The urge to smoke depends on the expectation of smoking

Attentional Bias in Alcohol and Cannabis Use Disorder Outpatients as Indexed by an Odd-One-Out Visual Search Task: Evidence for Speeded Detection of Substance Cues but Not for Heightened Distraction

Current cognitive models of addiction imply that speeded detection and increased distraction from substance cues might both independently contribute to the persistence of addictive behavior. Speeded detection might lower the threshold for experiencing craving, whereas increased distraction might further increase the probability of entering a bias-craving-bias cycle, thereby lowering the threshold for repeated substance use. This study was designed to examine whether indeed both attentional processes are involved in substance use disorders. Both attentional processes were indexed by an Odd-One-Out visual search task in individuals diagnosed with alcohol use disorder (AUD; n = 63) and cannabis use disorder (CUD; n = 28). To test whether the detection and/or the distraction component are characteristic for AUD and CUD, their indices were compared with matched individuals without these diagnoses (respectively, n = 63 and n = 28). Individuals with CUD showed speeded detection of cannabis cues; the difference in detection between AUD and the comparison group remained inconclusive. Neither the AUD nor the CUD group showed more distraction than the comparison groups. The sample size of the CUD group was relatively small. In addition, participants made relatively many errors in the attentional bias (AB) task, which might have lowered its sensitivity to detect ABs. The current study provided no support for the proposed role of increased distraction in CUD and AUD. The findings did, however, provide support for the view that speeded detection might be involved in CUD. Although a similar trend was evident for AUD, the evidence was weak and remained therefore inconclusive.

Altered subcallosal and posterior cingulate cortex-based functional connectivity during smoking cue and mental simulation processing in smokers

BACKGROUND

Long-term cigarette smoking induces sensitization of incentive salience and conditioning of contextual cues which involves brain function alteration across multiple regions. Understanding how nicotine affects hub-based functional connectivities involved in affective and cognitive function can help us determine the treatment strategy for nicotine dependence.

METHOD

Functional MRI was conducted on 30 smokers and 30 non-smokers while mentally simulating neutral and smoking hand movements. Smoking cue and mental simulation processing-related changes in functional connectivity strengths of the subcallosal and posterior cingulate cortex (SCC and PCC) with major brain network nodes were examined.

RESULTS

Compared to non-smokers, smokers showed cue-induced SCC functional connectivities which were enhanced with the intraparietal sulcus and reduced with the medial prefrontal cortex. The PCC activation and functional connectivity enhancements with the anterior insula cortex and rostro-lateral prefrontal cortex was found during smoking mental simulation. The PCC-lateral prefrontal cortex functional connectivity correlated with nicotine dependence severity.

CONCLUSION

The present results demonstrate that smokers can be identified by cue-induced SCC functional connectivity strength decline and increment in the default mode and dorsal attention network nodes. However, nicotine dependence was associated with smoking mental simulation-related PCC-lateral prefrontal cortex functional connectivity strength, suggesting that the development of nicotine dependence may depend on the strength of coupling between the default mode network and the central executive network at the cognitive level.

The impact of nicotine dose and instructed dose on smokers' implicit attitudes to smoking cues: An ERP study

It is unclear whether nicotine and perceived nicotine exposure can influence automatic evaluations of cigarette stimuli. In the present study, we investigated the effects of nicotine dose and instructed dose on motivational responses to smoking cues. Forty overnight nicotine-deprived smokers completed an Implicit Association Test (IAT) at each of the four laboratory sessions in a balanced-placebo design that crossed nicotine dose (Given-NIC [given nicotine] vs. Given-DENIC [given denicotinized]) with instructed dose expectancy (Told-NIC [told-nicotine] vs. Told-DENIC. [told-denicotinized]). We measured participants' behavioral performance, including reaction time (RT) and accuracy rate, and the early posterior negativity (EPN) component using the event-related potential (ERP) technique to the target pictures. During congruent trials when the categorization condition was smoking or unpleasant, smokers had greater classification accuracy, shorter RT latency, and greater EPN amplitudes compared to the incongruent trials when the categorization condition was smoking or pleasant. The Given-NIC condition was associated with increased classification accuracy, longer RT latency, and decreased EPN amplitudes compared to the Given-DENIC condition. Similarly, the Told-NIC condition was associated with increased accuracy and decreased EPN amplitudes compared to the Told-DENIC condition, but with shorter RT latency. Cigarette-related pictures produced greater EPN amplitudes than neutral pictures. Both behavioral and ERP results suggest that smokers have negative implicit attitudes toward smoking. While both nicotine dose and expected dose facilitated stimulus categorization, there was no evidence that either factor altered smokers' negative attitudes toward smoking cues. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Getting a grip on cognitive flexibility

Cognitive flexibility refers to the ability to quickly reconfigure our mind, like when we switch between different tasks. This review highlights recent evidence showing that cognitive flexibility can be conditioned by simple incentives typically known to drive lower-level learning, such as stimulus-response associations. Cognitive flexibility can also become associated with, and triggered by, bottom-up contextual cues in our environment, including subliminal cues. Therefore, we suggest that the control functions that mediate cognitive flexibility are grounded in, and guided by, basic associative learning mechanisms, and abide by the same learning principles as more low-level forms of behavior. Such a learning perspective on cognitive flexibility offers new directions and important implications for further research, theory, and applications.

Effects of drugs of abuse on hippocampal plasticity and hippocampus-dependent learning and memory: contributions to development and maintenance of addiction

It has long been hypothesized that conditioning mechanisms play major roles in addiction. Specifically, the associations between rewarding properties of drugs of abuse and the drug context can contribute to future use and facilitate the transition from initial drug use into drug dependency. On the other hand, the self-medication hypothesis of drug abuse suggests that negative consequences of drug withdrawal result in relapse to drug use as an attempt to alleviate the negative symptoms. In this review, we explored these hypotheses and the involvement of the hippocampus in the development and maintenance of addiction to widely abused drugs such as cocaine, amphetamine, nicotine, alcohol, opiates, and cannabis. Studies suggest that initial exposure to stimulants (i.e., cocaine, nicotine, and amphetamine) and alcohol may enhance hippocampal function and, therefore, the formation of augmented drug-context associations that contribute to the development of addiction. In line with the self-medication hypothesis, withdrawal from stimulants, ethanol, and cannabis results in hippocampus-dependent learning and memory deficits, which suggest that an attempt to alleviate these deficits may contribute to relapse to drug use and maintenance of addiction. Interestingly, opiate withdrawal leads to enhancement of hippocampus-dependent learning and memory. Given that a conditioned aversion to drug context develops during opiate withdrawal, the cognitive enhancement in this case may result in the formation of an augmented association between withdrawal-induced aversion and withdrawal context. Therefore, individuals with opiate addiction may return to opiate use to avoid aversive symptoms triggered by the withdrawal context. Overall, the systematic examination of the role of the hippocampus in drug addiction may help to formulate a better understanding of addiction and underlying neural substrates.

Effects of varenicline on sympatho-vagal balance and cue reactivity during smoking withdrawal: a randomised placebo-controlled trial

Background

Varenicline is an effective smoking cessation medication. Some concern has been raised that its use may precipitate adverse cardiovascular events although no patho-physiological mechanism potentially underlying such an effect has been reported. The aim of this study was to test the hypothesis that varenicline impacts on sympatho-vagal balance during smoking withdrawal.

