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Young CC, Papini S, Minami H, Morikawa H, Otto MW, Roache JD, Smits JAJ. Isradipine augmentation of virtual reality cue exposure therapy for tobacco craving: a triple-blind randomized controlled trial. Neuropsychopharmacology 2024:10.1038/s41386-024-01872-9. [PMID: 38789642 DOI: 10.1038/s41386-024-01872-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/10/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024]
Abstract
Preclinical research with rodents suggests that the L-type calcium channel blocker isradipine can enhance long-term extinction of conditioned place preference for addictive substances when it is administered in conjunction with extinction training. Although isradipine alone, which is FDA-approved for hypertension, has not shown a direct effect on craving in human drug users, its potential to augment behavioral treatments designed to reduce craving remains unknown. We conducted a triple-blind, randomized placebo-controlled pilot clinical trial of isradipine combined with a novel virtual reality cue exposure therapy (VR-CET) approach with multimodal cues that targeted craving. After 24 hours of abstinence, 78 adults with an ongoing history of daily cigarette use received isradipine (n = 40) or placebo (n = 38) and reported craving levels after each of 10 trials of VR-CET. Consistent with pre-registered hypotheses, the isradipine group had significantly lower mean craving across cue exposure trials at the medication-free 24-hour follow-up (d = -0.42, p = 0.046). There were no serious adverse events; however, side effects such as headache and dizziness occurred more frequently in the isradipine group. The findings of the current study support follow-up clinical trials that specifically test the efficacy of isradipine-augmented VR-CET for reducing smoking relapse rates after an initial quit attempt. clinicaltrials.gov: NCT03083353.
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Affiliation(s)
- Cara C Young
- School of Nursing, The University of Texas at Austin, Austin, TX, USA.
| | - Santiago Papini
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Haruka Minami
- Department of Psychology, Fordham University, New York, NY, USA
| | - Hitoshi Morikawa
- Department of Neuroscience and Waggoner Center for Alcohol and Addiction Research, The University of Texas at Austin, Austin, TX, USA
| | - Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - John D Roache
- Division of Alcohol & Drug Addiction, Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center, San Antonio, TX, USA
| | - Jasper A J Smits
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, Austin, TX, USA
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2
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Malbos E, Borwell B, Einig-Iscain M, Korchia T, Cantalupi R, Boyer L, Lancon C. Virtual reality cue exposure therapy for tobacco relapse prevention: a comparative study with standard intervention. Psychol Med 2023; 53:5070-5080. [PMID: 35924727 PMCID: PMC10476066 DOI: 10.1017/s0033291722002070] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/16/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Successful interventions have been developed for smoking cessation although the success of smoking relapse prevention protocols has been limited. Cognitive behavioural therapy (CBT) in particular has been hampered by a high relapse rate. Because relapse can be due to conditions associated with tobacco consumption (such as drinking in bars with friends), virtual reality cue exposure therapy (VRCE) can be a potential tool to generate 3D interactive environments that simulate risk situations for relapse prevention procedures. METHODS To assess the effectiveness of VRCE with CBT, a comparative trial involving 100 smoking abstinent participants was designed with all required virtual environments (VE) created with an inexpensive graphic engine/game level editor. RESULTS Outcome measures confirmed the immersive and craving eliciting effect of these VEs. Results demonstrated that more participants in the VRCE group did not experience smoking relapse and that VRCE is at least as efficacious as traditional CBT in terms of craving reduction and decrease in nicotine dependence. Dropout and relapse rate in the VRCE group was noticeably lower than the CBT group. Aside from mood scores, no significant differences were found regarding the other scales. CONCLUSION The present clinical trial provides evidence that VRCE was effective in preventing smoking relapse. Improvement in technology and methodology for future research and applications is delineated.
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Affiliation(s)
- Eric Malbos
- Department of Adult Psychiatry, Conception University Hospital, Marseille, France
- Equipe Imothep, Institut Fresnel, UMR 7249, Aix-Marseille Université, CNRS, Ecole Centrale Marseille, Marseille, France
| | - Baptiste Borwell
- Department of Adult Psychiatry, Conception University Hospital, Marseille, France
| | - Mélodie Einig-Iscain
- Department of Adult Psychiatry, Conception University Hospital, Marseille, France
- Equipe Imothep, Institut Fresnel, UMR 7249, Aix-Marseille Université, CNRS, Ecole Centrale Marseille, Marseille, France
| | - Théo Korchia
- Department of Adult Psychiatry, Conception University Hospital, Marseille, France
| | - Robin Cantalupi
- Cognitive Psychology Lab, UMR 7290, Aix-Marseille University, Marseille, France
| | - Laurent Boyer
- CEReSS, EA 3279, Center, La Timone Faculty of Medicine, Aix-Marseille Université, Marseille, France
| | - Christophe Lancon
- Department of Adult Psychiatry, Conception University Hospital, Marseille, France
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3
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Liu W, Andrade G, Schulze J, Doran N, Courtney KE. Using Virtual Reality to Induce and Assess Objective Correlates of Nicotine Craving: Paradigm Development Study. JMIR Serious Games 2022; 10:e32243. [PMID: 35166685 PMCID: PMC8889474 DOI: 10.2196/32243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 01/30/2023] Open
Abstract
Background Craving is a clinically important phenotype for the development and maintenance of nicotine addiction. Virtual reality (VR) paradigms are successful in eliciting cue-induced subjective craving and may even elicit stronger craving than traditional picture-cue methods. However, few studies have leveraged the advances of this technology to improve the assessment of craving. Objective This report details the development of a novel, translatable VR paradigm designed to both elicit nicotine craving and assess multiple eye-related characteristics as potential objective correlates of craving. Methods A VR paradigm was developed, which includes three Active scenes with nicotine and tobacco product (NTP) cues present, and three Neutral scenes devoid of NTP cues. A pilot sample (N=31) of NTP users underwent the paradigm and completed subjective measures of nicotine craving, sense of presence in the VR paradigm, and VR-related sickness. Eye-gaze fixation time (“attentional bias”) and pupil diameter toward Active versus Neutral cues, as well as spontaneous blink rate during the Active and Neutral scenes, were recorded. Results The NTP Cue VR paradigm was found to elicit a moderate sense of presence (mean Igroup Presence Questionnaire score 60.05, SD 9.66) and low VR-related sickness (mean Virtual Reality Sickness Questionnaire score 16.25, SD 13.94). Scene-specific effects on attentional bias and pupil diameter were observed, with two of the three Active scenes eliciting greater NTP versus control cue attentional bias and pupil diameter (Cohen d=0.30-0.92). The spontaneous blink rate metrics did not differ across Active and Neutral scenes. Conclusions This report outlines the development of the NTP Cue VR paradigm. Our results support the potential of this paradigm as an effective laboratory-based cue-exposure task and provide early evidence of the utility of attentional bias and pupillometry, as measured during VR, as useful markers for nicotine addiction.
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Affiliation(s)
- Weichen Liu
- Department of Computer Science and Engineering, University of California, San Diego, La Jolla, CA, United States
| | - Gianna Andrade
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Jurgen Schulze
- Department of Computer Science and Engineering, University of California, San Diego, La Jolla, CA, United States
| | - Neal Doran
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States.,Veterans Affairs San Diego Healthcare System, La Jolla, CA, United States
| | - Kelly E Courtney
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
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Haugg A, Manoliu A, Sladky R, Hulka LM, Kirschner M, Brühl AB, Seifritz E, Quednow BB, Herdener M, Scharnowski F. Disentangling craving- and valence-related brain responses to smoking cues in individuals with nicotine use disorder. Addict Biol 2022; 27:e13083. [PMID: 34363643 PMCID: PMC9285426 DOI: 10.1111/adb.13083] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/17/2021] [Accepted: 07/21/2021] [Indexed: 11/30/2022]
Abstract
Tobacco smoking is one of the leading causes of preventable death and disease worldwide. Most smokers want to quit, but relapse rates are high. To improve current smoking cessation treatments, a better understanding of the underlying mechanisms of nicotine dependence and related craving behaviour is needed. Studies on cue‐driven cigarette craving have been a particularly useful tool for investigating the neural mechanisms of drug craving. Here, functional neuroimaging studies in humans have identified a core network of craving‐related brain responses to smoking cues that comprises of amygdala, anterior cingulate cortex, orbitofrontal cortex, posterior cingulate cortex and ventral striatum. However, most functional Magnetic Resonance Imaging (fMRI) cue‐reactivity studies do not adjust their stimuli for emotional valence, a factor assumed to confound craving‐related brain responses to smoking cues. Here, we investigated the influence of emotional valence on key addiction brain areas by disentangling craving‐ and valence‐related brain responses with parametric modulators in 32 smokers. For one of the suggested key regions for addiction, the amygdala, we observed significantly stronger brain responses to the valence aspect of the presented images than to the craving aspect. Our results emphasize the need for carefully selecting stimulus material for cue‐reactivity paradigms, in particular with respect to emotional valence. Further, they can help designing future research on teasing apart the diverse psychological dimensions that comprise nicotine dependence and, therefore, can lead to a more precise mapping of craving‐associated brain areas, an important step towards more tailored smoking cessation treatments.
