Consistency of subjective responses to imagery-induced tobacco craving over multiple sessions

The Role of Emotion Differentiation in the Association Between Momentary Affect and Tobacco/Nicotine Craving in Young Adults

INTRODUCTION

Tobacco/nicotine use is commonly initiated during adolescence or young adulthood, which increases the likelihood of continued use into adulthood and related adverse health outcomes. Despite interest in cessation, achieving and maintaining abstinence is difficult among this population. Cravings are often a barrier to abstinence, which have been associated with intensity of affect at the moment level. Emotion differentiation involves the ability to distinguish between discrete emotion states, and previous work suggests it may moderate the effect of momentary affect on craving, which has never been explored among young adults who are smoking or vaping nicotine.

AIMS AND METHODS

In a sample of young adults (N = 37, observations = 2020, ages 18-25, 51% female, and 78% white) interested in quitting smoking or vaping, we used real-time, naturalistic data capture via mobile phones to examine the interaction of momentary affect and trait emotion differentiation on nicotine craving. Participants were prompted with four surveys per day for 35 days and asked to make a 48-h quit attempt on day 7.

RESULTS

Multilevel models showed moments of higher-than-average momentary negative affect (NA; b = 0.39, p < .001), and positive affect (PA; b = 0.26, p = .001) were associated with greater levels of craving. NA emotion differentiation significantly moderated the associations between PA and craving (b = -0.63, p = .031) and NA and craving (b = -0.67, p = .003).

CONCLUSIONS

Findings from this exploratory analysis suggest that for young adults engaging in a nicotine quit attempt, greater ability to differentiate NA weakens the momentary association between intense affect and craving.

IMPLICATIONS

Results of this study show that the ability to differentiate between discrete emotional experiences may protect young adults against nicotine craving during moments of intense affective experience. These preliminary findings suggest that emotion differentiation, a modifiable construct, could be an important treatment target for individuals engaged in treatment for nicotine dependence.

Non-Alcoholic Beverage Cues as Specific Comparison Images to Alcohol Image Cues

BACKGROUND

Visual alcohol cues are often used to elicit craving (e.g., cue-reactivity), and selection of appropriate comparison cues is important to isolate the specific effect of craving for alcohol.

OBJECTIVES

In the current study, via the development of a new set of non-alcoholic beverage cues, we examine measurement and methodological choices in testing alcohol images for cue-reactivity studies.

METHODS

The current project combined two independent studies of hazardous (Study 1; n = 80) and recent drinkers (Study 2; n = 244) recruited from Amazon Mechanical Turk. Participants viewed either alcohol cues (Lovett, Ham, & Veilleux, 2015 ) or newly developed non-alcoholic beverage cues. We also randomly assigned people to rate the cues regarding motivational (e.g., affect, craving for alcohol, resistance to alcohol) responses or non-motivational features (e.g., artistry).

RESULTS

In Study 1, we included presentation of non-beverage objects, and found that beverages were rated as more positive, less negative and with higher craving than non-beverage objects. In the combined sample, we found that the alcohol beverage cues were associated with greater craving than non-alcoholic beverage cues, and that there were no differences between cue types on either positive or negative affect. We also found an interaction between drinking experience and cue type in predicting resistance to drinking.

CONCLUSIONS

We conclude that the choice of control cues in alcohol cue-reactivity studies is important, and that the currently developed non-alcoholic beverage cue set provides an adequate control for alcohol beverage cues for use in cue-reactivity paradigms.

Does Vaping in E-Cigarette Advertisements Affect Tobacco Smoking Urge, Intentions, and Perceptions in Daily, Intermittent, and Former Smokers?

Visual depictions of vaping in electronic cigarette advertisements may serve as smoking cues to smokers and former smokers, increasing urge to smoke and smoking behavior, and decreasing self-efficacy, attitudes, and intentions to quit or abstain. After assessing baseline urge to smoke, 301 daily smokers, 272 intermittent smokers, and 311 former smokers were randomly assigned to view three e-cigarette commercials with vaping visuals (the cue condition) or without vaping visuals (the no-cue condition), or to answer unrelated media use questions (the no-ad condition). Participants then answered a posttest questionnaire assessing the outcome variables of interest. Relative to other conditions, in the cue condition, daily smokers reported greater urge to smoke a tobacco cigarette and a marginally significantly greater incidence of actually smoking a tobacco cigarette during the experiment. Former smokers in the cue condition reported lower intentions to abstain from smoking than former smokers in other conditions. No significant differences emerged among intermittent smokers across conditions. These data suggest that visual depictions of vaping in e-cigarette commercials increase daily smokers' urge to smoke cigarettes and may lead to more actual smoking behavior. For former smokers, these cues in advertising may undermine abstinence efforts. Intermittent smokers did not appear to be reactive to these cues. A lack of significant differences between participants in the no-cue and no-ad conditions compared to the cue condition suggests that visual depictions of e-cigarettes and vaping function as smoking cues, and cue reactivity is the mechanism through which these effects were obtained.