Methods

In this randomised, placebo-controlled trial, muscle sympathetic nerve activity (MSNA), baroreflex sensitivity (BRS), heart rate, and blood pressure were assessed in 17 smokers four weeks before a quit attempt (baseline) and again on the third day of that quit attempt (acute smoking withdrawal).

Results

Regarding the primary endpoint of our study, we did not find a significant effect of varenicline compared to placebo on changes in MSNA burst incidence between baseline and acute smoking withdrawal (−3.0 ± 3.3 vs.−3.9 ± 5.0 bursts/100 heart beats; p = 0.308). However, heart rate and systolic blood pressure significantly decreased in the placebo group only, while no significant changes in these parameters were observed in the varenicline group. Exposure to smoking cues during acute withdrawal lead to a significant increase of heart rate in the placebo group, while heart rate decreased in the varenicline group, and the difference in these changes was significant between groups (+2.7 ± 1.0 vs.−1.8 ± 0.5 1/min; p = 0.002). In all 17 participants combined, a significant increase in heart rate during smoking cue exposure was detected in subjects who relapsed in the course of six weeks after the quit date compared to those who stayed abstinent (+2.5 ± 1.2 vs.−1.1 ± 0.7; p = 0.018). Six-week abstinence rates were higher in the varenicline group compared to placebo (88 vs. 22 % p = 0.015).

Conclusion

We did not find evidence of adverse effects of varenicline on sympatho-vagal balance. Varenicline probably blunts the heart rate response to smoking cues, which may be linked to improved cessation outcome.

Attenuation of cue-induced reinstatement of nicotine seeking by URB597 through cannabinoid CB1 receptor in rats

RATIONALE

The endocannabinoid system is composed of endocannabinoids (such as anandamide), their target receptors (CB1 and CB2 receptors, CB1Rs and CB2Rs), the enzymes that degrade them (fatty-acid-amide-hydrolase (FAAH) for anandamide), and an endocannabinoid transporter. FAAH inhibition has been recently identified as having a critical involvement in behaviors related to nicotine addiction and has been shown to reduce the effect of nicotine on the mesolimbic dopaminergic system via CB1R and peroxisome proliferator-activated receptor alpha (PPARα). Thus, inhibition of FAAH may represent a novel strategy for smoking cessation, but its mechanism of action on relapse to nicotine seeking is still unknown.

OBJECTIVE

The study aims to explore the mechanism of action of the inhibitor of FAAH activity, URB597, on relapse to nicotine seeking by evaluating the effect of the CB1R, CB2R, and PPARα antagonists on the attenuating effect of URB597 on cue-induced reinstatement of nicotine seeking in rats.

RESULTS

URB597 reduced cue-induced reinstatement of nicotine seeking, an effect that was reversed by the CB1R antagonist rimonabant, but not by the CB2R or PPARα antagonists AM630 and MK886, respectively.

CONCLUSIONS

These results indicate that URB597 reduces cue-induced reinstatement in rats through a CB1 receptor-dependent mechanism, and not via CB2R or PPARα. Since FAAH inhibition represent a novel and promising strategy for tobacco smoking cessation, dissecting how it produces its action may lead to a better understanding of the neurobiological mechanisms underlying nicotine addiction.

In search of anticipatory cigarette cravings: The impact of perceived smoking opportunity and motivation to seek treatment

Craving has long been considered central to addiction, but it remains unclear just how it contributes to drug use or relapse. Improved understanding of its role in addiction requires a more fine-grained examination of craving, including the context in which it occurs. This study used a novel set of smoking-related and unrelated stimuli to investigate the responses of 227 nicotine-deprived smokers under conditions that manipulated perceived smoking opportunity and motivation to quit smoking. Specifically, we contrasted features of preconsumptive states when active smokers anticipate smoking soon to states when smokers do not have this expectation. Results indicated that under certain conditions (smokers not interested in quitting who expected to be able to smoke soon), exposure to smoking cues becomes attractive. Specifically, these smokers found smoking-related images to be more pleasant than did smokers who were either motivated to quit smoking within the next month or who were informed that they would not be permitted to smoke during the experiment. More broadly, the study raises the possibility that the loss of routinely experienced pleasant cravings upon quitting smoking may yield challenges to staying quit and requires greater clinical attention. (PsycINFO Database Record

Experimentally induced states of mind determine abstinent smokers' level of craving in reaction to smoking-cues

Introduction

The present study aims to contribute to our knowledge on the causes of variations in experienced craving of (ex)smokers. The general idea is tested that when (ex)smokers are exposed to a smoking-cue, their level of craving is determined by the momentary state of mind through which the smoking-cue is interpreted.

Methods

A cue-reactivity paradigm in temporary abstinent smokers is applied to trigger craving responses under different experimentally induced states of mind. Craving is assessed with a three-item self-report measure. In study 1 (N = 120) a self-affirmation procedure is applied right before abstinent smokers were exposed to their own smoking paraphernalia. In study 2 (N = 140) abstinent smokers received bogus feedback inducing a high or low self-efficacy and strong or weak positive outcome expectations.

Results

Study 1 showed a significant interaction: When involvement was high, self-affirmation increased the level of craving but when involvement was low self-affirmation lowered craving. Study 2 also showed a significant interaction: Only when the positive outcome expectation of smoking were high, self-efficacy lowered the level of craving. All analyses were controlled for the number of cigarettes smoked a day and number of past quit attempts.

Conclusions

The present studies provide experimental evidence that levels of craving can be determined by momentary states of mind. This theoretical perspective can be integrated in existing conditioning and social cognitive learning perspectives on craving and substance use.

Perceived smoking availability differentially affects mood and reaction time

INTRODUCTION

This between subjects study explored the relationship between smoking availability and smoking motivation and is the first study to include three smoking availability time points. This allowed for an examination of an extended period of smoking unavailability, and a test of the linearity of the relationships between smoking availability and smoking motivation measures.

METHODS

Ninety 3-hour abstinent smokers (mean ~15 cigarettes per day) were randomly assigned to one of three availability manipulations while being exposed to smoking stimuli (i.e., pack of cigarettes): smoke in 20 min, smoke in 3 h, or smoke in 24 h. Participants completed pre- and post-manipulation measures of urge, positive affect and negative affect, and simple reaction time.

RESULTS

The belief that smoking would next be available in 24 h resulted in a significant decrease in positive affect and increase in negative affect relative to the 3 h and 20 min conditions. A Lack of Fit test suggested a linear relationship between smoking availability and affect. A quadratic model appeared to be a better fit for the relationship between smoking availability and simple reaction time with participants in the 24 h and 20 min conditions showing a greater slowing of reaction time relative to the 3 h condition. There were no effects of the manipulations on self-reported urge, but baseline ceiling effects were noted.

CONCLUSIONS

Future investigations that manipulate three or more periods of time before smoking is available will help to better elucidate the nature of the relationship between smoking availability and smoking motivation.

Desire thinking as a mediator of the relationship between novelty seeking and craving

Background

The construct of craving has been shown to play a crucial role in the development and maintenance of addictive behaviors. Both novelty seeking and desire thinking have been identified, respectively, as important temperamental and cognitive predictors of craving.

Aims

In the present study we aimed to explore the relative contribution of novelty seeking and desire thinking towards craving, hypothesizing a sequence of multiple mediating relationships starting from novelty seeking and moving onto imaginal prefiguration, verbal perseveration and craving in serial fashion.

Method

A convenience sample of 270 individuals completed measures assessing novelty seeking, desire thinking, and craving relating to a chosen activity.

