Effects of varenicline on abstinence and smoking reward following a programmed lapse

Involvement of neuronal β2 subunit-containing nicotinic acetylcholine receptors in nicotine reward and withdrawal: implications for pharmacotherapies

WHAT IS KNOWN AND OBJECTIVE

Tobacco smoking remains a major health problem. Nicotine binds to nicotinic acetylcholine receptors (nAChRs), which can cause addiction and withdrawal symptoms upon cessation of nicotine administration. Pharmacotherapies for nicotine addiction target brain alterations that underlie withdrawal symptoms. This review will delineate the involvement of the β2 subunit of neuronal nAChRs in nicotine reward and in generating withdrawal symptoms to better understand the efficacy of smoking cessation pharmacotherapies.

COMMENT

Chronic nicotine desensitizes and upregulates β2 subunit-containing nAChRs, and the prolonged upregulation of receptors may underlie symptoms of withdrawal. Experimental research has demonstrated that the β2 subunit of neuronal nAChRs is necessary for generating nicotine reward and withdrawal symptoms.

WHAT IS NEW AND CONCLUSION

Smoking cessation pharmacotherapies act on β2 subunit-containing nAChRs to reduce nicotine reward and withdrawal symptom severity.

Demand curves for hypothetical cocaine in cocaine-dependent individuals

RATIONALE

Drug purchasing tasks have been successfully used to examine demand for hypothetical consumption of abused drugs including heroin, nicotine, and alcohol. In these tasks, drug users make hypothetical choices whether to buy drugs, and if so, at what quantity, at various potential prices. These tasks allow for behavioral economic assessment of that drug's intensity of demand (preferred level of consumption at extremely low prices) and demand elasticity (sensitivity of consumption to price), among other metrics. However, a purchasing task for cocaine in cocaine-dependent individuals has not been investigated.

OBJECTIVES

This study examined a novel Cocaine Purchasing Task and the relation between resulting demand metrics and self-reported cocaine use data.

METHODS

Participants completed a questionnaire assessing hypothetical purchases of cocaine units at prices ranging from $0.01 to $1,000. Demand curves were generated from responses on the Cocaine Purchasing Task. Correlations compared metrics from the demand curve to measures of real-world cocaine use.

RESULTS

Group and individual data were well modeled by a demand curve function. The validity of the Cocaine Purchasing Task was supported by a significant correlation between the demand curve metrics of demand intensity and O max (determined from Cocaine Purchasing Task data) and self-reported measures of cocaine use. Partial correlations revealed that after controlling for demand intensity, demand elasticity and the related measure, P max, were significantly correlated with real-world cocaine use.

CONCLUSIONS

Results indicate that the Cocaine Purchasing Task produces orderly demand curve data, and that these data relate to real-world measures of cocaine use.

Isolating behavioural economic indices of demand in relation to nicotine dependence

RATIONALE

Characterisation of drug dependence using principles from behavioural economics has provided a more detailed understanding of the disorder. Although questionnaires assessing economic demand for cigarettes have extended these principles to nicotine addiction, aspects of the reliability and selectivity of these questionnaires remain uncertain.

OBJECTIVE

Across two experiments, we attempted to reproduce significant associations of the cigarette purchase task with nicotine dependence in a young adult population of smokers and contrasted this measure with a novel chocolate purchase task. We also examined the association between these measures and performance on a preference task, measuring preference for cigarettes and chocolate.

METHODS

Questionnaire measures were used within a university setting.

RESULTS

In experiment 1, we observed associations between nicotine dependence and measures of behavioural economic demand for cigarettes, particularly O (max). In experiment 2, we replicated these findings again and extended them to show that similar correlations between nicotine dependence and demand for chocolate were not observed. Moreover, the indices of demand and choices on a concurrent choice cigarette task were moderately associated with each other and independently associated with nicotine dependence.

CONCLUSIONS

The two experiments clearly supported previous findings regarding the association between nicotine dependence and economic demand for cigarettes. We extend these observations by showing that the generalisation of economic demand across different commodities is relatively weak, but that generalisation across different procedures is strong. Our results therefore support behavioural economic models of nicotine addiction which emphasise a robust proximal role for the incentive value of cigarettes.

The dose effects of short-term dronabinol (oral THC) maintenance in daily cannabis users

BACKGROUND

Prior studies have separately examined the effects of dronabinol (oral THC) on cannabis withdrawal, cognitive performance, and the acute effects of smoked cannabis. A single study examining these clinically relevant domains would benefit the continued evaluation of dronabinol as a potential medication for the treatment of cannabis use disorders.

METHODS

Thirteen daily cannabis smokers completed a within-subject crossover study and received 0, 30, 60 and 120mg dronabinol per day for 5 consecutive days. Vital signs and subjective ratings of cannabis withdrawal, craving and sleep were obtained daily; outcomes under active dose conditions were compared to those obtained under placebo dosing. On the 5th day of medication maintenance, participants completed a comprehensive cognitive performance battery and then smoked five puffs of cannabis for subjective effects evaluation. Each dronabinol maintenance period occurred in a counterbalanced order and was separated by 9 days of ad libitum cannabis use.

RESULTS

Dronabinol dose-dependently attenuated cannabis withdrawal and resulted in few adverse side effects or decrements in cognitive performance. Surprisingly, dronabinol did not alter the subjective effects of smoked cannabis, but cannabis-induced increases in heart rate were attenuated by the 60 and 120mg doses.

CONCLUSIONS

Dronabinol's ability to dose-dependently suppress cannabis withdrawal may be therapeutically beneficial to individuals trying to stop cannabis use. The absence of gross cognitive impairment or side effects in this study supports safety of doses up to 120mg/day. Continued evaluation of dronabinol in targeted clinical studies of cannabis treatment, using an expanded range of doses, is warranted.