***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: The authors present results of a r and omized clinical trial of the efficacy of extended treatment with bupropion SR in producing longer term cigarette smoking cessation .  Adult smokers ( N = 362 ) received  open-label treatment  ( 11 weeks ) that combined relapse prevention training , bupropion SR , and nicotine patch followed by extended treatment ( 14 weeks ) with bupropion SR or matching placebo .  Abstinence percentages were relatively high ( week 11 : 52 % ; week 25 : bupropion , 42 % ; placebo , 38 % ; week 52 : bupropion , 33 % ; placebo , 34 % ) , but bupropion SR did not surpass placebo .  Gender and baseline craving level were identified as significant , independent moderators of treatment response . Men were more likely to abstain than women ( week 11 : 59 % vs. 43 % , p = .001 ; week 25 : 48 % vs. 31 % , p = .001 ; week 52 : 39 % vs. 27 % , p = .01 ) . Because most smokers suffer relapse with any current cessation treatment , the comparatively high abstinence percentages achieved in this trial are of interest The aims of the current study were to examine , prospect ively , ( a ) dynamic changes in affective state , self-efficacy , and urge in the hours before initial smoking and drinking lapses among individuals in concurrent alcohol and smoking treatment  , and ( b ) the extent to which self-efficacy , urge to use , and /or the use of one substance predicted lapse to the other substance . Ninety-six men and women recruited for a clinical trial of concurrent alcohol and tobacco treatment were eligible for inclusion . Only data from those who experienced an initial lapse to drinking ( n=29 ) or smoking ( n=32 ) were included . Two outpatient substance abuse clinics provided concurrent alcohol and smoking treatment on a weekly basis for three months .  Ecological Momentary Assessment ( EMA ) methods were employed over a 28-day monitoring period to assess antecedents to first drink , and a 14-day monitoring period was examined for initial smoking lapses . Baseline and EMA measures of positive and negative affect , alcohol/smoking urge , alcohol/smoking abstinence self-efficacy , nicotine withdrawal , and quantity/frequency of alcohol and tobacco use were examined as lapse predictors . Analyses of EMA ratings controlled for the corresponding baseline measure . Smoking lapse among individuals in concurrent alcohol and tobacco treatment  was foreshadowed by higher urges to smoke , lower positive mood , and lower confidence to resist smoking . Drinking lapse was preceded by lower confidence to resist smoking , but only among individuals who reported recent smoking . Concurrent alcohol and smoking treatment should focus on the enhancement of abstinence self-efficacy , positive mood , and the curbing of urges in order to offset lapse risk Rationale Research has demonstrated that psychosocial stressors increase smoking and risk for smoking relapse . Alterations in biological systems involved in the stress response caused by chronic smoking may contribute to early relapse . Objectives We examined the extent to which pituitary – adrenocortical and cardiovascular responses to stress following the first 24 h of a quit attempt predict early relapse . Methods Seventy-two smokers interested in cessation attended a laboratory stress session 24 h after the beginning of their cessation attempt .  Adrenocorticotropin ( ACTH ) , plasma and salivary cortisol concentrations , systolic and diastolic blood pressure ( BP ) , and heart rate ( HR ) responses to acute psychological stressors ( public speaking and cognitive challenges ) were used to predict relapse over a 4-week follow-up period . Results Those who relapsed within 4 weeks showed attenuated hormonal and cardiovascular responses to stress and exaggerated withdrawal symptoms . Cox proportional hazards survival analysis showed that attenuated ACTH , plasma cortisol , systolic and diastolic BP , positive affect , and exaggerated withdrawal symptoms and smoking urges during acute stress predicted early relapse . Stepwise model showed that ACTH , diastolic BP , and exaggerated withdrawal symptoms remain as significant predictors . When baseline smoking and psychological measures were included in the model , changes in ACTH , diastolic BP , and both factors of smoking urges remained significant predictors of relapse . Conclusions These results demonstrate that altered stress response predicts increased vulnerability for smoking relapse AIM The study aim ed to test simultaneously our underst and ing of the effects of bupropion sustained-release ( SR ) treatment on putative mediators and our underst and ing of determinants of post-quit abstinence , including