Results

Findings showed that, controlling for age and gender, desire thinking components predicted craving over and above novelty seeking. The indirect effect from novelty seeking to craving, via desire thinking components, was significant thus supporting a multiple-mediational sequence. Finally, the relationship between imaginal prefiguration and craving was found to be partially mediated by verbal perseveration.

Conclusions

The findings provide support for the conceptualization of desire thinking as an independent construct in predicting craving over and above novelty seeking.

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We examined the relationship between desire thinking, temperament and craving.

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Findings support a multiple mediational sequence from novelty seeking to craving.

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Desire thinking mediates the relationship between novelty seeking and craving.

The impact of anticipated and unanticipated smoking opportunities on cigarette smoking and nicotine lozenge responses

BACKGROUND

Perceptions regarding the availability of smoking opportunities are known to affect cigarette craving; however, whether they impact actual smoking or how smokers respond to acute nicotine replacement therapy (NRT) administration is not known. This study examined the impact of pharmacological and expectancy components of NRT administration on craving and smoking in smokers anticipating or not anticipating an imminent smoking opportunity.

METHODS

In total, 154 smokers (84 male) completed an experimental session in which instructions regarding the nicotine content of a lozenge (4 mg vs. no nicotine) and regarding the availability of a future smoking opportunity were manipulated. Cigarette craving was assessed before and after manipulations and lozenge administration. All participants were then allotted 1h to self-administer as many cigarette puffs as they wished.

RESULTS

Unanticipated smoking opportunities reduced latency to self-administration (p<0.001), regardless of nicotine expectancy or pharmacology. When analyses included all participants, nicotine reduced intentions to smoke (p=0.016) and withdrawal-related craving (p=0.043) regardless of expectancy. Conversely, analyses using only "believers" of the nicotine content instructions revealed that nicotine expectancy reduced intentions to smoke (p=0.034) and withdrawal-related craving (p=0.047) regardless of actual nicotine administration. "Believers" also reported increased withdrawal-related craving when a smoking opportunity was perceived to be imminent (p=0.041). These effects were not significant when analyses included all participants.

CONCLUSIONS

Findings suggest that unexpected smoking opportunities may be more appealing than expected ones regardless of perceived or actual acute NRT use. They also highlight the importance of reporting balanced placebo findings using all participants as well as "believers" only.

A hierarchical instrumental decision theory of nicotine dependence

It is important to characterize the learning processes governing tobacco-seeking in order to understand how best to treat this behavior. Most drug learning theories have adopted a Pavlovian framework wherein the conditioned response is the main motivational process. We favor instead a hierarchical instrumental decision account, wherein expectations about the instrumental contingency between voluntary tobacco-seeking and the receipt of nicotine reward determines the probability of executing this behavior. To support this view, we review titration and nicotine discrimination research showing that internal signals for deprivation/satiation modulate expectations about the current incentive value of smoking, thereby modulating the propensity of this behavior. We also review research on cue-reactivity which has shown that external smoking cues modulate expectations about the probability of the tobacco-seeking response being effective, thereby modulating the propensity of this behavior. Economic decision theory is then considered to elucidate how expectations about the value and probability of response-nicotine contingency are integrated to form an overall utility estimate for that option for comparison with qualitatively different, nonsubstitute reinforcers, to determine response selection. As an applied test for this hierarchical instrumental decision framework, we consider how well it accounts for individual liability to smoking uptake and perseveration, pharmacotherapy, cue-extinction therapies, and plain packaging. We conclude that the hierarchical instrumental account is successful in reconciling this broad range of phenomenon precisely because it accepts that multiple diverse sources of internal and external information must be integrated to shape the decision to smoke.

The effects of nicotine dose expectancy and motivationally relevant distracters on vigilance

The imminence of drug use (i.e., drug availability) has been found to be related to intensity of drug craving, but its effects on attentional bias to drug cues are unclear. This study investigated the effects of nicotine availability on attentional bias to smoking, affective, and neutral cues in a sample of adult smokers during a vigilance task. At the beginning of each of 4 laboratory sessions, overnight nicotine-deprived smokers (n = 51) were instructed that they would smoke a cigarette containing either nicotine (Told-NIC) or no nicotine (Told-DENIC) after completing the rapid visual information processing task with central emotional distracters (RVIP-CED). The RVIP-CED presented digits at a rapid pace, with participants instructed to respond with button presses to every third consecutive even or odd digit. Some digits were preceded by smoking, pleasant, unpleasant, or neutral distracter slides. During Told-NIC conditions, participants produced significantly longer reaction time (RT) latency than during Told-DENIC conditions. RT sensitivity (d'), a measure of the ability to discriminate true positives from false positives, was significantly lower during the Told-NIC than during the Told-DENIC conditions to targets following cigarette distracters. These results suggest that nicotine-deprived smokers expecting to imminently smoke a cigarette experience greater distraction, particularly to smoking-related stimuli, than when expecting to smoke a denicotinized cigarette.

Ecological momentary assessment of posttraumatic stress disorder symptoms during a smoking quit attempt

INTRODUCTION

Smokers with posttraumatic stress disorder (PTSD) tend to lapse more quickly following a quit attempt, which might be explained by changes in PTSD symptoms during a quit attempt. The present study examines changes in PTSD symptoms, negative affect, and craving before and during a quit attempt.

METHODS

Participants in this study were 52 smokers with PTSD who completed random-alarm ecological momentary assessments of PTSD symptoms, negative affect, cigarette craving, and smoking behavior throughout a prequit phase of ad hoc smoking, a phase of abstinence from smoking, and a postlapse phase.

RESULTS

Relative to the prequit phase, the abstinent phase was marked by decreases in PTSD reexperiencing, avoidance, and numbing clusters (ps ≤ .01). The odds of PTSD symptom or negative affect variability from one reading in the ecological momentary assessment (EMA)to the next reading was decreased in PTSD reexperiencing, avoidance, and numbing clusters (ps ≤ .02). Smoking cravings were also mildly decreased in the abstinent and postlapse phases (ps < .01), although some cravings in both phases were rated at the maximum intensity. Increased craving was predicted by the previous EMA reading of PTSD symptoms.

CONCLUSIONS

Results suggested that smoking abstinence is not associated with exacerbation of PTSD symptoms, but PTSD symptoms during abstinence were related to craving levels during the quit attempt.

Brief psycho-education affects circadian variability in nicotine craving during cessation

BACKGROUND

Nicotine cravings are a key target of smoking cessation interventions. Cravings demonstrate circadian variation during abstinence, often peaking during the morning and evening hours. Although some research has also shown diurnal variation in the efficacy of nicotine replacement medications, little research has examined how brief psychosocial interventions affect temporal patterns of craving during abstinence. The present study examined the impact of two brief psycho-education interventions on circadian variations in cravings during a 24-h period.

METHOD

176 adult smokers interested in quitting participated in two lab sessions. During the first session, participants received (a) mindfulness psycho-education that encouraged acceptance of cravings as a normal, tolerable part of quitting that people should not expect to perfectly control, (b) standard cessation psycho-education, or (c) no psycho-education. Half the sample initiated a cessation attempt the following day. Dependent variables were assessed using ecological momentary assessment (24-h of monitoring, immediately after first lab session) and questionnaires four days later.