Withdrawal Symptoms and Nicotine Dependence Severity Predict Virtual Reality Craving in Cigarette-Deprived Smokers

INTRODUCTION

Virtual reality (VR) has been shown to be effective in eliciting responses to nicotine cues in cigarette smokers. The primary aim of this study was to investigate whether cigarette-deprived smokers would exhibit increased craving and changes in heart rate when viewing cigarette related cues as compared to non-smoking cues in a VR environment, and the secondary aim was to assess the extent to which self-assessed measures of withdrawal and dependence correlated with VR craving.

METHODS

Nicotine-dependent cigarette smokers were recruited for a 2 day study. On Day 1, participants smoked as usual and on Day 2 were deprived from smoking overnight. On both days, participants completed self-assessment questionnaires on withdrawal, craving, and nicotine-dependence. Participants completed a VR session during the cigarette deprivation condition only (Day 2). During this session, they were exposed to active smoking and placebo (non-smoking) cues.

RESULTS

The data show that self-reported levels of "craving" (p < .01) and "thinking about cigarettes" (p < .0001) were significantly greater after exposure to the active cues versus non-smoking cues. Significant increases in heart rate were found for 3 of 4 active cues when compared to non-smoking cues (p < .05). Finally, significant positive correlations were found between self-reported craving prior to the VR session and craving induced by active VR cues (p < .01).

CONCLUSIONS

In this report, active VR cues elicited craving during cigarette deprivation. This is the first study to demonstrate that self-reported craving, withdrawal symptoms, and nicotine dependence severity predict cue-induced craving in the VR setting.

Interoceptive conditioning with nicotine using extinction and re-extinction to assess stimulus similarity with bupropion

Bupropion is an atypical antidepressant that increases long-term quit rates of tobacco smokers. A better understanding of the relation between nicotine and this first-line medication may provide insight into improving treatment. For all experiments, rats first had nicotine (0.4 mg base/kg) and saline session intermixed; intermittent access to sucrose only occurred on nicotine session. Nicotine in this protocol comes to differentially control "anticipatory" dipper entries. To more closely examine the overlap in the interoceptive stimulus effects of nicotine and bupropion, we assessed whether subsequent prolonged and repeated non-reinforced (extinction) sessions with the bupropion stimulus could weaken responding to nicotine (i.e., transfer of extinction). We also examined whether retraining the discrimination after initial extinction and then conducting extinction again (i.e., re-extinction) with bupropion would affect responding. We found that bupropion (20 and 30 mg/kg) fully substituted for the nicotine stimulus in repeated 20-min extinction sessions. The extent of substitution in extinction did not necessarily predict performance in the transfer test (e.g., nicotine responding unchanged after extinction with 20 mg/kg bupropion). Generalization of extinction back to nicotine was not seen with 20 mg/kg bupropion even after increasing the number of extinction session from 6 to 24. Finally, there was evidence that learning in the initial extinction phase was retained in the re-extinction phase for nicotine and bupropion. These findings indicate that learning involving the nicotine stimuli are complex and that assessment approach for stimulus similarity changes conclusions regarding substitution by bupropion. Further research will be needed to identify whether such differences may be related to different facets of nicotine dependence and/or its treatment.