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Affiliation(s)
- Amelie Haugg
- Psychiatric University Hospital Zurich Zurich Switzerland
- Faculty of Psychology University of Vienna Vienna Austria
| | - Andrei Manoliu
- Psychiatric University Hospital Zurich Zurich Switzerland
- McLean Hospital Belmont Massachusetts USA
- Harvard Medical School Harvard University Boston Massachusetts USA
| | - Ronald Sladky
- Faculty of Psychology University of Vienna Vienna Austria
| | - Lea M. Hulka
- Psychiatric University Hospital Zurich Zurich Switzerland
| | - Matthias Kirschner
- Psychiatric University Hospital Zurich Zurich Switzerland
- Montreal Neurological Institute McGill University Montreal Canada
| | | | - Erich Seifritz
- Psychiatric University Hospital Zurich Zurich Switzerland
| | | | | | - Frank Scharnowski
- Psychiatric University Hospital Zurich Zurich Switzerland
- Faculty of Psychology University of Vienna Vienna Austria
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Papini S, Young CC, Gebhardt CS, Perrone A, Morikawa H, Otto MW, Roache JD, Smits JAJ. Isradipine enhancement of virtual reality cue exposure for smoking cessation: Rationale and study protocol for a double-blind randomized controlled trial. Contemp Clin Trials 2020; 94:106013. [PMID: 32335287 DOI: 10.1016/j.cct.2020.106013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/15/2020] [Accepted: 04/22/2020] [Indexed: 11/24/2022]
Abstract
Cigarette smoking remains a leading cause of preventable death in the United States, contributing to over 480,000 deaths each year. Although significant strides have been made in the development of effective smoking cessation treatments, most established interventions are associated with high relapse rates. One avenue for increasing the effectiveness of smoking cessation interventions is to design focused, efficient, and rigorous experiments testing engagement of well-defined mechanistic targets. Toward this aim, the current protocol will apply a pharmacologic augmentation strategy informed by basic research in animal models of addiction. Our goal is to evaluate the enhancing effect of isradipine, an FDA-approved calcium channel blocker, on the extinction of craving-a key mechanism of drug relapse after periods of abstinence. To activate craving robustly in human participants, we will use multimodal smoking cues including novel 360° video environments developed for this project and delivered through consumer virtual reality headsets. Adult smokers will take either isradipine or placebo and complete the cue exposure protocol in a double-blind randomized control trial. In order to test the hypothesis that isradipine will enhance retention of craving extinction, participants will repeat cue exposure 24 h later without the administration of isradipine or placebo. The study will be implemented in a primary care setting where adult smokers receive healthcare, and smoking behavior will be tracked throughout the trial with ecological momentary assessment.
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Affiliation(s)
- Santiago Papini
- Department of Psychology, The University of Texas at Austin, Austin, TX, United States.; Institute for Mental Health Research, The University of Texas at Austin, Austin, TX, USA.
| | - Cara C Young
- School of Nursing, The University of Texas at Austin, Austin, TX, USA
| | - Catherine S Gebhardt
- Department of Psychology, The University of Texas at Austin, Austin, TX, United States.; Institute for Mental Health Research, The University of Texas at Austin, Austin, TX, USA
| | - Alex Perrone
- Department of Psychology, The University of Texas at Austin, Austin, TX, United States.; Institute for Mental Health Research, The University of Texas at Austin, Austin, TX, USA
| | - Hitoshi Morikawa
- Department of Neuroscience, The University of Texas at Austin, Austin, TX, USA
| | - Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - John D Roache
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Jasper A J Smits
- Department of Psychology, The University of Texas at Austin, Austin, TX, United States.; Institute for Mental Health Research, The University of Texas at Austin, Austin, TX, USA
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6
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Sadeghi-Ardekani K, Haghighi M, Zarrin R. Effects of omega-3 fatty acid supplementation on cigarette craving and oxidative stress index in heavy-smoker males: A double-blind, randomized, placebo-controlled clinical trial. J Psychopharmacol 2018; 32:995-1002. [PMID: 30136619 DOI: 10.1177/0269881118788806] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Smoking-induced oxidative stress is thought to contribute to lower levels of omega-3 fatty acids in plasma and brain tissue. This lower level leads to impaired function in a dopaminergic system related to dependence and craving. AIMS The aim of this study was to evaluate the effects of omega-3 fatty acid supplementation on cigarette craving and oxidative stress index in heavy-smoker males. METHODS In this double-blind, randomized clinical trial, 54 heavy-smoker males (smoke ⩾20 cigarettes per day) were randomly selected to receive either five capsules of fish-oil-derived omega-3 fatty acid supplements ( n = 27, each 1 g capsule containing 180 mg of eicosapentaenoic acid and 120 mg of docosahexanoic acid) or a placebo ( n = 27) for 3 months. The psychometric evaluations (nicotine dependence and cigarette craving), biochemical markers (urinary cotinine, serum total antioxidant capacity and total oxidant status) and self-reported smoking status were used to assess the cigarette craving and oxidative stress index (oxidative stress index = total oxidant status/total antioxidant capacity). RESULTS There was a greater reduction in levels of nicotine dependence, cigarette craving and cigarettes smoked per day in the omega-3 fatty acid group compared to the placebo group, and the difference between the two groups increased from baseline to 3-month follow up. The model estimated that these differences were statistically significant ( p < 0.001, p < 0.001 and p < 0.001, respectively). Also, a significant decrease was observed in levels of total oxidant status ( p = 0.008) and oxidative stress index ( p = 0.011) in the omega-3 fatty acid group after intervention. CONCLUSIONS This study showed that high-dose omega-3 fatty acid supplementation appears to be useful in reducing cigarette craving and oxidative stress index in heavy-smoker males.
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Affiliation(s)
- Kiana Sadeghi-Ardekani
- 1 Nutrition Department, School of Medicine, The Urmia University of Medical Sciences, Iran
| | - Mahmonir Haghighi
- 2 Psychiatry Department, The Urmia University of Medical Sciences, Iran
| | - Rasoul Zarrin
- 1 Nutrition Department, School of Medicine, The Urmia University of Medical Sciences, Iran
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7
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Faulkner P, Ghahremani DG, Tyndale RF, Hellemann G, London ED. Functional Connectivity of the Raphe Nuclei: Link to Tobacco Withdrawal in Smokers. Int J Neuropsychopharmacol 2018; 21:800-808. [PMID: 29924326 PMCID: PMC6119292 DOI: 10.1093/ijnp/pyy054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 06/18/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Although nicotine alters serotonergic neurochemistry, clinical trials of serotonergic medications for smoking cessation have provided mixed results. Understanding the role of serotonergic dysfunction in tobacco use disorder may advance development of novel pharmacotherapies. METHODS Functional magnetic resonance imaging was used to measure resting-state functional connectivity of the raphe nuclei as an indicator of serotonergic function. Connectivity of the dorsal and median raphe nuclei was compared between 18 young smokers (briefly abstinent, ~40 minutes post-smoking) and 19 young nonsmokers (16-21 years old); connectivity was also examined in a separate sample of overnight-abstinent smokers (18-25 years old), before and after smoking the first cigarette of the day. Relationships between connectivity of the raphe nuclei with psychological withdrawal and craving were tested in smokers. RESULTS Connectivity of the median raphe nucleus with the right hippocampal complex was weaker in smokers than in nonsmokers and was negatively correlated with psychological withdrawal in smokers. In overnight-abstinent smokers, smoking increased connectivity of the median raphe nucleus with the right hippocampal complex, and the increase was positively correlated with the decrease in psychological withdrawal. CONCLUSIONS Relief of withdrawal due to smoking is potentially linked to the serotonergic pathway that includes the median raphe nucleus and hippocampal complex. These results suggest that serotonergic medications may be especially beneficial for smokers who endorse strong psychological withdrawal during abstinence from smoking.