RESULTS

Partially consistent with hypotheses, both forms of psycho-education were associated with differential diurnal variation in cravings during cessation. Relative to those receiving no psycho-education, standard smoking cessation psycho-education decreased morning cravings. Psycho-education encouraging acceptance of cravings was associated with lower craving in both the morning and evening, albeit only among successfully abstinent smokers.

CONCLUSIONS

Results demonstrate that brief non-pharmacological interventions can affect circadian craving patterns during smoking cessation. Further investigation of mechanisms of change and of the impact of psycho-education on cessation outcomes is warranted.

Facilitation of Voluntary Goal-Directed Action by Reward Cues

Reward-associated cues are known to influence motivation to approach both natural and man-made rewards, such as food and drugs. However, the mechanisms underlying these effects are not well understood. To model these processes in the laboratory with humans, we developed an appetitive Pavlovian-instrumental transfer procedure with a chocolate reward. We used a single unconstrained response that led to an actual rather than symbolic reward to assess the strength of reward motivation. Presentation of a chocolate-paired cue, but not an unpaired cue, markedly enhanced instrumental responding over a 30-s period. The same pattern was observed with 10-s and 30-s cues, showing that close cue-reward contiguity is not necessary for facilitation of reward-directed action. The results confirm that reward-related cues can instigate voluntary action to obtain that reward. The effectiveness of long-duration cues suggests that in clinical settings, attention should be directed to both proximal and distal cues for reward.

Smoking and opioid detoxification: behavioral changes and response to treatment

INTRODUCTION

The relevance of tobacco use in opioid addiction (OA) has generated a demand for available and more effective interventions. Thus, further analysis of less explored nicotine-opioid clinical interactions is warranted.

METHODS

A post-hoc analysis of OA participants in a double-blind, randomized very low dose naltrexone (VLNTX) inpatient detoxification trial evaluated measures of opioid withdrawal and tobacco use. Intreatment smokers were compared with nonsmokers, or smokers who were not allowed to smoke.

RESULTS

A total of 141 (81%) of 174 OA participants were smokers, all nicotine-dependent. Inpatient smoking was a predictor of opioid withdrawal discomfort. Intreatment smokers (n = 96) showed significantly higher opioid craving (F = 3.7, p < .001) and lower detoxification completion rate (χ(2) = 7.9, p < .02) compared with smokers who were not allowed to smoke (n = 45) or nonsmokers (n = 33). Smoking during treatment was associated with more elevated cigarette craving during detoxification (F = 4.1, p < .001) and a higher number of cigarettes smoked at follow-up (F = 3.6, p < .02). Among intreatment smokers, VLNTX addition to methadone taper was effective in easing opioid withdrawal and craving more than other treatments, whereas the combination VLNTX-clonidine was associated with significantly reduced cigarette craving and smoking during detoxification.

CONCLUSIONS

Failure to address tobacco use may negatively affect pharmacologically managed opioid discontinuation. Opioid detoxification may offer a window of opportunity to expand smoking cessation treatment, hence improving OA outcomes. The observed effects support testing of VLNTX-clonidine in smoking cessation trials among individuals with or without substance abuse.

Presentation of smoking-associated cues does not elicit dopamine release after one-hour smoking abstinence: A [11C]-(+)-PHNO PET study

The presentation of drug-associated cues has been shown to elicit craving and dopamine release in the striatum of drug-dependent individuals. Similarly, exposure to tobacco-associated cues induces craving and increases the propensity to relapse in tobacco- dependent smokers. However, whether exposure to tobacco-associated cues elicits dopamine release in the striatum of smokers remains to be investigated. We hypothesized that presentation of smoking-related cues compared to neutral cues would induce craving and elevation of intrasynaptic dopamine levels in subregions of the striatum and that the magnitude of dopamine release would be correlated with subjective levels of craving in briefly abstinent tobacco smokers. Eighteen participants underwent two [(11)C]-(+)-PHNO positron emission tomography (PET) scans after one-hour abstinence period: one during presentation of smoking-associated images and one during presentation of neutral images. Smoking cues significantly increased craving compared to neutral cues on one, but not all, craving measures; however, this increase in craving was not associated with overall significant differences in [(11)C]-(+)-PHNO binding potential (BPND) (an indirect measure of dopamine release) between the two experimental conditions in any of the brain regions of interest sampled. Our findings suggest that presentation of smoking cues does not elicit detectable (by PET) overall increases in dopamine in humans after one-hour nicotine abstinence. Future research should consider studying smoking cue-induced dopamine release at a longer abstinence period, since recent findings suggest the ability of smoking-related cues to induce craving is associated with a longer duration of smoking abstinence.

Dorsolateral prefrontal and orbitofrontal cortex interactions during self-control of cigarette craving

Drug-related cues induce craving, which may perpetuate drug use or trigger relapse in addicted individuals. Craving is also under the influence of other factors in daily life, such as drug availability and self-control. Neuroimaging studies using drug cue paradigms have shown frontal lobe involvement in this contextual influence on cue reactivity, but have not clarified how and which frontal area accounts for this phenomenon. We explored frontal lobe contributions to cue-induced drug craving under different intertemporal drug availability conditions by combining transcranial magnetic stimulation and functional magnetic resonance imaging in smokers. We hypothesized that the dorsolateral prefrontal cortex (DLPFC) regulates craving during changes in intertemporal availability. Subjective craving was greater when cigarettes were immediately available, and this effect was eliminated by transiently inactivating the DLPFC with transcranial magnetic stimulation. Functional magnetic resonance imaging demonstrated that the signal most proportional to subjective craving was located in the medial orbitofrontal cortex across all contexts, whereas the DLPFC most strongly encoded intertemporal availability information. The craving-related signal in the medial orbitofrontal cortex was attenuated by inactivation of the DLPFC, particularly when cigarettes were immediately available. Inactivation of the DLPFC also reduced craving-related signals in the anterior cingulate and ventral striatum, areas implicated in transforming value signals into action. These findings indicate that DLPFC builds up value signals based on knowledge of drug availability, and support a model wherein aberrant circuitry linking dorsolateral prefrontal and orbitofrontal cortices may underlie addiction.

A utilização dos jogos cooperativos no tratamento de dependentes de crack internados em uma unidade de desintoxicação

O objetivo deste estudo foi avaliar a efetividade dos jogos cooperativos no manejo do craving (fissura) e da ansiedade, bem como na motivação para a mudança do comportamento aditivo em dependentes de crack/cocaína internados em uma unidade de desintoxicação. Trata-se de um ensaio clínico do tipo quase-experimental, em que foram pesquisados 30 sujeitos, do sexo masculino, entre 18 e 50 anos, dependentes de crack/cocaína, distribuídos em oito grupos. Os instrumentos utilizados foram: ficha com dados sociodemográficos, mini-mental state examination, University of Rhode Island Change Assessment scale (URICA), Beck anxiety inventory (BAI) e escala analógica visual (EAV). Foram apresentadas imagens e vídeos da cocaína sob a forma de crack com o objetivo de induzir o craving nos participantes e, em seguida, foram aplicados a EAV, a URICA e o BAI. Após, foi realizada uma oficina de jogos cooperativos, sendo reaplicados os instrumentos. Foi encontrada diferença significativa no craving e sintomas de ansiedade a partir dos jogos cooperativos (p < 0,001), porém não houve alteração na motivação para mudança do comportamento aditivo. Conclui-se que os jogos cooperativos podem ser um importante instrumento no tratamento de dependentes de crack/cocaína.

