Craving Reduction and Smoking Outcomes in Psilocybin-Assisted and Standard Cessation Care.

OBJECTIVE: Smoking cessation outcomes are heterogeneous, and factors associated with these differences are not fully understood. We examined longitudinal smoking trajectories across distinct smoking profiles and evaluated whether early craving and affective symptom changes were associated with verified abstinence. METHODS: Participants in this observational cohort were classified as dependence-predominant or affective-predominant using measures of smoking severity and affective symptoms. Abstinence was defined as 7-day self-reported abstinence verified by exhaled CO <8 ppm. RESULTS: Psilocybin-assisted care was associated with greater smoking reduction at week 12 (β = 5.56, 95% CI 2.18-8.94, p = .001) and greater urge reductions at T1 (β = -3.26, 95% CI -5.31 to -1.21, p = .002) and T2 (β = -2.74, 95% CI -4.85 to -0.63, p = .011). Psilocybin-assisted care was not associated with abstinence after adjustment (OR = 1.82, 95% CI 0.68-4.86, p = .233). Early craving reduction was associated with the outcome (OR = 1.54, 95% CI 1.17-2.03, p = .002). CONCLUSIONS: Distinct patterns of change were observed across treatment pathways and smoking profiles, while early craving reduction was associated with abstinence. Future studies may clarify whether these profiles and early trajectories could help inform treatment stratification and individualized cessation strategies.