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Affiliation(s)
- Paul Faulkner
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
| | - Dara G Ghahremani
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
| | - Rachel F Tyndale
- Department of Pharmacology and Toxicology, and Department of Psychiatry, University of Toronto, Toronto, ON, Canada,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Gerhard Hellemann
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
| | - Edythe D London
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California,Department of Molecular and Medical Pharmacology, University of California, Los Angeles, California,The Brain Research Institute, University of California, Los Angeles, California,Correspondence: Edythe D. London, PhD, Semel Institute, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90095 ()
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8
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Trait Persistence Moderates the Association between Gender and Change in Smoking Urge Across Repeated Cue Exposure Trials. J Smok Cessat 2018. [DOI: 10.1017/jsc.2018.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Previous research suggests that persistence, an individual difference characteristic representing the ability and willingness to maintain engagement in challenging or aversive contexts, may relate to smoking relapse. Improving understanding of the persistence-relapse risk association could guide improvements in behavioural interventions. We explored whether persistence and gender related to change in smoking urges across multiple cue exposure trials (an analogue of extinction learning and relapse risk). Participants included abstinent smokers who completed 12 massed, 5-minute smoking cue exposure trials using guided imagery as well as olfactory, tactile, visual and motor cues associated with smoking. We used multilevel logistic growth curve modelling to explore predictor associations with change in urge. Results suggested that gender related to urge whereby males showed greater initial and sustained reactivity than females. Persistence was not associated with female urge trajectories. However, compared to males with high persistence, males with low persistence evidenced sustained urge reactivity over time. Results suggest that greater persistence relates to reduction of conditioned responding (e.g., urges) among abstinent male smokers when exposure trials include complex cues most closely related to nicotine self-administration. Because persistence is modifiable, males with low persistence may benefit from interventions that include elements designed to increase persistence in urge eliciting situations.
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9
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Hartwell KJ, Hanlon CA, Li X, Borckardt JJ, Canterberry M, Prisciandaro JJ, Moran-Santa Maria MM, LeMatty T, George MS, Brady KT. Individualized real-time fMRI neurofeedback to attenuate craving in nicotine-dependent smokers. J Psychiatry Neurosci 2016; 41:48-55. [PMID: 26505139 PMCID: PMC4688028 DOI: 10.1503/jpn.140200] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Cue-induced craving plays an important role in relapse, and the neural correlates of cue-induced craving have been elucidated using fMRI. This study examined the utility of real-time fMRI (rtfMRI) neurofeedback to strengthen self-regulation of craving-related neural activation and cue-reactivity in cigarette smokers. METHODS Nicotine-dependent smokers were randomized to rtfMRI neurofeedback or to a no-feedback control group. Participants completed 3 neuroimaging visits. Within each visit, an initial run during which smoking-related cues were used to provoke craving, an individualized craving-related region of interest (ROI) in the prefrontal cortex or anterior cingulate cortex was identified. In the rtfMRI group, activity from the ROI was fed back via a visual display during 3 subsequent runs while participants were instructed to reduce craving during cue exposure. The control group had an identical experience with no feedback provided. RESULTS Forty-four nicotine-dependent smokers were recruited to participate in our study; data from the 33 participants who completed a 1-week follow-up visit were included in the analysis. Subjective craving ratings and cue-induced brain activation were lower in the rtfMRI group than in the control group. LIMITATIONS As participants were not seeking treatment, clinical outcomes are lacking. CONCLUSION Nicotine-dependent smokers receiving rtfMRI feedback from an individualized ROI attenuated smoking cue-elicited neural activation and craving, relative to a control group. Further studies are needed in treatment-seeking smokers to determine if this intervention can translate into a clinically meaningful treatment modality.
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Affiliation(s)
- Karen J. Hartwell
- Correspondence to: K.J. Hartwell, 125 Doughty St, Suite 190, Charleston, SC 29403;
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10
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Ruscio AC, Muench C, Brede E, Waters AJ. Effect of Brief Mindfulness Practice on Self-Reported Affect, Craving, and Smoking: A Pilot Randomized Controlled Trial Using Ecological Momentary Assessment. Nicotine Tob Res 2016; 18:64-73. [PMID: 25863520 DOI: 10.1093/ntr/ntv074] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 03/22/2015] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Despite efficacious pharmacological and behavioral treatments, most smokers attempt to quit without assistance and fail to quit. Mindfulness practice may be useful in smoking cessation. METHODS This ecological momentary assessment (EMA) study was a pilot parallel group randomized controlled trial of a brief mindfulness practice (Brief-MP) intervention on self-reported smoking behavior delivered to smokers on a Personal Digital Assistant (PDA) in the field. Adult community smokers (N = 44) were randomly assigned to a Brief-MP (n = 24) or Control (sham meditation; n = 20) group. Participants were instructed to smoke as much or as little as they liked. Participants carried a PDA for 2 weeks and were instructed to initiate 20 minutes of meditation (or control) training on the PDA daily, completing an assessment of cognitive and affective processes immediately afterwards. Additionally, they completed assessments at random times up to four times per day. Primary outcome variables were negative affect, craving, and cigarettes smoked per day, all self-reported. RESULTS Thirty-seven participants provided EMA data totaling 1874 assessments. Linear Mixed Model analyses on EMA data revealed that Brief-MP (vs. Control) reduced overall negative affect, F(1, 1798) = 13.8, P = .0002; reduced craving immediately post-meditation, (Group × Assessment Type interaction, F(2, 1796) = 12.3, P = .0001); and reduced cigarettes smoked per day over time (Group × Day interaction, F(1, 436) = 5.50, P = .01). CONCLUSIONS Brief-MP administered in the field reduced negative affect, craving, and cigarette use, suggesting it may be a useful treatment.
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Affiliation(s)
- Aimee C Ruscio
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD
| | | | - Emily Brede
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Andrew J Waters
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD;
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11
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Dziak JJ, Li R, Tan X, Shiffman S, Shiyko MP. Modeling intensive longitudinal data with mixtures of nonparametric trajectories and time-varying effects. Psychol Methods 2015; 20:444-69. [PMID: 26390169 PMCID: PMC4679529 DOI: 10.1037/met0000048] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Behavioral scientists increasingly collect intensive longitudinal data (ILD), in which phenomena are measured at high frequency and in real time. In many such studies, it is of interest to describe the pattern of change over time in important variables as well as the changing nature of the relationship between variables. Individuals' trajectories on variables of interest may be far from linear, and the predictive relationship between variables of interest and related covariates may also change over time in a nonlinear way. Time-varying effect models (TVEMs; see Tan, Shiyko, Li, Li, & Dierker, 2012) address these needs by allowing regression coefficients to be smooth, nonlinear functions of time rather than constants. However, it is possible that not only observed covariates but also unknown, latent variables may be related to the outcome. That is, regression coefficients may change over time and also vary for different kinds of individuals. Therefore, we describe a finite mixture version of TVEM for situations in which the population is heterogeneous and in which a single trajectory would conceal important, interindividual differences. This extended approach, MixTVEM, combines finite mixture modeling with non- or semiparametric regression modeling, to describe a complex pattern of change over time for distinct latent classes of individuals. The usefulness of the method is demonstrated in an empirical example from a smoking cessation study. We provide a versatile SAS macro and R function for fitting MixTVEMs.
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Affiliation(s)
- John J Dziak
- The Methodology Center, The Pennsylvania State University
| | - Runze Li
- Department of Statistics, The Pennsylvania State University
| | - Xianming Tan
- Research Institute of the McGill University Health Centre, McGill University
| | | | - Mariya P Shiyko
- Department of Counseling and Applied Educational Psychology, Northeastern University
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12
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Mason M, Mennis J, Way T, Lanza S, Russell M, Zaharakis N. Time-varying effects of a text-based smoking cessation intervention for urban adolescents. Drug Alcohol Depend 2015; 157:99-105. [PMID: 26507175 PMCID: PMC4831210 DOI: 10.1016/j.drugalcdep.2015.10.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 10/01/2015] [Accepted: 10/06/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Craving to smoke is understood as an important mechanism for continued smoking behavior. Identifying how smoking interventions operate on craving with particular populations is critical for advancing intervention science. This study's objective was to investigate the time-varying effect of a text-delivered smoking cessation intervention. METHODS Toward this end, we used ecological momentary assessment (EMA) data collected from a five-day, automated text-messaging smoking cessation randomized clinical trial with 200 urban adolescents. We employed a time-varying effect model (TVEM) to estimate the effects of stress (time-varying covariate) and baseline nicotine dependence level (time-invariant covariate) on craving over six months by treatment condition. The TVEM approach models behavioral change and associations of coefficients expressed dynamically and graphically represented as smooth functions of time. RESULTS Controlling for gender, age, and current smoking, differences in trajectories of craving between intervention and control conditions were apparent over the course of the study. During months 2 to 3, the association between stress and craving was significantly stronger among the control group, suggesting treatment dampens this association during this time period. The intervention also reduced the salience of baseline dependence among treatment adolescents, with craving being reduced steadily over time, while the control group increased craving over time. CONCLUSIONS These results provide insight into the time-varying nature of treatment effects for adolescents receiving a text-based smoking cessation intervention. The ability to specify when in the course of an intervention the effect is strongest is important in developing targeted and adaptive interventions that can adjust strategically with time.