Electrophysiological correlates of associative learning in smokers: a higher-order conditioning experiment

BACKGROUND

Classical conditioning has been suggested to play an important role in the development, maintenance, and relapse of tobacco smoking. Several studies have shown that initially neutral stimuli that are directly paired with smoking are able to elicit conditioned responses. However, there have been few human studies that demonstrate the contribution of higher-order conditioning to smoking addiction, although it is assumed that higher-order conditioning predominates learning in the outside world. In the present study a higher-order conditioning task was designed in which brain responses of smokers and non-smokers were conditioned by pairing smoking-related and neutral stimuli (CS1smoke and CS1neutral) with two geometrical figures (CS2smoke and CS2neutral). ERPs were recorded to all CSs.

RESULTS

Data showed that the geometrical figure that was paired with smoking stimuli elicited significantly larger P2 and P3 waves than the geometrical figure that was paired with neutral stimuli. During the first half of the experiment this effect was only present in smokers whereas non-smokers displayed no significant differences between both stimuli, indicating that neutral cues paired with motivationally relevant smoking-related stimuli gain more motivational significance even though they were never paired directly with smoking. These conclusions are underscored by self-reported evidence of enhanced second-order conditioning in smokers.

CONCLUSIONS

It can be concluded that smokers show associative learning for higher-order smoking-related stimuli. The present study directly shows the contribution of higher-order conditioning to smoking addiction and is the first to reveal its electrophysiological correlates. Although results are preliminary, they may help in understanding the etiology of smoking addiction and its persistence.

Smoking behavior in context: where and when do people smoke?

Cue-reactivity research in humans has primarily focused on proximal cues, but little is known about the role of distal cues, such as environments and situations, in cue-reactivity. The aim of this study was to get an overview of contexts in which people smoke and to assess the relationship between contexts and smoking urges. Moderately addicted Belgian smokers (N = 110) recorded each smoked cigarette during four days and described the place and situation and the feeling they experienced when starting to smoke. The data demonstrate that different contexts were related to differences in the amount of craving and enjoyment that was experienced. Finally, differences in (amount of) contexts could be predicted by the level of nicotine dependence. These results are relevant for conceptualizing and optimizing smoking addiction treatments.

O relaxamento respiratório no manejo do craving e dos sintomas de ansiedade em dependentes de crack

INTRODUÇÃO: O objetivo deste estudo foi verificar a efetividade do relaxamento respiratório no manejo do craving e dos sintomas de ansiedade em dependentes de crack internados para tratamento em uma unidade de desintoxicação. MÉTODO: Ensaio clínico do tipo quase-experimental de análise quantitativa. A amostra foi por conveniência, sendo composta por 32 homens dependentes de cocaína (crack). Eles tinham a cocaína como a droga de escolha e haviam utilizado esta substância por última vez entre 2 e 3 semanas antes do início do tratamento, conseguindo realizar a técnica do relaxamento respiratório adequadamente do ponto de vista biomecânico. Os instrumentos aplicados foram: Cocaine Craving Questionnaire-Brief (CCQB), escala analógica visual (EAV), Inventário Beck de ansiedade (BAI) e ficha com dados sociodemográficos e referentes ao padrão de consumo de substâncias psicoativas (FDS). Foi realizada uma intervenção em grupo na qual, inicialmente, foram aplicados o CCQB, a EAV e o BAI. Depois, foram apresentadas imagens relacionadas ao uso do crack e foram reaplicados os mesmos instrumentos. A seguir, foi realizado o relaxamento respiratório durante 10 minutos e foram aplicados, pela terceira vez, os instrumentos. Após esta intervenção, foi realizada uma entrevista individual com aplicação da FDS. RESULTADOS: Os resultados desta pesquisa demonstraram uma redução dos escores do CCQB, da EAV e do BAI pelo relaxamento respiratório em uma amostra cujo perfil corresponde ao padrão geral dos usuários de crack. CONCLUSÃO: Este estudo, apesar de ter algumas limitações metodológicas, sugere que o relaxamento respiratório pode ser uma estratégia efetiva no manejo do craving e dos sintomas de ansiedade em dependentes de crack.

Nicotine withdrawal disrupts new contextual learning

Interactions between nicotine and learning could contribute to nicotine addiction. Although previous research indicates that nicotine withdrawal disrupts contextual learning, the effects of nicotine withdrawal on contextual memories acquired before withdrawal are unknown. The present study investigated whether nicotine withdrawal disrupted recall of prior contextual memories by examining the effects of nicotine withdrawal on recall of nicotine conditioned place preference (CPP) and contextual fear conditioning. C57BL/6J mice trained in CPP exhibited a significant preference for an initially non-preferred chamber that was paired with 0.35 mg/kg nicotine. Following CPP, mice were implanted with mini-osmotic pumps containing 6.3 mg/kg/d nicotine or saline. Pumps were removed twelve days later and nicotine CPP was retested 24 h later. Mice withdrawn from chronic nicotine exhibited CPP, suggesting that older drug-context associations are not disrupted by nicotine withdrawal. One hour later, the same mice were trained in contextual and cued fear conditioning; nicotine withdrawal disrupted contextual but not cued fear conditioning. A subsequent experiment demonstrated that nicotine withdrawal did not disrupt recall of contextual or cued fear conditioning when acquisition occurred before nicotine withdrawal. These data suggest that nicotine withdrawal disrupts new contextual learning, but does not alter contextual learning that occurred before withdrawal.

The effect of a nicotine patch on cigarette craving over the course of the day: results from two randomized clinical trials

OBJECTIVES

The objective of this analysis was to assess the efficacy of a 21 mg/24-h nicotine patch for the reduction of craving throughout the waking day, compared both to placebo, and to a 15 mg/16-h patch differing pharmacokinetic profile over the day. The primary end-point was craving during the evening hours, because previous research suggested that smoking relapse was particularly likely at that time.

RESEARCH DESIGN AND METHODS

Data were drawn from two similar randomized clinical trials among nicotine-dependent smokers who were quitting smoking: Study 1 compared the 21 mg/24-h patch to a placebo patch, while Study 2 compared the 21 mg/24-h patch to a 15 mg/16-h nicotine patch. In both studies, subjects (Study 1: n = 102; Study 2: n = 244) were prompted by an electronic diary to rate their craving multiple times per day during a 1 week baseline period, and for up to 2 weeks after quitting. For analysis, the day was divided into five blocks: morning (up to 10:59 a.m.), mid-day (11:00 a.m.-1:59 p.m.), afternoon (2:00 p.m.-4:59 p.m.), evening (5:00 p.m.-8:59 p.m.), and late night (9:00 p.m. onwards). The individual craving ratings were divided into three intervals based on time since quitting: Days 1-3, 4-7, and 8-14.

RESULTS

The 21 mg/24-h nicotine patch resulted in significantly lower craving during all post-quit intervals, at each time of day, both compared to placebo (Study 1), and compared to the 15 mg/16-h nicotine patch (Study 2). Study 2 saw a significant treatment by interval interaction: in later time intervals, the difference in craving experience between 24- and 16-h patch conditions shrunk--while remaining significantly different--as overall levels of craving experienced by subjects in the two groups dropped. Adverse events reported in both studies tended to be mild and transient, consistent with the well characterized adverse event profile of nicotine patches.