withdrawal distress , cigarette craving , positive affect and subjective reactions to cigarettes smoked during a lapse . The specificity of bupropion SR effects was also tested in exploratory analyses . DESIGN Data from a r and omized , placebo-controlled clinical trial of bupropion SR were su bmi tted to mediation analyses . SETTING Center for Tobacco Research and Intervention , Madison , WI , USA . PARTICIPANTS A total of 403 adult , daily smokers without contraindications to bupropion SR use . INTERVENTION Participants were assigned r and omly to receive a 9-week course of bupropion SR or placebo pill and to receive eight brief individual counseling sessions or no counseling . MEASUREMENTS Ecological momentary assessment ratings of smoking behavior and putative mediators were collected pre- and post-quit . FINDINGS Results of structural equation and hierarchical linear models did not support the hypothesis that bupropion SR treatment improves short-term abstinence by reducing withdrawal distress or affecting the subjective effects of a lapse cigarette , but provided partial support for mediation by cigarette craving reduction and enhanced positive affect .  Bupropion SR effects on point-prevalence abstinence at 1 month post-quit were also mediated partially by enhanced motivation to quit and self-efficacy . CONCLUSIONS Results provided some support for models of bupropion SR treatment and relapse and suggested that motivational processes may partially account for bupropion SR efficacy Little is known about the role that smoking cues play in relapse after smoking cessation . Two studies examined the psychophysiologic , behavioral and cognitive reactions of Ss who participated in a smoking cue-exposure trial ( CUET ) .  Study 1 compared male relapsers , long-term quitters and nevers-mokers ( controls ) . Relapsers had significantly higher anxiety and urges to smoke than either quitters or controls . Relapsers also had greater heart-rate ( HR ) reactivity and were rated by judges as having less effective coping skills than controls . In Study 2 the CUET was tested prospect ively in a treatment outcome study for smoking cessation . Responses on the CUET at pre-treatment were related to smoking status at 6 months post-treatment . Prospect i ve quitters had significantly less HR reactivity during the CUET and reported less anxiety than the smokers . There was some lack of consistency across response modes in the results of Studies 1 and 2 . Taken together , the two studies suggest that reactivity to smoking cues may play a role in smoking relapse AIM To examine changes in nicotine withdrawal , nicotine craving , self-efficacy to quit smoking , and perceived control over withdrawal symptoms as predictors of smoking cessation following behavioral counseling and nicotine replacement therapy in a sample of smokers . DESIGN AND SETTING The data were ascertained from a r and omized effectiveness trial comparing nicotine patch to nicotine lozenge . Predictors of smoking cessation were assessed at baseline and 5 weeks post-baseline , and 24-hour point prevalence abstinence , biochemically confirmed , was assessed at the end-of-treatment ( week 15 ) and 6 months after a target quit date ( week 27 ) . PARTICIPANTS 642 treatment-seeking smokers r and omized to 12 weeks of nicotine patch or nicotine lozenge . FINDINGS Participants who showed a greater increase in self-efficacy to quit smoking ( OR=1.09 , 95 % CI : 1.02 - 1.16 , p=.01 ) and perceived control over withdrawal symptoms ( OR=1.02 , 95 % CI : 1.00 - 1.04 , p=.05 ) were significantly more likely to have quit smoking at week 15 . Participants who showed a greater increase in self-efficacy to quit smoking ( OR=1.04 , 95 % CI : 1.01 - 1.06 , p=.01 ) were significantly more likely to have quit smoking at week 27 . Changes in withdrawal symptoms and craving were not related to week 15 or week 27 abstinence rates . CONCLUSIONS The results highlight two relatively under-studied potential psychological predictors of abstinence following treatment for nicotine dependence . Behavioral counseling interventions to promote smoking cessation should help smokers develop confidence in their ability to quit smoking and increase their sense of control over withdrawal symptoms to increase their chances for cessation BACKGROUND Most ( > 50 % ) smokers who attempt to stop smoking relapse within the first year of abstinence . The effect of continued use of pharmacotherapy for smoking cessation on relapse rates is unknown . Bupropion sustained-release ( SR ) is the first non-nicotine-based therapy that is effective for achieving abstinence from smoking . OBJECTIVE This analysis explored the factors involved in relapse to smoking in patients who had successfully stopped smoking using bupropion SR .  