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Affiliation(s)
- Michael Mason
- Virginia Commonwealth University, Richmond, VA, United States.
| | | | - Thomas Way
- Villanova University, Villanova, PA, United States
| | - Stephanie Lanza
- Pennsylvania State University, University Park, PA, United States
| | - Michael Russell
- Pennsylvania State University, University Park, PA, United States
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Abstract
This technical report serves to provide the evidence base for the American Academy of Pediatrics' policy statements "Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke" and "Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke." Tobacco use and involuntary exposure are major preventable causes of morbidity and premature mortality in adults and children. Tobacco dependence almost always starts in childhood or adolescence. Electronic nicotine delivery systems are rapidly gaining popularity among youth, and their significant harms are being documented. In utero tobacco smoke exposure, in addition to increasing the risk of preterm birth, low birth weight, stillbirth, placental abruption, and sudden infant death, has been found to increase the risk of obesity and neurodevelopmental disorders. Actions by pediatricians can help to reduce children's risk of developing tobacco dependence and reduce children's involuntary tobacco smoke exposure. Public policy actions to protect children from tobacco are essential to reduce the toll that the tobacco epidemic takes on our children.
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Pericot-Valverde I, Germeroth LJ, Tiffany ST. The Use of Virtual Reality in the Production of Cue-Specific Craving for Cigarettes: A Meta-Analysis. Nicotine Tob Res 2015; 18:538-46. [PMID: 26453669 DOI: 10.1093/ntr/ntv216] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 09/15/2015] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The cue-reactivity procedure has demonstrated that smokers respond with increases in subjective craving in the presence of smoking-related cues. Virtual reality is an emerging mode of cue presentation for cue-reactivity research. Despite the successful implementation of virtual reality during the last decade, no systematic review has investigated the magnitude of effects across studies. METHODS This research systematically reviewed findings from studies using virtual reality in cigarette craving assessment. Eligible studies assessed subjective craving for cigarettes in smokers exposed to smoking-related and neutral environments. Cohen's d was used to assess differences in craving between smoking-related and nonsmoking-related virtual environments. A random effects approach was used to combine effect sizes. RESULTS A total of 18 studies involving 541 smokers was included in the final analyses. Environments with smoking-related cues produced significant increases in craving relative to environments without smoking-related cues. The mean overall effect size (Cohen's d) was 1.041 (SE = 0.12, 95% CI = 0.81 to 1.28, Z = 8.68, P < .001). CONCLUSIONS The meta-analysis suggested that presentations of smoking cues through virtual reality can produce strong increases in craving among cigarette smokers. This strong cue-reactivity effect, which was comparable in magnitude to the craving effect sizes found with more conventional modes of cue presentation, supports the use of virtual reality for the generation of robust cue-specific craving in cue-reactivity research.
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Affiliation(s)
| | - Lisa J Germeroth
- Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY
| | - Stephen T Tiffany
- Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY
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15
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Kleinjan M, Engels RCME, DiFranza JR. Parental smoke exposure and the development of nicotine craving in adolescent novice smokers: the roles of DRD2, DRD4, and OPRM1 genotypes. BMC Pulm Med 2015; 15:115. [PMID: 26449981 PMCID: PMC4599744 DOI: 10.1186/s12890-015-0114-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 09/28/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Among adolescent novice smokers, craving is often the first, and is the most reported, symptom of nicotine dependence. Until now, little has been known about the development of craving symptoms in novice smokers. The aim of this study was to identify specific genetic (i.e., DRD2 Taq1A, DRD4 48 bp VNTR, and OPRM1 A118G polymorphisms) and environmental mechanisms that underlie the emergence of both cue-induced and cognitive craving among adolescent novice smokers. METHOD A five-wave longitudinal, genetically-informed survey study was conducted with intervals of four months. The sample included 376 early adolescent smokers (12-13 years of age at baseline). Self-report questionnaires were completed regarding smoking behavior, observed parental smoking behavior, and both cue-induced and cognitive craving. RESULTS Data were analyzed with a latent growth curve approach. For both cue-induced and cognitive craving, significant interaction effects were found for DRD2 Taq1A with parental smoke exposure. A1-allele carriers did not seem to be influenced by the environment with regard to craving development. Adolescents who are homozygous for the A2-allele and who are more exposed to parental smoking experience the highest levels of both types of craving over time. No significant interaction effects were found between parental smoke exposure and DRD4 48 bp VNTR or OPRM1 A118G. CONCLUSIONS Previous studies identified DRD2 Taq1A A1-allele carriers as vulnerable to developing nicotine dependence. However, this study showed that parental smoking increased the chances of developing dependence more rapidly for early adolescents who are considered to be less sensitive to the rewarding effects of nicotine according to their DRD2 Taq1A genotype. It is thus especially important that these young people not be exposed to smoking in their social environment.
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Affiliation(s)
- Marloes Kleinjan
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Da Costakade 45, 3521 VS, Utrecht, The Netherlands.
| | - Rutger C M E Engels
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Da Costakade 45, 3521 VS, Utrecht, The Netherlands.
- Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, 6525 HR, Nijmegen, The Netherlands.
| | - Joseph R DiFranza
- University of Massachusetts Medical School, 55 N Lake Ave, Worcester, MA, 01655, USA.
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Clyburne-Sherin AVP, Thurairajah P, Kapadia MZ, Sampson M, Chan WWY, Offringa M. Recommendations and evidence for reporting items in pediatric clinical trial protocols and reports: two systematic reviews. Trials 2015; 16:417. [PMID: 26385379 PMCID: PMC4574457 DOI: 10.1186/s13063-015-0954-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 09/11/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Complete and transparent reporting of clinical trial protocols and reports ensures that these documents are useful to all stakeholders, that bias is minimized, and that the research is not wasted. However, current studies repeatedly conclude that pediatric trial protocols and reports are not appropriately reported. Guidelines like SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) and CONSORT (Consolidated Standards of Reporting Trials) may improve reporting, but do not offer guidance on issues unique to pediatric trials. This paper reports two systematic reviews conducted to build the evidence base for the development of pediatric reporting guideline extensions: 1) SPIRIT-Children (SPIRIT-C) for pediatric trial protocols, and 2) CONSORT-Children (CONSORT-C) for pediatric trial reports. METHOD MEDLINE, the Cochrane Methodology Register, and reference lists of included studies were searched. Publications of any type were eligible if they included explicit recommendations or empirical evidence for the reporting of potential items in a pediatric protocol (SPIRIT-C systematic review) or trial report (CONSORT-C systematic review). Study characteristics, recommendations and evidence for pediatric extension items were extracted. Recurrent themes in the recommendations and evidence were identified and synthesized. All steps were conducted by two reviewers. RESULTS For the SPIRIT-C and CONSORT-C systematic reviews 366 and 429 publications were included, respectively. Recommendations were identified for 48 of 50 original reporting items and sub-items from SPIRIT, 15 of 20 potential SPIRIT-C reporting items, all 37 original CONSORT items and sub-items, and 16 of 22 potential CONSORT-C reporting items. The following overarching themes of evidence to support or refute the utility of reporting items were identified: transparency; reproducibility; interpretability; usefulness; internal validity; external validity; reporting bias; publication bias; accountability; scientific soundness; and research ethics. CONCLUSION These systematic reviews are the first to systematically gather evidence and recommendations for the reporting of specific items in pediatric protocols and trials. They provide useful and translatable evidence on which to build pediatric extensions to the SPIRIT and CONSORT reporting guidelines. The resulting SPIRIT-C and CONSORT-C will provide guidance to the authors of pediatric protocols and reports, respectively, helping to alleviate concerns of inappropriate and inconsistent reporting, and reduce research waste.
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Affiliation(s)
- April V P Clyburne-Sherin
- The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, SickKids Research Institute, Child Health Evaluative Sciences, 686 Bay Street, Toronto, ON, M5G 0A4, Canada.
| | - Pravheen Thurairajah
- The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, SickKids Research Institute, Child Health Evaluative Sciences, 686 Bay Street, Toronto, ON, M5G 0A4, Canada.
| | - Mufiza Z Kapadia
- The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, SickKids Research Institute, Child Health Evaluative Sciences, 686 Bay Street, Toronto, ON, M5G 0A4, Canada.
| | - Margaret Sampson
- Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
| | - Winnie W Y Chan
- The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, SickKids Research Institute, Child Health Evaluative Sciences, 686 Bay Street, Toronto, ON, M5G 0A4, Canada.
| | - Martin Offringa
- The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, SickKids Research Institute, Child Health Evaluative Sciences, 686 Bay Street, Toronto, ON, M5G 0A4, Canada. .,Senior Scientist and Program Head Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, SickKids Research Institute, 686 Bay Street, Toronto, ON, M5G 0A4, Canada.