CONCLUSIONS

Study 1 demonstrated that a 21 mg/24-h patch was effective in reducing craving throughout the day, including the evening period when relapse risk is heightened. A further study comparing the 21 mg/24-h patch to a 15 mg/16-h nicotine patch found that craving was significantly lower at all times of day for smokers using the 21 mg/24-h patch. The studies were limited in that craving was only monitored for the first 2 weeks of quitting (when craving is most prominent), and cannot elucidate the impact of patch use on craving outside of this time. Also, there was substantial attrition of the sample over time, partly due to relapse in all conditions.

The relevance and treatment of cue-induced cravings in tobacco dependence

Craving to smoke is often conceptualized and measured as a tonic, slowly changing state induced by abstinence. In this article, we review the literature on the existence, causes, and treatment of cue-induced cravings: intense, episodic cravings typically provoked by situational cues associated with drug use. In laboratory research, smokers exposed to smoking-related cues demonstrate increased craving as well as distinct patterns of brain activation. Observational field studies indicate that such cue-induced cravings are substantially responsible for relapse to smoking but that smoking can often be averted by coping responses. The effects of pharmacological interventions are mixed. Steady-state medications (bupropion, varenicline, nicotine patch) do not appear to protect smokers from cue-induced cravings. However, acutely administered nicotine medications (such as nicotine gum and lozenge), used after cue exposure as "rescue medications," can help a smoker's recovery from cue-induced cravings. Cue-induced craving plays an important role in smoking and relapse and likely in other addictions as well. Treatments to mitigate the effect of cue-induced craving are both important and needed.

Contextual renewal of nicotine seeking in rats and its suppression by the cannabinoid-1 receptor antagonist Rimonabant (SR141716A)

Nicotine-associated paraphernalia such as cigarettes and ashtrays are potent smoking relapse triggers. In addition to these discrete cues, environmental contexts previously associated with smoking elicit strong cigarette craving, indicating that contextual stimuli also contribute to high smoking relapse rates. Nonetheless, little is known about the precise role of these stimuli in smoking relapse and the neuropharmacological mechanisms implicated herein. To address this issue, we determined whether re-exposure to the nicotine self-administration context after long-term extinction reinstates nicotine seeking behavior in rats. Further, we examined the effects of SR141716A (Rimonabant), a selective cannabinoid CB1 receptor antagonist which has been shown to attenuate cue-induced relapse to nicotine seeking, on context-induced reinstatement of nicotine seeking. Rats were trained to self-administer nicotine intravenously (30microg/kg/infusion). Nicotine infusions were paired with an audiovisual compound stimulus. Subsequently, nose poking behavior was extinguished in the presence of this discrete cue in a context different from the self-administration context. Hereafter, rats were injected with 0, 1, or 3mg/kg Rimonabant (i.p.) prior to re-exposure to either the self-administration or the extinction context. Re-exposure to the self-administration context, but not to the extinction context robustly reinstated responding for the discrete nicotine cues, an effect that was dose-dependently attenuated by Rimonabant. This is the first demonstration of contextual renewal of nicotine seeking in rodents after prolonged withdrawal. Further, our results indicate that the endocannabinoid system is involved in context-induced relapse to nicotine seeking, and as such these data provide further evidence for the use of CB1 antagonists in smoking cessation.

Genetic variability in nicotinic acetylcholine receptors and nicotine addiction: converging evidence from human and animal research

Tobacco smoking is a leading preventable cause of death in the United States and produces a major health and economic burden. Although the majority of smokers want to quit, few are successful. These data highlight the need for additional research into the neurobiology of tobacco dependence. Addiction to nicotine, the main psychoactive component of tobacco, is influenced by multiple factors that include individual differences in genetic makeup. Twin studies have demonstrated that genetic factors can influence vulnerability to nicotine addiction, and subsequent research has identified genes that may alter sensitivity to nicotine. In humans, genome-wide and candidate gene association studies have demonstrated that genes encoding nicotinic acetylcholine receptor (nAChR) proteins are associated with multiple smoking phenotypes. Similarly, research in mice has provided evidence that naturally occurring variability in nAChR genes is associated with changes in nicotine sensitivity. Furthermore, the use of genetic knockout mice has allowed researchers to determine the nAChR genes that mediate the effects of nicotine, whereas research with knockin mice has demonstrated that changes to nAChR genes can dramatically alter nicotine sensitivity. This review will examine the genetic factors that alter susceptibility to nicotine addiction, with an emphasis on the genes that encode nAChR proteins.

Craving e dependência química: conceito, avaliação e tratamento

O craving ou fissura, cuja definição mais comum é o desejo intenso por uma substância, é um conceito controverso entre os pesquisadores da área da dependência química. OBJETIVO: Realizar revisão teórica a respeito do craving nos bancos de dados PsycInfo, Medline, ProQuest e Science Direct. MÉTODO: As palavras-chave utilizadas foram craving, dependence e drug e o período pesquisado foi entre 1995 e 2007. RESULTADOS: Os resultados demonstraram que são encontrados diversos significados para o craving, alguns se restringindo a desejo, e outros, considerando-o não só como desejo, mas como antecipação do resultado positivo do uso da substância, alívio dos sintomas de abstinência ou afeto negativo e intenção de fumar, o que reflete uma visão multidimensional deste construto. A etiologia do craving pode ser explicada por intermédio dos modelos: comportamental, cognitivo ou psicossocial e neurobiológico, porquanto a opção por um destes influencia a avaliação e o manejo. CONCLUSÃO: Conclui-se quanto à multidimensionalidade do craving e quanto à necessidade de que seja utilizado um modelo biopsicossocial que integre os diversos modelos no tratamento de dependentes químicos. Destaca-se a importância da realização de mais estudos para a compreensão do craving em função deste ser um dos principais riscos de recaída.

From the office to the pub: the role of smoking-relevant contexts and cue-elicited urge to smoke

The present study investigates how environmental contexts can affect cue-elicited urge to smoke. A total of 33 smokers were repeatedly presented with a cue predicting smoking and a cue predicting no smoking in one room and the effect of context change in a different room was assessed. Results endorsed earlier findings that a cue predicting smoking availability elicited more urge to smoke than a cue predicting smoking unavailability. Furthermore, this study shows that a context switch from a low smoking-relevant room to a high smoking-relevant room reduces the learned differential urge responding between the two availability cues. These findings are discussed in relation to the role that smoking-relevant contexts play in the generalization of differential urge responding after a context switch. Furthermore, implications for government policies on smoking and clinical issues are discussed.

The experience of women with advanced chronic obstructive pulmonary disease of repeatedly relapsing to smoking

Living with chronic obstructive pulmonary disease (COPD) a smoking-related disease and repeatedly relapsing to smoking is a complicated health problem, particularly for people expected to be at the peak of their productivity in life. As the prevalence of COPD among women is on the rise devoted attentiveness must be given to women's smoking. The purpose of this study is to illuminate the experience of women with COPD of repeatedly relapsing to smoking. The study draws on interpretive phenomenology. Seven women, aged 47-65 years, selected out of convenience, were interviewed twice, shortly after being hospitalized for an exacerbation of the disease. Data were analysed into themes emphasizing commonalities and differences in the lived experience. Results illustrate the intricacies between the lung disease, which controls life of participants on a very fundamental level and smoking cigarettes, which only augments the disease. Six not mutually exclusive themes emerged with one, being caught in a spider web, overarching. Other themes were: circumstances of the relapses, shame, the excuse, ambivalence and incomplete attempts to quit. The capacity of the women participating in this study to refrain from smoking was limited and they vacillated between wanting and not wanting to stop. This suggests that for women in similar situations an exhaustive and long-term nursing care is necessary for them to be able to come to terms with what they really aspire to and to stay with that decision.

