An understanding of the relationships selleck compound between craving and outcome is also clinically relevant. Craving is widespread among smokers (Tiffany et al., 2009), cited as an obstacle to initiating a quit attempt (Orleans, Rimer, Cristinzio, Keintz, & Fleisher, 1991), and experienced long after successful cessation (Hughes, 2010). Determining the extent of the relationships between craving and smoking relapse has important implications for focusing on craving in intervention efforts. Both pharmacological- and psychosocial-based interventions are commonly portrayed as effective because they target craving; however, the hypothesis that craving reduction influences subsequent treatment status is rarely tested explicitly (for exceptions, see Ferguson, Shiffman, & Gwaltney, 2006; McCarthy et al., 2008).

There are several examples of strong assertions in the tobacco literature about the relationship between craving and smoking cessation outcome. These range from statements that there is a well-documented relationship between craving and outcome to those that deny this association. Some authors have focused on the instances in which craving appears to be linked with treatment outcome, making claims such as, ��Craving is the most unpleasant consequence of smoking cessation and also the most frequent cause of relapse�� (Durcan et al., 2002, p. 548; for other examples, see Bagot, Heishman, & Moolchan, 2007; Businelle et al., 2010; Shiffman, Ferguson, Gwaltney, Balabanis, & Shadel, 2006; Waters et al., 2004).

Others have drawn attention to studies that fail to find evidence for this relationship and conclude that ��craving is a poor predictor of relapse�� (Witkiewitz & Marlatt, 2004, p. 227; for other examples, see Bailey, Hammer, Bryson, Schatzberg, & Killen, 2010; Drummond, Litten, Lowman, & Hunt, 2000). The conflicting accounts describing this relationship may be driven by a lack of consistent findings across studies. If this is the case, a host of factors related to the variables Entinostat being measured and the conditions and timing of assessment could be responsible for divergent study results. Such factors might include the time relative to quitting that craving is measured (e.g., prequit vs. postquit), the assessment tool used to measure craving, and the timeframe over which outcome is assessed. An additional consideration when examining possible moderators of the relationship between craving and cessation outcome concerns the type of craving being measured. Craving can be manifest in two primary ways. First, general levels of craving, which can fluctuate relatively slowly over the course of a day, are likely related to the level of deprivation that increases over the interval between cigarettes (Schuh & Stitzer, 1995).