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Day AM, Kahler CW, Metrik J, Spillane NS, Tidey JW, Rohsenow DJ. Working Memory Moderates the Association Between Smoking Urge and Smoking Lapse Behavior After Alcohol Administration in a Laboratory Analogue Task. Nicotine Tob Res 2014; 17:1173-7. [PMID: 25481913 DOI: 10.1093/ntr/ntu259] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 11/17/2014] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Lapses after smoking cessation often occur in the context of alcohol use, possibly because alcohol increases urge to smoke. Poor working memory, or alcohol-induced decrements in working memory, may influence this relationship by making it more difficult for an individual to resist smoking in the face of smoking urges. METHODS Participants (n = 41) completed measures of working memory and urge to smoke before and after alcohol administration (placebo, 0.4 g/kg, and 0.8 g/kg, within subjects) and then participated in a laboratory analogue task in which smoking abstinence was monetarily incentivized. RESULTS Working memory moderated the relationship between smoking urge and latency to smoke: for those with relatively poorer working memory, urge to smoke was more strongly and negatively associated with latency to smoke (i.e., higher urges were associated with shorter latency). CONCLUSIONS Those with weak working memory may need additional forms of treatment to help them withstand smoking urges.
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Affiliation(s)
- Anne M Day
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI;
| | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI
| | - Jane Metrik
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI; Providence VA Medical Center, Providence, RI
| | - Nichea S Spillane
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI
| | - Damaris J Rohsenow
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI; Providence VA Medical Center, Providence, RI
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Pericot-Valverde I, Secades-Villa R, Gutiérrez-Maldonado J, García-Rodríguez O. Effects of systematic cue exposure through virtual reality on cigarette craving. Nicotine Tob Res 2014; 16:1470-7. [PMID: 24962558 PMCID: PMC4342674 DOI: 10.1093/ntr/ntu104] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 05/21/2014] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Cigarette cravings have been associated with less successful attempts to quit smoking and a greater likelihood of relapse after smoking cessation. Background craving refers to a relatively steady and continuous experience of craving, while cue-induced craving refers to phases of intense craving triggered by cues associated with smoking. Cue exposure treatment (CET) involves repeated exposure to stimuli associated with substance use in order to reduce craving responses. However, mixed results have been found regarding the effect of CET on both types of craving. The aim of this study was to assess the effect of systematic virtual reality cue exposure treatment (VR-CET) on background and cue-induced cravings. METHODS Participants were 48 treatment-seeking smokers. The VR-CET consisted of prolonged exposure sessions to several interactive virtual environments. The VR-CET was applied once a week over 5 weeks. An individualized hierarchy of exposure was drawn up for each patient starting from the easiest virtual environment. Background and cue-induced cravings were recorded in each session. RESULTS Cue-induced craving decreased over each session as a result of prolonged exposure. VR-CET also reduced cue-induced and background cravings across the 5 sessions, showing a cumulative effect across the exposure sessions. CONCLUSIONS Our results evidenced the utility of VR-CET in reducing both types of cigarette craving. A combination of CET through VR with psychological treatments may improve current treatments for smoking cessation.
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Affiliation(s)
| | | | - José Gutiérrez-Maldonado
- Department of Personality, Assessment, and Psychological Treatments, University of Barcelona, Barcelona, Spain
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19
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Laboratory-induced cue reactivity among individuals with prescription opioid dependence. Addict Behav 2014; 39:1217-23. [PMID: 24813546 DOI: 10.1016/j.addbeh.2014.04.007] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 03/17/2014] [Accepted: 04/02/2014] [Indexed: 11/22/2022]
Abstract
Prescription opioid (PO) dependence is a critical health problem. Although examination of drug cue reactivity paradigms has advanced the understanding of risk factors for relapse for a variety of substances (e.g., cocaine, alcohol, nicotine), no PO specific drug cue paradigm has been developed. The current study addressed this gap in the literature and evaluated the ability of a newly developed PO drug cue paradigm to elicit subjective, physiological, and neuroendocrine changes among PO-dependent participants (n = 20) as compared to controls (n = 17). The drug cue paradigm included an induction script, viewing and handling paraphernalia (e.g., bottle of oxycontin pills, pill crusher) and watching a video depicting people using POs as well as places related to POs (e.g., pharmacies). Consistent with hypotheses, the PO group demonstrated significant pre- to post-cue increases on subjective ratings of craving, difficulty resisting POs, stress, and anger. The control group did not demonstrate significant changes on any of the subjective measures. Both the PO group and the control group evidenced significant pre- to post-cue increases in physiological responses (e.g., blood pressure, skin conductance), as expected given the arousing nature of the drug cue stimuli. The PO group, but not the control group, evidenced a significant pre- to post-cue increase in heart rate and salivary cortisol levels. The development and validation of a drug cue paradigm for POs may help inform future research and treatment development efforts for patients with PO dependence.
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Adolescents' use of nicotine replacement therapy for smoking cessation: predictors of compliance trajectories. Psychopharmacology (Berl) 2014; 231:1743-52. [PMID: 24595505 DOI: 10.1007/s00213-014-3511-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 02/17/2014] [Indexed: 10/25/2022]
Abstract
RATIONALE Previous research has shown limited efficacy of nicotine replacement therapy (NRT) among adolescents and generally low compliance rates. As higher compliance rates are associated with improved abstinence rates, the present study examined predictors of NRT compliance. OBJECTIVES This study aims to test whether different NRT compliance trajectories can be distinguished among adolescents, to test whether these trajectories can be predicted by demographic, smoking-related, and personality factors, and to examine abstinence rates for each trajectory. METHODS Data were used from a randomized controlled trial that tested the efficacy of nicotine patches versus placebo patches among 265 Dutch adolescents. During NRT treatment, adolescents filled out six online questionnaires in which they reported on the number of days they used the patches. Predictors (i.e., demographic and smoking-related factors and personality characteristics) and end-of-treatment abstinence were also administered through these self-reports. Latent class growth analysis (LCGA) was used to analyze compliance data by classifying individuals into similar growth trajectories. RESULTS Three compliance trajectories were found (i.e., "compliers" (n = 89), "moderate decreasers" (n = 41), and "strong decreasers" (n = 127)). The compliers can be characterized by higher levels of conscientiousness and agreeableness and lower levels of extraversion compared with the strong decreasers, and by higher levels of conscientiousness and education compared with the moderate decreasers. Among the compliers, a substantially higher percentage of adolescents achieved abstinence at end-of-treatment (10 %) compared with the moderate decreasers (3 %) and the strong decreasers (6 %). CONCLUSIONS These findings could be the starting point for person-tailored interventions that aim to enhance NRT compliance rates among adolescents.
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Carpenter MJ, Saladin ME, Larowe SD, McClure EA, Simonian S, Upadhyaya HP, Gray KM. Craving, cue reactivity, and stimulus control among early-stage young smokers: effects of smoking intensity and gender. Nicotine Tob Res 2014; 16:208-15. [PMID: 24042699 PMCID: PMC3880235 DOI: 10.1093/ntr/ntt147] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 08/08/2013] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Smoking initiation usually begins in adolescence, but how and for whom nicotine dependence emerges during this period is unclear. The cue-reactivity paradigm is well suited to examine one marker of dependence: craving-related stimulus control, i.e., the ability of environmental cues to elicit craving to smoke. This study examined the effects of both level of smoking involvement (daily vs. occasional smoking) and gender on reactivity to both smoking and alcohol cues. METHODS Young (age range 16-20; 42% female) daily (n = 55) and occasional (n = 52) smokers were exposed to each of three counterbalanced cues: (a) in vivo smoking (e.g., sight, smell, lighting of cigarette), (b) alcohol (e.g., opening, pouring, and smell of preferred beverage), and (c) neutral cue. RESULTS Daily smokers exhibited higher levels of tonic (i.e., noncue-elicited) craving than did occasional smokers. Both groups showed significant increases in craving in response to cues (i.e., cue-elicited craving), with little evidence that cue-elicited craving differed between groups. Females were more cue reactive to both the alcohol and smoking cues than males, particularly for the positively reinforced aspects of smoking (i.e., hedonic craving). There were no gender × group interaction effects in response to either the alcohol or the smoking cue. CONCLUSIONS Findings show the presence of cue-elicited craving even among occasional smokers and are consistent with literature demonstrating heightened sensitivity to environmental cues among females. Cue-elicited craving may be one mechanism that contributes to the maintenance of smoking behavior and perhaps to the development of nicotine dependence within early stage smokers.