Limbic activation to cigarette smoking cues independent of nicotine withdrawal: a perfusion fMRI study

Exposure to cigarette smoking cues can trigger physiological arousal and desire to smoke. The brain substrates of smoking cue-induced craving (CIC) are beginning to be elucidated; however, it has been difficult to study this state independent of the potential contributions of pharmacological withdrawal from nicotine. Pharmacological withdrawal itself may have substantial effects on brain activation to cues, either by obscuring or enhancing it, and as CIC is not reduced by nicotine replacement strategies, its neuro-anatomical substrates may differ. Thus, characterizing CIC is critical for developing effective interventions. This study used arterial spin-labeled (ASL) perfusion fMRI, and newly developed and highly appetitive, explicit smoking stimuli, to examine neural activity to cigarette CIC in an original experimental design that strongly minimizes contributions from pharmacological withdrawal. Twenty-one smokers (12 females) completed smoking and nonsmoking cue fMRI sessions. Craving self-reports were collected before and after each session. SPM2 software was employed to analyze data. Blood flow (perfusion) in a priori-selected regions was greater during exposure to smoking stimuli compared to nonsmoking stimuli (p<0.01; corrected) in ventral striatum, amygdala, orbitofrontal cortex, hippocampus, medial thalamus, and left insula. Perfusion positively correlated with intensity of cigarette CIC in both the dorsolateral prefrontal cortex (r2=0.54) and posterior cingulate (r2=0.53). This pattern of activation that includes the ventral striatum, a critical reward substrate, and the interconnected amygdala, cingulate and OFC, is consistent with decades of animal research on the neural correlates of conditioned drug reward.

Effect of impulsivity on craving and behavioral reactivity to smoking cues

INTRODUCTION

Nearly 25% of American adults remain regular smokers. Current smokers may be especially likely to possess characteristics that impair their ability to quit, such as impulsivity. Impulsive individuals may be overly prone to smoke because they are particularly drawn to rewarding stimuli and related cues. The aim of this study was to test the hypothesis that more impulsive smokers are more responsive to cigarette cues than other smokers.

MATERIALS AND METHODS

In a repeated measures design, 60 euthymic, adult smokers (50% female) were exposed to a smoking cue and a neutral cue in two experimental sessions. Cue reactivity was operationalized as changes in cigarette craving and preference for immediate vs delayed smoking after cue exposure.

RESULTS

Impulsivity predicted a heightened craving response to both cues but particularly the smoking cue (t [161] = 3.21, p = 0.002). Smokers with high levels of impulsivity exhibited a greater preference for immediate rewards over larger, delayed rewards in terms of both hypothetical (t [58] = 5.99, p = 0.001) and actual (z = 3.02, p = 0.003) rewards.

CONCLUSION

These data suggest that increased reactivity to environmental smoking cues contributes to the link between impulsivity and smoking.

Pavlovian conditioning of an approach bias in low-dependent smokers

RATIONALE

In the present study, it was investigated whether smokers can acquire a behavioural approach bias through Pavlovian conditioning.

OBJECTIVES

More specifically, it was tested whether pairing neutral stimuli with either smoking availability or unavailability would lead to both differential urge responding to these stimuli and a corresponding shift in approach bias.

MATERIALS AND METHODS

Thirty-nine low-dependent smokers performed a stimulus-response compatibility (SRC) task with which one can determine an approach bias. Next, participants received a conditioning session in which one cue (either a blue or yellow background screen colour) was paired with the opportunity to smoke (CS+) and another cue was paired with the absence of the opportunity to smoke (CS-). After conditioning, all participants again performed the SRC task.

RESULTS

Evidence for the conditioning of an approach bias but not smoking urges was found. This effect, although, was only apparent when smokers had been prompted to determine the contingency between the cues and smoking outcome.

CONCLUSIONS

It is concluded that one can differentially condition an approach bias in low-dependent smokers.

Reevaluating the nicotine delivery kinetics hypothesis

RATIONALE

The view of smoking as an addiction to nicotine implies that nicotine is an addictive drug and a primary reinforcer. However, nicotine other than in tobacco does not appear to be very rewarding for smokers. This potential anomaly to the nicotine addiction thesis is resolved by the proposition that the reward associated with smoking depends on "high-nicotine boli." According to the nicotine delivery kinetics hypothesis, smoked nicotine reaches the brain in 5-10 s in high concentrations, which provide reinforcing "hits" of nicotine to the brain.

OBJECTIVES

Because of its essential role in the nicotine addiction thesis, this review set out to examine the current empirical basis of the nicotine delivery kinetics hypothesis.

MATERIALS AND METHODS

We reviewed studies that bear on two questions: First, does nicotine from cigarettes reach the brain significantly faster than from other nicotine delivery devices? Second, is there a relationship between delivery kinetics and any rewarding effects of nicotine?

RESULTS

There is little empirical support for the nicotine delivery kinetics hypothesis. Several studies found that arterial nicotine levels associated with smoking are much lower than predicted by the nicotine delivery kinetics thesis and not higher than with other nicotine delivery devices. More importantly, comparisons of nicotine delivery devices with varying speeds of delivery do not suggest any correlation between nicotine delivery profile and subjective reward.

CONCLUSIONS

This review indicates that the wide endorsement of the nicotine delivery kinetics hypothesis is unjustified. Critical research is required to resolve the anomalies within the nicotine addiction theory of smoking.

Renewal of cue-elicited urge to smoke: Implications for cue exposure treatment

The effects of cue exposure therapy are limited, because renewal after extinction is an important source of relapse. In this study, 33 smokers were exposed to a cue predicting smoking availability and a cue predicting smoking unavailability in one context (acquisition context A). Following extinction in another context (extinction context B), a test for renewal took place in the original acquisition context A (i.e. ABA renewal). Urge to smoke was measured using a Visual Analogue Scale. Renewal of differential conditioned urge responding occurred when participants were tested in the acquisition context, while differential urge responding remained extinguished when tested in the extinction context. This experiment provides evidence that ABA renewal occurred in smokers. Clinical implications are discussed.

Reduction of abstinence-induced withdrawal and craving using high-dose nicotine replacement therapy

RATIONALE

Decreasing withdrawal and craving during smoking cessation is a major aim of cessation medications. Prior studies have shown that Nicotine Replacement Therapy (NRT) decreases withdrawal symptom severity but have relied on retrospective reports and lacked robust measures of baseline symptoms or symptoms during unmedicated abstinence.

OBJECTIVES AND METHODS

We tested the effect of high-dose (35 mg) nicotine patch on withdrawal and craving during abstinence using real-time assessment with electronic diaries during ad libitum smoking, a brief period of experimentally directed trial abstinence, and the first 3 days of cessation. Subjects were 324 smokers randomized to high-dose nicotine patches or placebo.

RESULTS

Treatment with active patches reduced withdrawal and craving during cessation and completely eliminated deprivation-related changes in affect or concentration.

CONCLUSION

High-dose NRT reduces withdrawal symptoms and craving and can eliminate some symptoms entirely.

Craving to smoke in orthodox Jewish smokers who abstain on the Sabbath: a comparison to a baseline and a forced abstinence workday

RATIONALE

Previous studies suggest that craving for cigarettes is substantially influenced by non-nicotine mechanisms such as habits, cues, and expectations. As orthodox Jews must refrain from smoking during the Sabbath, examining their craving levels during this habitual abstinence may be informative in separating smoking deprivation from other determinants of craving and withdrawal.