These patients were participants in a double-blind , placebo-controlled trial of bupropion SR for the prevention of relapse to smoking . METHODS Participants who had stopped smoking with 7 weeks of open-label bupropion SR  were r and omly assigned to receive double-blind treatment with either bupropion SR or placebo for 45 weeks . The primary efficacy outcome of the main study was the rate of relapse to smoking . The analyses presented here examine the levels of reported cigarette craving and , in those participants who returned to smoking , the reasons associated with relapse , using patient-completed question naires . RESULTS Craving was cited most frequently as a factor contributing to relapse in those participants receiving placebo ( cited by 49.2 % of relapsers ) but significantly less frequently by participants receiving bupropion SR ( cited by 22.4 % of relapsers ) ( P < 0.05 ) . Results from patients ' diaries showed no differences between bupropion SR and placebo in terms of " craving in the past 24 hours " but significantly lower scores for " craving right now " for bupropion SR at weeks 11 and 12 ( P < 0.05 ) . Results at scheduled visits showed that " craving in the past 24 hours " was significantly less with bupropion SR compared with placebo at weeks 12 , 20 , and 48 , and " craving right now " was significantly less with bupropion SR compared with placebo at weeks 12 , 16 , 20 , 24 , 48 , and 52 ( P < 0.05 ) . CONCLUSIONS Craving continues to be a significant concern for individuals even after they have successfully stopped smoking . Bupropion SR appears to reduce reported cravings , which may contribute to the overall reduction in the rate of relapse observed with this pharmacotherapy BACKGROUND The suggested mechanism for the effects of nicotine replacement medications such as nicotine lozenges on smoking abstinence is reduction in the withdrawal symptoms of emotional distress and craving ( the subjective desire to smoke ) . OBJECTIVES This study assessed the effect of nicotine lozenges on affective withdrawal symptoms ( collectively termed emotional distress ) and craving over 6 weeks of treatment and the role of emotional distress and craving in mediating the effect of the lozenges on smoking abstinence . METHODS This was a secondary analysis of data from a r and omized , double-blind , placebo-controlled clinical trial of nicotine lozenges .  High-dependence smokers ( those who smoked their first cigarette of the day within 30 minutes of waking ) were assigned to receive the 4-mg lozenge ;  low-dependence smokers ( those who smoked their first cigarette of the day > 30 minutes after waking ) were assigned to receive the 2-mg lozenge .  Participants were r and omized to receive active or placebo lozenges within these dose and dependence strata . Smokers were to rate their withdrawal symptoms daily during the baseline week ( while still smoking ) and for 6 weeks after starting treatment . Study analyses included the effect of the active lozenge on affective symptoms ( ie , anxiety ; anger , irritability , or frustration ; difficulty concentrating ; restlessness ; and depressed mood ) during weeks 1 through 6 in high- and low-dependence smokers ; the prospect i ve associations between these symptoms and craving and subsequent abstinence ; and the mediating influence of these symptoms on the lozenge 's effect on abstinence . The analyses included smokers who provided symptom data for the baseline period and for at least week after the initiation of treatment . RESULTS Of 1,818 smokers enrolled in the original study , this analysis included data from 1,144 . The population was predominantly white , had a mean age ranging ranging from 40.65 to 46.01 years , and included slightly more women than men . The 2-mg lozenge did not have consistently significant effects on the withdrawal symptoms of emotional distress among low-dependence smokers ; however , in high-dependence smokers , the 4-mg 
    Output:
    
In general , the findings indicated ( a ) there were only a few cases of significant associations between craving collected as part of cue-reactivity studies and treatment outcome , ( b ) postquit craving was a stronger predictor of treatment outcome than prequit craving , and ( c ) several moderators likely influence the relationship between craving and cessation outcome .
The overall results suggest that craving is not a necessary condition of relapse .
In addition , inconsistent relationships between craving and treatment outcome call into question the value of craving as a target of treatment and underscore limitations in the prognostic utility of craving