, Perz WG, Gnys M, Kassel JD, Hickcox M (1997) A day at a time: predicting smoking lapse from daily urge. J Abnorm Psychol 106:104–116PubMedCrossRefGoogle Scholar
  23. Stapleton J (1998) Cigarette smoking prevalence, cessation and relapse. Stat Methods Med Res 7:187–203PubMedCrossRefGoogle Scholar
  24. Stead LF, Lancaster T (2005) Group behaviour therapy programmes for smoking cessation. Cochrane Database Syst Rev 2:CD001007PubMedGoogle Scholar
  25. Tomson T, Toftgård M, Gilljam H, Helgason AR (2006) Symptoms in smokers trying to quit. Tob Induc Dis 3:44–58CrossRefGoogle Scholar
  26. Tonstad S, Tønnesen P, Hajek P, Williams KE, Billing CB, Reeves KR (2006) Varenicline Phase 3 Study Group: effect of maintenance therapy with varenicline on smoking cessation: a randomized controlled trial. JAMA 296:64–71PubMedCrossRefGoogle Scholar
  27. West R, Hajek P (2004) Evaluation of the mood and physical symptoms scale (MPSS) to assess cigarette withdrawal. Psychopharmacology 177:195–199PubMedCrossRefGoogle Scholar
  28. West R, Russell M (1985) Pre-abstinence smoke intake and smoking motivation as predictors of severity of cigarette withdrawal symptoms. Psychopharmacology 87:334–336PubMedCrossRefGoogle Scholar
  29. West R, Ussher M (2009) Is the ten-item Questionnaire of Smoking Urges (QSU-brief) more sensitive to abstinence than shorter craving measures? Psychopharmacology 208:427–432PubMedCrossRefGoogle Scholar
  30. West R, Hajek P, Stead L, Stapleton J (2005) Outcome criteria in smoking cessation trials: proposal for a common standard. Addiction 100:299–303PubMedCrossRefGoogle Scholar
  31. West R, Ussher M, Evans M, Rashid M (2006) Assessing DSM-IV nicotine withdrawal symptoms: a comparison and evaluation of five different scales. Psychopharmacology 184:619–627PubMedCrossRefGoogle Scholar
  32. West R, May S, McEwen A, McRobbie H, Hajek P, Vangeli E (2010) A randomised trial of glucose tablets to aid smoking cessation. Psychopharmacology 207:631–635PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Michael Ussher
    • 1
    Email author
  • Emma Beard
    • 2
  • Gboyega Abikoye
    • 3
  • Peter Hajek
    • 4
  • Robert West
    • 2
  1. 1.Division of Population Health Sciences and EducationSt George’s University of LondonLondonUK
  2. 2.Department of Epidemiology and Public HealthUniversity College LondonLondonUK
  3. 3.Department of Clinical PsychologyNiger Delta UniversityWilberforce IslandNigeria
  4. 4.Psychology SectionBarts and The London School of Medicine and DentistryLondonUK

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