OBJECTIVE

To examine the extent to which the habitual abstinence of Orthodox Jews during the Sabbath is associated with craving to smoke and with other reactions to smoking abstinence.

METHODS

Twenty orthodox Jewish heavy smokers were assessed three times: on a workday when smoking as usual, on a Sabbath when they never smoke, and on a forced abstinence workday. Craving, irritability, and other commonly reported smoking withdrawal symptoms were assessed retrospectively at several time points during the preceding 24 h.

RESULTS

Craving to smoke, and to a lesser extent, irritability, was lower during the Sabbath than during the two other test days. Self-reported difficulty in abstaining was also lower on the Sabbath than on the workday. Craving in the evening preceding the test day was always significantly higher than in the next morning, despite the overnight abstinence before the morning assessment.

CONCLUSIONS

These results support previous findings in showing that craving to smoke is determined to a large extent by smoking-related habits, cues, and expectations.

Implicit and explicit attitudes toward smoking in a smoking and a nonsmoking setting

To test whether global smoking attitudes may be a driving factor in smoking behavior, Experiment 1 assessed smoking associations with the Implicit Association Test (IAT). Although smokers' attitudes (N=24) were less negative than those of nonsmokers (N=24), both displayed negative associations with smoking. To test whether these findings may be an artifact of measurement setting and/or the indirect measure that was used, Experiment 2 assessed attitudes in a smoking (N=20) or a nonsmoking setting (N=20) using the IAT and an Affective Simon Task. In both settings, negative attitudes emerged, suggesting that global (implicit) attitudes may be a moderating rather than a driving factor in smoking behavior.

Cocaine abuse in schizophrenic patients treated with olanzapine versus haloperidol

Comorbid cocaine abuse adversely affects clinical outcomes in schizophrenia. Using a prospective, randomized, parallel group design (N = 24), we tested the hypothesis that patients with schizophrenia treated with olanzapine have reduced cocaine craving and abuse compared with those treated with haloperidol. In addition, we examined whether this differential effect correlated with reductions in extrapyramidal symptoms, positive and negative symptoms, and/or depression. There were no significant differences overall in proportions of positive drug screens between treatment groups; no differences in positive, negative, or depressive symptoms; and few differences between treatment conditions in extrapyramidal symptoms. However, craving for cocaine was rated significantly lower by patients treated with haloperidol compared with patients treated with olanzapine. Important study limitations include a small sample size and high attrition rates. Larger controlled studies are necessary to determine optimal antipsychotic therapy for patients with schizophrenia and comorbid cocaine abuse.

Tobacco abstinence symptom suppression: the role played by the smoking-related stimuli that are delivered by denicotinized cigarettes

AIMS

Cigarette smoking causes cancer and disease, yet people find quitting difficult due to aversive symptoms that accompany tobacco abstinence. Understanding how to suppress these symptoms is critical in developing effective smoking cessation treatments. Pharmacologically, pure nicotine suppresses tobacco abstinence symptoms partially, and non-nicotine, smoking-related stimuli suppress these abstinence symptoms fully, at least for 24 hours. The current study was designed to clarify the impact of smoking-related stimuli on tobacco withdrawal, and to explore the duration of their ability to suppress withdrawal in smokers.

DESIGN

Three double-blind, within-subjects, Latin square-ordered, 5-day conditions in which participants smoked nicotinized, denicotinized or no cigarettes.

SETTING

Out-patient laboratory at Virginia Commonwealth University.

PARTICIPANTS

Thirteen women and 19 men.

MEASUREMENTS

Subjective, physiological and performance measures were collected daily and compliance with study conditions was verified objectively.

FINDINGS

Smoking-related stimuli are sufficient for suppressing some symptoms of tobacco abstinence over a 5-day period [i.e. Questionnaire of Smoking Urges (QSU) factor 1, 'Desire for sweets', 'Hunger' and 'Urges to smoke'], while in this study a combination of nicotine and smoking-related stimuli suppressed other symptoms (i.e. 'Difficulty concentrating', 'Increased eating', 'Restlessness' and 'Impatient').

CONCLUSIONS

These results indicate that, while some tobacco abstinence symptoms may be suppressed with nicotine, suppressing others may also require strategies that address the absence of smoking-related stimuli.

Context-dependency of cue-elicited urge to smoke

AIMS

Earlier studies have suggested that the cue-induced urge to smoke depends on the expectation of the availability of smoking. The present study investigated whether a 'room context' change could undo the learned discrimination between two stimuli, respectively, predicting smoking availability or smoking unavailability.

DESIGN

A 2 (smoking cue) x 2 (availability context cue) x 6 (trial) x 2 (room context change) within-subjects design was used. Participants were repeatedly presented with a context cue predicting smoking availability (blue serving tray) and a context cue predicting unavailability (yellow serving tray) in one room and tested for an effect of context change in a different room.

SETTING

Two distinct rooms located in different department buildings of Maastricht University.

PARTICIPANTS

Seventeen daily smokers who had smoked at least five cigarettes a day for at least 2 years.

MEASUREMENTS

Self-reported urge to smoke using a visual analogue scale (VAS).

FINDINGS AND CONCLUSIONS

Results replicated the finding that a context cue that predicted smoking elicited greater urges to smoke than a context cue that predicted no smoking, irrespective of the presence of smoking cues. In addition, this study showed that this differential effect on the urge to smoke was generalized to a context other than the context in which learning took place. These findings are discussed in relation to the significance of a context change regarding the predictive value of smoking availability.

Cue reactivity in smokers: the effects of perceived cigarette availability and gender

We examined the effects of perceived cigarette availability and gender on smoking cue reactivity. Smokers were exposed to smoking cues (smoking paraphernalia) and control cues whilst their subjective and physiological responses were measured. Perceived cigarette availability was manipulated on a between-subjects basis before cue exposure. Relative to control cues, smoking cues evoked increases in the level of skin conductance in all participants. Cigarette craving was also increased in the presence of smoking cues, but only in female participants. Perceived cigarette availability had no effect on these responses. Participants also showed salivary reactivity to smoking cues, with males showing a decrease in salivation, and females showing an increase, but only when cigarettes were perceived as unavailable. These results suggest that perceived cigarette availability may not influence craving and skin conductance reactivity to smoking cues in minimally dependent smokers who are not nicotine deprived. In addition, the present data suggest that there are important gender differences in craving reactivity to smoking cues.

A avaliação do craving em alcoolistas na síndrome de abstinência

O craving pode ser entendido como um desejo de utilizar uma substância. Este estudo pretende verificar características do craving em alcoolistas, nos primeiros três dias de abstinência, comparar sua intensidade com a do período de consumo do álcool e verificar se está associado com a gravidade do alcoolismo. A amostra foi de 77 homens alcoolistas, internados para desintoxicação. Foi utilizada a Escala de Avaliação do Craving e o Short-Form Alcohol Dependence Data. Destes sujeitos, 58,2 nunca sentiu vontade de utilizar bebidas alcoólicas nos três primeiros dias de abstinência. Quanto ao período antes da internação, 90,9 relatou apresentar craving, mais intenso durante essa fase de consumo do que na abstinência. Obteve-se correlação positiva entre o craving e a gravidade da dependência. Conhecer as características do craving de alcoolistas torna possível ampliar as técnicas de prevenção de recaída.