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Affiliation(s)
- Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
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Berlin I, Singleton EG, Heishman SJ. Predicting smoking relapse with a multidimensional versus a single-item tobacco craving measure. Drug Alcohol Depend 2013; 132:513-20. [PMID: 23623506 DOI: 10.1016/j.drugalcdep.2013.03.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 03/26/2013] [Accepted: 03/27/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Research suggests that craving is a predictor of smoking relapse. Craving can be assessed by multiple item or multifactorial scales or by single items. However, no systematic comparisons of their prognostic validity or accuracy have been published. METHODS The French versions of the 12-item Tobacco Craving Questionnaire (FTCQ-12) and the single craving item on the Minnesota Nicotine Withdrawal Scale (MNWS) are brief, valid, and reliable self-report measures of tobacco craving. In this secondary study, we analyzed data from French smokers with health-related problems enrolled in the Adjustment of DOses of NIcotine in Smoking (ADONIS) cessation trial. We estimated prediction models for each measure and compared their ability to distinguish correctly participants who relapsed from those who did not at 1-8 weeks after their quit date. RESULTS Adjusted for all potential confounders FTCQ-12 risk score (RS; Factor 2, Expectancy plus Factor 4, Purposefulness) and MNWS craving were valid predictors of smoking relapse at endpoints measured 1-7 weeks apart. Prognostic accuracy of FTCQ-12 RS was greatest at 1-2 weeks follow-up compared to only 1 week for MNWS craving. Sensitivity for FTCQ-12 RS and MNWS craving was 85% and 53%, respectively. CONCLUSIONS FTCQ-12 RS suggests a relapse process involving urges and desires in anticipation of the positive benefits of smoking linked with intent and planning to smoke. Findings also suggest that FTCQ-12 RS may be a better predictor instrument for smoking relapse than MNWS craving.
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Affiliation(s)
- Ivan Berlin
- Département de Pharmacologie, Hôpital Pitié-Salpêtrière-Faculté de médicine, Université P. and M. Curie - INSERM U669, Paris, France.
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Scherphof CS, van den Eijnden RJJM, Engels RCME, Vollebergh WAM. Short-term efficacy of nicotine replacement therapy for smoking cessation in adolescents: a randomized controlled trial. J Subst Abuse Treat 2013; 46:120-7. [PMID: 24029624 DOI: 10.1016/j.jsat.2013.08.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 07/01/2013] [Accepted: 08/05/2013] [Indexed: 11/16/2022]
Abstract
The aim of this randomized, double-blind placebo-controlled clinical trial is to test the efficacy and safety of nicotine replacement therapy (NRT) in promoting end-of-treatment abstinence among adolescents and whether this relation is moderated by medication compliance. Participants (N=257, age: 16.7±1.13 years) attended an information meeting followed by a 6- or 9-week treatment. Self-reported smoking cessation, compliance, and side effects were measured by means of online questionnaires. Intent-to-treat analyses showed that independent of compliance, NRT is effective in promoting abstinence rates after 2 weeks (OR=2.02, 95% CI=1.11-3.69), but not end-of-treatment abstinence. However, end-of-treatment abstinence rates significantly increased in high-compliant (OR=1.09, 95% CI=1.01-1.17) and not in low-compliant participants. No serious adverse events were found. Future research is warranted to disentangle the process involving the decrease in abstinence rates and compliance rates from the third week after the quit date onwards.
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Wray JM, Gass JC, Tiffany ST. A systematic review of the relationships between craving and smoking cessation. Nicotine Tob Res 2013; 15:1167-82. [PMID: 23291636 PMCID: PMC3682845 DOI: 10.1093/ntr/nts268] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 11/12/2012] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Craving is often portrayed as a defining feature of addiction, but the role of craving in the addictive process is controversial. Particularly contentious is the extent to which drug craving predicts subsequent relapse. METHODS This review synthesizes findings from 62 smoking cessation studies published through December 2011. Eligible studies measured craving for cigarettes in treatment-seeking smokers and related this to subsequent smoking status. The relationships of general craving and cue-specific craving with treatment outcome were examined separately. Further, analyses that related general craving to smoking status were divided into those that used craving data collected before the quit attempt, after the quit attempt, and those that used change in craving over time as a predictor. RESULTS Results across studies revealed a total of 198 indices of association with 94 (47%) of these being significant. In general, the findings indicated (a) there were only a few cases of significant associations between craving collected as part of cue-reactivity studies and treatment outcome, (b) postquit craving was a stronger predictor of treatment outcome than prequit craving, and (c) several moderators likely influence the relationship between craving and cessation outcome. CONCLUSIONS The overall results suggest that craving is not a necessary condition of relapse. In addition, inconsistent relationships between craving and treatment outcome call into question the value of craving as a target of treatment and underscore limitations in the prognostic utility of craving.
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Affiliation(s)
- Jennifer M Wray
- Department of Psychology, University at Buffalo, The State University of New York, Buffalo, NY 14260, USA.
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Mindfulness training for smoking cessation: moderation of the relationship between craving and cigarette use. Drug Alcohol Depend 2013; 130:222-9. [PMID: 23265088 PMCID: PMC3619004 DOI: 10.1016/j.drugalcdep.2012.11.015] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 11/20/2012] [Accepted: 11/20/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Smoking is the leading cause of preventable death in the US, while abstinence rates remain modest. Smoking has been shown to be perpetuated by operant conditioning, notably negative reinforcement (e.g., smoking to relieve negative affective states). Mindfulness training (MT) shows promise for smoking cessation, by potentially altering an individual's tendency to smoke in response to craving. The purpose of this study was to examine the effects of MT and mindfulness practice on the relationship between smoking and craving after receiving four weeks of MT. METHODS 33 adults received MT as part of a randomized trial for smoking cessation. Individuals in the MT condition recorded formal and informal mindfulness practice during treatment using daily diaries. RESULTS Analyses showed that strong correlations between craving and smoking at baseline (r=0.582) were attenuated at the end of treatment (r=0.126). Mindfulness home practice significantly predicted cigarette use (formal: B=-1.21, p=0.007; informal: B=-1.52, p<0.0001) and informal practice moderated the relationship between craving and smoking at the end of treatment (B=0.52, p=0.03). CONCLUSIONS These findings suggest that MT may be effective as a treatment for smoking cessation and that informal mindfulness practice predicts a decoupling of the association between craving and smoking.
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Sarkar S, Sharma A, Basu D. Comparison of craving between smoked and smokeless tobacco across a variety of cue exposures. Subst Use Misuse 2013; 48:233-8. [PMID: 23302058 DOI: 10.3109/10826084.2012.752851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Smokeless tobacco use is a major health issue but has received less attention in craving research. The present non-funded study aimed to assess craving associated with smokeless tobacco compared to smoked forms. Forty-eight nicotine dependent male subjects attending a deaddiction center in India were recruited. The subjects were exposed to six nicotine related and two control cues in random order for variable time durations. The urge to consume the tobacco product was rated. Tobacco-related cues produced different patterns and degrees of craving among users of smoked and smokeless tobacco. This has implications for management and drug development.
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Affiliation(s)
- Siddharth Sarkar
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India.
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Branstetter SA, Blosnich J, Dino G, Nolan J, Horn K. Gender differences in cigarette smoking, social correlates and cessation among adolescents. Addict Behav 2012; 37:739-42. [PMID: 22405835 DOI: 10.1016/j.addbeh.2012.02.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 01/05/2012] [Accepted: 02/13/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Despite well-established gender differences in adult smoking behaviors, relatively little is known about gender discrepancies in smoking behaviors among adolescents, and even less is known about the role of gender in smoking cessation among teen populations. METHOD The present study examined gender differences in a population of 755 adolescents seeking to quit smoking through the American Lung Association's Not-On-Tobacco (N-O-T) program. All participants enrolled in the N-O-T program between 1998 and 2009. All participants completed a series of questionnaires prior to and immediately following the cessation intervention. Analyses examined gender differences in a range of smoking variables, cessation success and direct and indirect effects on changes in smoking behaviors. RESULTS Females were more likely to have parents, siblings and romantic partners who smokes, perceive that those around them will support a cessation effort, smoke more prior to intervention if they have friends who smoke, and to have lower cessation motivation and confidence if they have a parent who smokes. Conversely, males were more likely to have lower cessation motivation and confidence and be less likely to quit if they have a friend who smokes. CONCLUSIONS Gender plays an important role in adolescent smoking behavior and smoking cessation. Further research is needed to understand how these differences may be incorporated into intervention design to increase cessation success rates among this vulnerable population of smokers.
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Perkins KA. Subjective reactivity to smoking cues as a predictor of quitting success. Nicotine Tob Res 2012; 14:383-7. [PMID: 22140145 PMCID: PMC3313783 DOI: 10.1093/ntr/ntr229] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 08/30/2011] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Acutely increased urge to smoke, or craving, in response to smoking cues (i.e., "cue reactivity") is often believed to identify those less able to later quit smoking. Although absolute craving level can predict smoking behavior, smoking cue reactivity per se may not predict cessation outcome. METHODS All clinical trials of cue reactivity and cessation outcome published before 2007 were identified and supplemented with a web-based search of clinical studies published after 2006, producing one additional trial. Examined were a total of 6 studies that directly related self-reported craving in response to laboratory-presented smoking cues with subsequent ability to quit smoking. RESULTS Of the 6 studies, only one found that lower cue reactivity predicted greater quitting success (with nicotine but not placebo patch). Another study found the opposite, that higher cue reactivity was related to greater, rather than less, quitting success (in an unaided attempt). The other studies showed no association between cue reactivity and cessation outcome. CONCLUSIONS This limited research does not clearly support self-reported craving in response to smoking cues per se as a predictor of later quitting success. Lack of consistent results may partly be due to variability in methods of smoking cue assessment, type of cessation treatment, and duration of follow-up assessment. If it is to improve our understanding of an individual's ability to quit smoking, research on cue reactivity needs to show significant and reliable associations with subsequent long-term smoking behavior.
