Nicotine dependence: development, mechanisms, individual differences and links to possible neurophysiological correlates

Transcranial direct current stimulation reduces negative affect but not cigarette craving in overnight abstinent smokers

Transcranial direct current stimulation (tDCS) can enhance cognitive control functions including attention and top-down regulation over negative affect and substance craving in both healthy and clinical populations, including early abstinent (∼1.5 h) smokers. The aim of this study was to assess whether tDCS modulates negative affect, cigarette craving, and attention of overnight abstinent tobacco dependent smokers. In this study, 24 smokers received a real and a sham session of tDCS after overnight abstinence from smoking on two different days. We applied anode to the left dorsolateral prefrontal cortex and cathode to the right supra-orbital area for 20 min with a current of 2.0 mA. We used self-report questionnaires Profile of Mood States (POMS) to assess negative affect and Urge to Smoke (UTS) Scale to assess craving for cigarette smoking, and a computerized visual target identification task to assess attention immediately before and after each tDCS. Smokers reported significantly greater reductions in POMS scores of total mood disturbance and scores of tension-anxiety, depression-dejection, and confusion-bewilderment subscales after real relative to sham tDCS. Furthermore, this reduction in negative affect positively correlated with the level of nicotine dependence as assessed by Fagerström scale. However, reductions in cigarette craving after real vs. sham tDCS did not differ, nor were there differences in reaction time or hit rate change on the visual task. Smokers did not report significant side effects of tDCS. This study demonstrates the safety of tDCS and its promising effect in ameliorating negative affect in overnight abstinent smokers. Its efficacy in treating tobacco dependence deserves further investigation.

Can Smoking for Positive or Negative Reinforcement Together With Dependence Help Us Better Diagnose Smokers?

With more medications available for smoking cessation treatment the need to diagnose the tobacco dependence for better tailoring of treatment is growing. It has been suggested that smokers can be peak seekers or trough maintainers vis-à-vis blood nicotine concentrations (Russell, 1990), or smoking predominantly for coping with withdrawal or smoking for pleasure (Juniper et al., 2005). In this article a related concept, smoking for negative reinforcement (NR) or positive reinforcement (PR), is investigated. A simple 1-question assessment of type of reinforcement is suggested. From data from smokers attending smoker's clinics — 2 from Sweden using varenicline and 1 from Spain using nicotine patches — it looks as if smokers smoking predominantly for PR do better than NR smokers when treated with varenicline, while there is no difference when they are treated with nicotine replacement. When degree of nicotine dependence is crossed with type of reinforcement it looks as if NR/low nicotine dependent smokers have the best outcome (64%) compared with 47% (p < .01) for the whole sample treated with nicotine replacement. When varenicline is used, the PR/low dependent group had the best quit rate with 85% compared with 67% (p < .05) for the whole sample. This brief report proposes that smoking for PR or NR, possibly combined with degree of dependence, should be further studied as a tool for tailoring smoking cessation treatments.

Predictors of DSM and Fagerstrom-defined nicotine dependence in African American and Puerto Rican young adults

This study examined the psychosocial predictors of nicotine dependence, as defined by a variant of the criteria employed in the DSM-IV-specifically that of the University of Michigan Composite International Diagnostic Interview (UM-CIDI)-and the Fagerstrom Test for Nicotine Dependence (FTND). The study was conducted with a community sample of African American and Puerto Rican young adults (N = 475; mean age = 26). Predictor variables included physiologically based psychosocial (i.e., depressive symptoms and family problems with smoking) as well as social-behavioral psychosocial (i.e., rebelliousness and partner's problems with smoking) predictors of nicotine dependence. Using multiple regression analyses, UM-CIDI-defined dependence was predicted by each of the four psychosocial variables, while FTND-defined dependence was predicted only by the social-behavioral variables. These findings bear out the disparate dimensions of nicotine dependence each measure taps. Research and clinical implications of the findings are discussed, and the study's limitations are noted.