Cue-induced cigarette craving and mixed emotions: a role for positive affect in the craving process

Craving is an important component of nicotine addiction, and extant research has demonstrated a clear link between cue-induced craving and negative affect, with mixed results in the positive affect domain. The current study was designed to test the idea that cue-reactive craving might be associated with a mixed emotional process, or the simultaneous experience of positive and negative affect. Participants were 86 non-deprived regular smokers and tobacco chippers who provided simultaneous ratings of positive and negative affect during cue exposure to pleasant, unpleasant, neutral and cigarette cues. Results indicated that self-reported craving was elevated in response to cigarette cues compared to other valenced cue types and craving was higher to pleasant cues than either neutral or unpleasant cues. Mixed emotional responses were higher to cigarette cues than other cue types. In addition, mixed emotional responses to cigarette cues predicted craving even after controlling for smoker type, difficulties regulating negative emotion, baseline craving level and mixed emotional responses to neutral cues. As the first study to investigate mixed emotions and cigarette craving, our results highlight the importance of examining the relationship between cue-reactive craving and emotional response using models of emotion that allow for measurement of nuanced emotional experience. In addition, our findings suggest that positive affect processes may indeed play a role in craving among non-deprived smokers.

A rodent "self-report" measure of methamphetamine craving? Rat ultrasonic vocalizations during methamphetamine self-administration, extinction, and reinstatement

Rats emit ultrasonic vocalizations (USVs) in a variety of contexts, and it is increasingly clear that USVs reflect more complex information than mere positive and negative affect states. We sought to examine USVs in a common model of addiction and relapse, the self-administration/reinstatement paradigm, in order to gain insight into subjective states experienced by rats during various types of methamphetamine seeking. We measured three subtypes of "50kHz" USVs [flats, trills, and non-trill frequency modulated (FM) USVs], as well as long and short duration "22kHz" USVs, during self-administration and extinction training, and during reinstatement elicited by cues, a methamphetamine prime, cues+prime, or the pharmacological stressor yohimbine. During self-administration and extinction, rats emitted many flats and FMs, (and short duration "22kHz" USVs on day 1 of self-administration), but few trills. In contrast, methamphetamine priming injections potently enhanced FMs and trills, and trill production was correlated with the degree of methamphetamine+cue-elicited reinstatement. Cues alone yielded increases only in flat USVs during reinstatement, though a subset of rats displaying strong cue-induced reinstatement also emitted long duration, aversion-related "22kHz" USVs. Although yohimbine administration caused reinstatement, it did not induce "22kHz" USVs in methamphetamine-experienced or methamphetamine-naïve rats (unlike footshock stress, which did induce long duration "22kHz" USVs). These findings demonstrate heterogeneity of rat USVs emitted during different types of methamphetamine seeking, and highlight their potential usefulness for gaining insight into the subjective states of rats in rodent models of drug addiction and relapse.

Visual Attention to Antismoking PSAs: Smoking Cues Versus Other Attention-Grabbing Features

This study examines how addicted smokers attend visually to smoking-related public service announcements (PSAs) in adults smokers. Smokers' onscreen visual fixation is an indicator of cognitive resources allocated to visual attention. Characteristic of individuals with addictive tendencies, smokers are expected to be appetitively activated by images of their addiction-specifically smoking cues. At the same time, these cues are embedded in messages that associate avoidance responses with these appetitive cues, potentially inducing avoidance of PSA processing. Findings suggest that segments of PSAs that contain smoking cues are processed similarly to segments that contain complex stimuli (operationalized in this case as high in information introduced) and that visual attention is aligned with smoking cues on the screen.

Prolonged duration of craving, mood, and autonomic responses elicited by cues and imagery in smokers: Effects of tobacco deprivation and sex

Increases in self-reported craving and changes in autonomic functioning are reliably elicited when smokers are exposed to tobacco-related stimuli compared with neutral stimuli. However, few studies have reported the time course of cue-elicited craving or have directly compared the effectiveness of smoking cues versus imagery to evoke a craving response. In addition to these two issues, we investigated the influence of tobacco deprivation and sex on craving, mood, and autonomic responses. Sixty cigarette smokers (30 men, 30 women) were tested in two counterbalanced sessions, one after overnight tobacco deprivation and one during ad libitum smoking. At each session, participants were exposed to four randomized experimental trials: smoking imagery, neutral imagery, smoking cues, and neutral cues. Tobacco craving and mood were assessed repeatedly and physiological measures were recorded continuously for 30 min after imagery or cue exposure. Compared with neutral trials, smoking cues and smoking imagery reliably increased tobacco craving, negative mood, heart rate, and blood pressure and decreased positive mood ratings. Changes were observed immediately after cue and imagery presentation and remained unchanged for 30 min. Responding was greater in the nondeprived condition, and cues elicited more robust responding than imagery for most measures. Women responded more robustly to smoking cues only in the nondeprived condition, whereas imagery evoked greater responses in men during both conditions. These findings provide new data on the time course, magnitude, and tobacco deprivation effects on elicited craving. Sex differences were dependent on stimulus type and deprivation condition.