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Affiliation(s)
- Kenneth A Perkins
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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Kleinjan M, Visser AF, Engels RC. Examining nicotine craving during abstinence among adolescent smokers: the roles of general perceived stress and temptation-coping strategies. JOURNAL OF SUBSTANCE USE 2011. [DOI: 10.3109/14659891.2011.565110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Schuck K, Otten R, Engels RCME, Kleinjan M. The relative role of nicotine dependence and smoking-related cognitions in adolescents' process of smoking cessation. Psychol Health 2011; 26:1310-26. [PMID: 21598190 DOI: 10.1080/08870446.2010.520715] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The present study evaluates the role of distinct components of nicotine dependence (craving, withdrawal, behavioural dependence) in comparison to smoking-related cognitions (attitudes, perceived social approval, self-efficacy) in adolescent smoking cessation. In the process towards smoking cessation, we distinguish between distinct behavioural transitions, respectively, short-term abstinence, reduction in smoking behaviour and prolonged cessation, to evaluate differences in cessation-related antecedents as a function of varying behavioural outcomes. A total of 850 adolescent smokers (age 14-16) participated in the present study. Smoking behaviour was assessed 1 year after baseline. Results showed that all dependence components had a distinct role in the prediction of behavioural change towards cessation. Furthermore, each behavioural transition was predicted by a distinct set of variables, indicating that contributions of cessation-related factors vary across the course towards cessation. Overall, our findings suggest that smoking-related cognitions are particularly relevant in the initiation of behavioural change, such as short-term abstinence, whereas nicotine dependence, craving in particular, becomes increasingly important in the prediction of maintained behavioural change, such as prolonged cessation. Implications encompass enhanced attention to the multidimensional nature of nicotine dependence and the value of comparing different behavioural outcomes in a comprehensive understanding of cessation-related factors.
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Affiliation(s)
- Kathrin Schuck
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands.
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Castro Y, Kendzor DE, Businelle MS, Mazas CA, Cofta-Woerpel L, Cinciripini PM, Wetter DW. Structural and predictive equivalency of the Wisconsin Smoking Withdrawal Scale across three racial/ethnic groups. Nicotine Tob Res 2011; 13:548-55. [PMID: 21454912 DOI: 10.1093/ntr/ntr039] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The Wisconsin Smoking Withdrawal Scale (WSWS) is a valid and reliable scale among non-Latino Whites but has not been validated for use among other racial/ethnic groups despite increasing use with these populations. The current study examined the structural invariance and predictive equivalency of the WSWS across three racial/ethnic groups. METHODS The WSWS scores of 424 African American, Latino, and White smokers receiving smoking cessation treatment were analyzed in a series of factor analyses and multiple-group analyses. Additionally, hierarchical logistic regression analyses were conducted to determine whether WSWS scores differentially predicted smoking relapse across racial/ethnic groups. These analyses were consistent with a step-down hierarchical regression procedure for examination of test bias. RESULTS The 7-factor structure of the WSWS was largely confirmed in the current study, with the exception of the removal of two offending items. Evidence of full invariance across race/ethnicity was found in multiple-group analyses. The WSWS total score and subscales measuring anger, anxiety, concentration, and sadness predicted relapse, whereas the hunger, craving, and sleep subscales did not. None of these scales displayed differential predictive ability across race/ethnicity. The WSWS sleep subscale showed a significant interaction with race/ethnicity such that it was a significant predictor of relapse among Whites but not African Americans or Latinos. CONCLUSIONS Overall, the WSWS is similar in structure and predictive of relapse across racial/ethnic groups. Caution should be exercised when using the WSWS sleep subscale with African Americans and Latinos.
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Affiliation(s)
- Yessenia Castro
- Department of Health Disparities Research-Unit 1440, The University of Texas MD Anderson Cancer Center, Houston, TX 77230-1402, USA.
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Araujo RB, Oliveira MDS, Pedroso RS, Castro MDGTD. Coping strategies for craving management in nicotine dependent patients. BRAZILIAN JOURNAL OF PSYCHIATRY 2010; 31:89-94. [PMID: 19578678 DOI: 10.1590/s1516-44462009000200002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Accepted: 04/04/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the association between the intensity of craving and the types of coping skills used by nicotine-dependent patients. METHOD This was an experimental study. The sample comprised 201 subjects, mean age 38.15 years. The participants were randomly divided into groups of zero, 30 and 60 minutes of nicotine abstinence. The following instruments were administered: the Chart of Sociodemographic Data, the Fagerström Test for Nicotine Dependence, the Questionnaire of Smoking Urges, and the Coping Strategies Inventory. RESULTS The most frequently used coping strategies are presented in descending order: accepting responsibility, self-control and distancing. There was a positive correlation between the confrontive coping strategy and the total score on the Questionnaire of Smoking Urges (rs = 0.146; p = 0.045) and the score on Factor 1 (rs = 0.165; p = 0.023). CONCLUSION The most intense craving can lead nicotine-dependent individuals to use confrontive coping strategies that make them unable to control their emotions or to face the situations of high risk of relapse. This finding demonstrates that the treatment of smokers should include psychological education about the pitfalls of using these types of strategy and should teach them new types of coping strategies for craving management.
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Businelle MS, Kendzor DE, Reitzel LR, Costello TJ, Cofta-Woerpel L, Li Y, Mazas CA, Vidrine JI, Cinciripini PM, Greisinger AJ, Wetter DW. Mechanisms linking socioeconomic status to smoking cessation: a structural equation modeling approach. Health Psychol 2010; 29:262-73. [PMID: 20496980 PMCID: PMC2922845 DOI: 10.1037/a0019285] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Although there has been a socioeconomic gradient in smoking prevalence, cessation, and disease burden for decades, these disparities have become even more pronounced over time. The aim of the current study was to develop and test a conceptual model of the mechanisms linking socioeconomic status (SES) to smoking cessation. DESIGN The conceptual model was evaluated using a latent variable modeling approach in a sample of 424 smokers seeking treatment (34% African American; 33% Latino; 33% White). Hypothesized mechanisms included social support, neighborhood disadvantage, negative affect/stress, agency, and craving. MAIN OUTCOME MEASURE The primary outcome was Week 4 smoking status. RESULTS As was hypothesized, SES had significant direct and indirect effects on cessation. Specifically, neighborhood disadvantage, social support, negative affect/stress, and agency mediated the relation between SES and smoking cessation. A multiple group analysis indicated that the model was a good fit across racial/ethnic groups. CONCLUSION The present study yielded one of the more comprehensive models illuminating the specific mechanisms that link SES and smoking cessation. Policy, community, and individual-level interventions that target low SES smokers and address the specific pathways identified in the current model could potentially attenuate the impact of SES on cessation.
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Affiliation(s)
- Michael S Businelle
- Department of Health Disparities Research, University of Texas M. D. Anderson Cancer Center, UT School of Public Health, Dallas Regional Campus, 5323 Harry Hines Blvd., Dallas, TX 75390-9128, USA.
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West R, Ussher M. Is the ten-item Questionnaire of Smoking Urges (QSU-brief) more sensitive to abstinence than shorter craving measures? Psychopharmacology (Berl) 2010; 208:427-32. [PMID: 20033133 DOI: 10.1007/s00213-009-1742-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Accepted: 11/18/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The Questionnaire on Smoking Urges is now very widely used as a measure of craving but is considerably longer than alternatives in current use. Longer scales carry a significant cost in studies and clinical practice. This study compared the ten-item Questionnaire on Smoking Urges (QSU-brief) with six shorter measures of craving in terms of sensitivity to abstinence and reliability. METHODS Sixty smokers were randomly assigned to continue smoking (N = 30) or abstain completely for 24 h (n = 30), by which time the craving would be expected to have increased. Craving was measured at baseline and after 24 h. The craving measures tested were the QSU-brief, the Minnesota Nicotine Withdrawal Scale (MNWS), the Mood and Physical Symptoms Scale (MPSS), the Shiffman Scale (SS), the Wisconsin Smoking Withdrawal Scale and the Cigarette Withdrawal Scale and a simple rating of 'craving' (CR). RESULTS All measures showed significant increases in scores following smoking abstinence. The two-item MPSS measure was similar to the QSU-brief (eta-squared 0.41 versus 0.45, respectively), and the CR was only slightly lower (eta-squared 0.37). The MNWS showed the least sensitivity (eta-squared 0.22). Stability while still smoking was good with the exception of the SS which showed a significant reduction on retest. CONCLUSIONS The ten-item QSU-brief is not more sensitive to abstinence or reliable than the two-item MPSS or a single rating of craving.
