Teasing Out the Role of Cues and Smoking Addiction

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In smoking cessation treatment, diagnosticians are interested in what are known as “smoking cues” so they can blunt these sources of stimulation of the unwanted behavior. Cues (also called triggers) differ by smoker, but some common ones are (from the Mayo Clinic):

  • Certain times of the day, such as with morning coffee or during breaks at work
  • After a meal
  • Drinking alcohol
  • Certain places or friends
  • Talking on the phone
  • Stressful situations or when you're feeling down
  • The smell of a burning cigarette
  • Driving your car

These cues trigger a heightened craving and represent one of the most difficult challenges to those attempting to quit smoking. A recently published article in the journal Addiction introduces an important feature of cues – they matter a great deal to some patients, but not much for others. And this difference can and should drive the types of treatment offered.

The example given compares a final craving score of 70 (out of a possible 100) between two types of smokers. One may suffer a “background” craving, due to abstinence alone, of 60 and a rise to 70 when a cue is present. A second type of smoker may only have an abstinence based craving of 10, but is very susceptible to triggers and then rises to a level of 70 when a cue is present.

Because the smokers both report a maximum craving of 70, this nuance may not be noticed and targeted for treatment. However, the first smoker wouldn’t benefit much from preventing trigger-induced craving – their background rate is high already. The second patient (the one with a background craving at 10) would benefit greatly by learning not to respond to cues.

In other words, teasing out the different types of cravings has a clinical value when determining treatment.

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