Extinction with varenicline and nornicotine, but not ABT-418, weakens conditioned responding evoked by the interoceptive stimulus effects of nicotine

The interoceptive stimulus effects of nicotine acquire control over behavior. This observation, among others, suggests that the stimulus effects of nicotine are important in the development and tenacity of tobacco dependence. Despite this importance, there has been little research examining whether non-reinforced presentations (extinction) of a ligand that share stimulus effects of nicotine will weaken responding controlled by nicotine. Rats were trained to discriminate nicotine (0.4 mg/kg) from saline using a discriminated goal-tracking task in which nicotine signaled intermittent access to sucrose; sucrose was withheld on saline sessions. Experiment 1 examined substitution for nicotine by ABT-418, nornicotine, epibatidine, varenicline, or cytisine in 4-min extinction tests. Experiments 2-5 [low-dose nicotine (0.05 mg/kg), ABT-418, nornicotine, or varenicline, respectively] examined whether substitution for nicotine would persist if extinction tests were increased to 20 min and repeated daily for 6 days. Finally, generalization of this extinction back to the nicotine training stimulus was assessed. Full substitution in brief 4-min extinction tests was seen for ABT-418, nornicotine, epibatidine, varenicline, and cytisine. Low-dose nicotine, ABT-418, nornicotine, and varenicline, evoked only a partial 'nicotine-like' response in the first 20-min extinction test. With repeated extinction, only low-dose nicotine, nornicotine, and varenicline continued to substitute. Extinction with nornicotine and varenicline transferred back to nicotine as indicated by a partial conditioned response to the training stimulus. Interpretations regarding 'nicotine-like' effects of a ligand depend on the nature of the test. Understanding the processes mediating transfer of extinction learning with potential pharmacotherapies may reveal new treatment targets.

Clinical and laboratory assessment of the subjective experience of drug craving

Measures of subjective drug craving - often defined as the experience of an intense or compelling urge or desire - may be used to predict relapse, evaluate psychological and pharmacological treatments, and test theories of addiction and craving. This review summarizes both direct self-report questionnaires and indirect behavioral, physiological and reaction time measures designed to assess craving for alcohol, amphetamines, cocaine, heroin, marijuana, and tobacco. Multi-item questionnaires have typically been based on one of four underlying conceptualizations of addiction or craving (obsessive-compulsive, approach-avoidance, multi-dimensional, intensity-frequency-duration). Most multi-item self-report questionnaires have high internal consistency, correlate significantly with single-item craving ratings, and demonstrate several aspects of construct validity. Proposed indirect or proxy measures of craving include drug dreams, speed of drug consumption, willingness to work for drug access, selection of monetary rewards over drug access, psychophysiological reactivity, and attentional bias to drug cues. These proxy measures of craving are presumed to obviate self-report biases, to be less subject to conscious self-control, and to reflect craving which the person may not be able to articulate; however, there have been too few demonstrations of their validity and they have too many practical limitations to supplant self-report measures of craving at this time.

Reliability and validity of a Short Form of the Tobacco Craving Questionnaire

The Tobacco Craving Questionnaire (TCQ) is a valid and reliable 47-item self-report instrument that assesses tobacco craving in four dimensions: emotionality, expectancy, compulsivity, and purposefulness. For use in research and clinical settings, we constructed a 12-item version of the TCQ by selecting three items from each of the four factors that exhibited optimal within-factor reliability (Cronbach's alpha coefficient) and inter-item correlation. Smokers (N = 196) completed the TCQ-Short Form (TCQ-SF) after overnight tobacco deprivation and on a separate day during ad libitum smoking. Confirmatory factor analyses indicated acceptable model fit for a 4-factor model, with congruence coefficients suggesting high to very high similarity in factor patterns and magnitude of factor loadings between the TCQ and TCQ-SF in both conditions. Scores on each factor were significantly greater after tobacco deprivation than ad libitum smoking, were associated with measures of tobacco withdrawal, and varied with degree of nicotine dependence. Cronbach's alpha coefficients and average inter-item correlations were similar in both conditions and were consistent with reliability values obtained in the initial validation of the TCQ. Test-retest correlation coefficients were also similar to those found in a previous study. These findings suggest that the TCQ-SF is as valid and reliable as the 47-item TCQ in measuring tobacco craving.