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Affiliation(s)
- Robert West
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London WC1E6BT, UK.
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Ortendahl M, Näsman P. Judgments of Risk for Consequences of Continuing or Quitting Smoking—A Study of Pregnant and Nonpregnant Women Intending and Not Intending to Quit. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2009; 34:225-33. [DOI: 10.1080/00952990701877169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Carter BL, Lam CY, Robinson JD, Paris MM, Waters AJ, Wetter DW, Cinciripini PM. Generalized craving, self-report of arousal, and cue reactivity after brief abstinence. Nicotine Tob Res 2009; 11:823-6. [PMID: 19477914 DOI: 10.1093/ntr/ntp068] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Numerous studies report smokers' increased craving and physiological arousal when exposed to cigarette stimuli. These responses are attributed to learning processes (e.g., classical conditioning) and are associated with motivational factors that maintain nicotine dependence. However, much less is known about the degree to which these responses are maintained or diminished during quitting. METHODS Treatment-seeking smokers (N = 104) were randomly assigned to continue smoking or to enter a 2-week treatment program. Abstainers (n = 25) were continuously abstinent for 14-17 days at the time of testing. Control subjects (n = 38) continued to smoke at their usual rate. Participants who were assigned to treatment but resumed smoking during the study (n = 41) were considered to be relapsers. Approximately 2 weeks after baseline measurements, abstainers and controls viewed a series of neutral (n = 12) and cigarette (n = 12) pictures, rating them for craving and arousal (feelings of calm vs. excitement). RESULTS Non-cued craving (measured during exposure to neutral cues) was diminished in abstaining smokers. However, cigarette cues produced craving increases of the same magnitude in both abstainers and controls, showing that these cues still had evocative power for both groups. Abstaining smokers, who were not physiologically monitored, had lower self-reports of arousal to cigarette pictures than did controls, but the groups did not differ in arousal to neutral pictures. DISCUSSION These findings suggest that the foundations of cue-induced craving, generalized craving, and physiological arousal associated with craving may arise from separate processes.
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Affiliation(s)
- Brian L Carter
- Department of Behavioral Science, Unit 1330, University of Texas M. D. Anderson Cancer Center, PO Box 301439, Houston, TX 77230-1439, USA.
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Subjective, cognitive/psychomotor, and physiological effects of aripiprazole in Chinese light and heavy smokers. Drug Alcohol Depend 2009; 101:42-52. [PMID: 19070440 DOI: 10.1016/j.drugalcdep.2008.10.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Revised: 10/27/2008] [Accepted: 10/29/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND Drug addiction researchers have begun to study dopamine partial agonists as potential therapeutic agents. The partial dopamine D(2) receptor agonist aripiprazole has recently been tested as a treatment for stimulant and alcohol dependence in both animal and clinical studies. METHODS A randomized and placebo-controlled pilot clinical study was conducted in a population of Chinese light and heavy smokers to assess the effect of aripiprazole on various responses to smoking. The primary outcomes were subject's ratings on questionnaires of smoking urge, withdrawal syndromes, and cigarette evaluation. Placebo, 5, and 10mg aripiprazole were acutely administered in all participants, with administrations at least 7 days apart. Subjective responses to a smoked cigarette, working memory, and attention/psychomotor performance were assessed before and after drug administration in each experimental session. Abstinence-induced smoking urge, withdrawal symptoms, blood pressure, and heart rate were also measured every 45 min after drug administration. Finally, a cue-testing session was carried out 4h after each drug administration. RESULTS Administration of 10mg aripiprazole significantly decreased both the subjective response and psychological reward derived from smoking a cigarette in heavy smokers. While neither 5 nor 10mg aripiprazole significantly decreased abstinence-induced smoking urges or withdrawal symptoms in light and heavy smokers, these doses substantially attenuated drug cue-induced smoking urges in heavy smokers. Aripiprazole did not affect working memory or attention/psychomotor performance. CONCLUSIONS Light and heavy smokers responded differently to aripiprazole across various dependent measures. Aripiprazole may potentially affect various subjective responses to smoking in heavy smokers.
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Sayette MA, Loewenstein G, Griffin KM, Black JJ. Exploring the cold-to-hot empathy gap in smokers. Psychol Sci 2009; 19:926-32. [PMID: 18947359 DOI: 10.1111/j.1467-9280.2008.02178.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Many decisions related to cigarette smoking require people in an affectively neutral, or "cold," state to predict how they will feel or behave when in a craving, or "hot," state. Research in other domains has revealed that individuals in cold states often underestimate the impact of being in a hot state on their own future behavior. In a study testing whether this is true of cigarette craving, 98 smokers were assigned to one of three conditions: hot (during a high-craving first session, they made predictions about a high-craving state in a second session), cold (during a low-craving first session, they made predictions about a high-craving state in a second session), and comparison (they experienced a high-craving session only). As predicted, in contrast to smokers in the hot group, smokers in the cold group underpredicted the value they would place on smoking during the second session. Results support the existence of a cold-to-hot empathy gap in smokers and help to explain diverse aspects of tobacco addiction.
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Affiliation(s)
- Michael A Sayette
- Department of Psychology, University of Pittsburgh, 3137 Sennott Square, Pittsburgh, PA 15260, USA.
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Mechanisms of adolescent smoking cessation: roles of readiness to quit, nicotine dependence, and smoking of parents and peers. Drug Alcohol Depend 2009; 99:204-14. [PMID: 18848408 DOI: 10.1016/j.drugalcdep.2008.08.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Revised: 07/25/2008] [Accepted: 08/06/2008] [Indexed: 11/20/2022]
Abstract
Multiple levels of influence should be considered in interventions aimed at the adolescent smoker, including psychological, addiction, peer and parental influences. However, the mechanism by which these variables influence the process of smoking cessation in adolescents is not well elucidated. Therefore, this prospective study tested two models among 850 adolescent smokers, specifying the direct and indirect relations between adolescents' readiness to quit smoking, levels of nicotine dependence, and smoking behavior of their parents and friends. One year later smoking cessation was assessed. Results showed that, among adolescent smokers, readiness to quit was positively associated with quit attempts, while nicotine dependence was inversely associated with successful cessation. Instead of a direct relation, parental and peers' smoking were inversely related to smoking cessation through nicotine dependence. The findings emphasize that interventions should be developed and tested within and outside the school setting, as well as within the family situation. In addition, the strong impact of nicotine dependence on successful cessation indicates that a more direct approach is needed to lower nicotine dependence among adolescents.
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Smith AE, Cavallo DA, Dahl T, Wu R, George TP, Krishnan-Sarin S. Effects of acute tobacco abstinence in adolescent smokers compared with nonsmokers. J Adolesc Health 2008; 43:46-54. [PMID: 18565437 PMCID: PMC2527725 DOI: 10.1016/j.jadohealth.2007.12.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Revised: 11/29/2007] [Accepted: 12/01/2007] [Indexed: 11/17/2022]
Abstract
PURPOSE Abstinence effects such as nicotine withdrawal and mood changes contribute to the maintenance of cigarette smoking in adult smokers, and emerging reports on adolescent smokers suggest they may experience similar subjective effects when deprived. This study aimed to prospectively document tobacco abstinence-induced changes during the first 48 hours of abstinence in adolescent smokers compared with nonsmokers, to distinguish effects distinct from typical adolescent lability. METHODS Fifty-seven adolescent smokers and 44 adolescent nonsmokers were assessed during a 48-hour inpatient session. Characteristic nicotine withdrawal symptoms, cravings for cigarettes, and mood symptoms were measured at 13 time points following initiation of abstinence. RESULTS The only abstinence-related effects observed were changes in craving for tobacco and feelings of anger. Tobacco craving increased and peaked quickly following initiation of abstinence and displayed a slight decrease toward the end of the 48-hour abstinence period, while anger symptoms peaked after a more prolonged abstinence. Overall, smokers' symptoms and cravings were positively associated with amount of daily smoking but not with reports of dependence or biological measures of extent of use. CONCLUSIONS We observed that among adolescent smokers, the primary effects associated with abstinence from cigarettes are relatively minimal, and include a heightened and persistent craving to smoke and increases in anger. Although smokers had greater negative mood symptoms compared with nonsmokers, the presence and severity of most of these symptoms appear to be minimally altered by abstinence and not associated with dependency or biological indicators of amount of tobacco use.
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Affiliation(s)
- Anne E Smith
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06519, USA
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