Effects of ethanol on nicotine-induced conditioned place preference in C57BL/6J mice

It has been shown that small doses of ethanol (<or= 1.0 g/kg) may antagonize the discriminative stimulus properties of nicotine. The aim of the present study was to evaluate whether ethanol could antagonize nicotine's rewarding effects in the conditioned place preference procedure. For comparison, effects of ethanol on nicotine-induced seizures were assessed. Male C57BL/6J mice were used in all experiments. Lower doses of nicotine (0.3 and 0.6 mg/kg, s.c.) induced significant conditioned place preference, while higher doses (0.9 and 1.2 mg/kg) induced neither conditioned place preference nor conditioned place aversion. In the following experiments, ethanol (0.5 or 1.0 g/kg, i.p.) was administered 5 min before 0.3 mg/kg nicotine. Ethanol did not antagonize nicotine-induced conditioned place preference. Contrary to our hypothesis, a non-significant (p = 0.07) enhancement of nicotine-induced place preference conditioning was observed in mice pre-treated with 1.0 g/kg ethanol. Both doses of ethanol (0.5 and 1.0 g/kg) suppressed seizures elicited by a high dose of nicotine (6.0 mg/kg). Ethanol totally eliminated clonic-tonic component of nicotine-induced seizures. Maximal blood ethanol levels after i.p. administration of 0.5 or 1.0 g/kg ethanol exceeded 60 and 115 mg%, respectively. The present results may indicate that the rewarding and seizure-inducing effects of nicotine are differentially modulated by clinically relevant concentrations of ethanol in mice.

Nicotine-induced conditioned taste aversion in the rat: Effects of ethanol

It has been shown that small doses of ethanol antagonise the discriminative stimulus properties of nicotine in the rat. The aim of the present study was to evaluate whether ethanol could antagonise the aversive stimulus effects of nicotine. Wistar rats were trained to associate nicotine injections with a novel tasting fluid (0.1% saccharin) in the conditioned taste aversion procedure. Nicotine (0.3 mg/kg, s.c.) was injected 5 min after the end of a 20-min exposure to the saccharin solution. Ethanol (0.25-0.5 g/kg, i.p.) was administered 5 or 50 min before nicotine. In general, ethanol did not inhibit nicotine-induced conditioned taste aversion. Contrary to the findings in drug discrimination studies, a slight but significant enhancement of nicotine-induced taste aversion conditioning was observed after ethanol pre-treatment. Blood ethanol levels were measured in a separate group of rats. Maximal blood ethanol levels after i.p. administration of 0.25 or 0.5 g/kg ethanol exceeded 20 and 80 mg%, respectively. Concluding, the present results may indicate that ethanol does not attenuate nicotine-induced conditioned taste aversion in the rat.

Prevalence of patients continuing to smoke after vascular interventions

INTRODUCTION

Smoking is one of the most important risk factors for the development and progression of atherosclerosis. Smoking cessation is an obligatory element in the management of vascular problems and in patients scheduled for vascular interventions. The aim of this study was to assess the prevalence of patients smoking before and after vascular surgical procedures and to evaluate the requirements for inpatient programs for smoking cessation and nicotine replacement therapy.

METHODS

500 patients admitted for vascular interventions were included in this prospective study. Smoking status was evaluated both objectively and subjectively. All patients underwent measurements of exhaled breath carbon monoxide to quantify nicotine dependency and all answered a standardized Fagerström questionnaire both on admission and after surgery to identify current smokers.

RESULTS

Of 500 vascular patients included in the study, only 70 (14 %) never had smoked, 243 (49 %) had given up smoking before admission and 161 (32 %) were current smokers. Of the current smokers, 64 (40 %) did not smoke during hospitalization but 97 (60 %) continued to smoke in hospital. Of these 97 patients, 78 (80 %) were men and 19 women; their mean age was 61 +/- 4 years (range 40-84). Four patients had surgery for infrarenal aortic aneurysm, 40 underwent carotid endarterectomy and 53 had peripheral arterial occlusive disease (PAD). There was no difference between abstinent patients and continuing smokers in previous cigarette consumption or Fagerström score, a predictor for long-term smoking behavior. Patients with carotid artery stenosis were significantly more abstinent while hospitalized (P = 0.006); patients with PAD, however, were more likely to continue smoking as inpatients (P = 0.004). Sixty-five percent of continuing smokers stated that they would stop smoking in hospital if counseling and nicotine replacement therapy were provided. With regard to their predominant location of atherosclerosis, patients with PAD were less willing than those with carotid stenosis to abstain from smoking while hospitalized (53 % vs 88 %, respectively; P < 0.001).

CONCLUSION

A substantial proportion of patients admitted for vascular surgery are smokers. More than half of these continue to smoke in the hospital, an environment where smoking is prohibited by law. Counseling, nicotine replacement therapy and smoking-cessation programs are urgently needed for vascular surgical inpatients.

Extended blockade of the discriminative stimulus effects of nicotine with low doses of ethanol

The aim of the present study was to further evaluate effects of ethanol on nicotine discrimination and to correlate these effects with blood ethanol levels. Rats were trained to discriminate 0.3 mg/kg nicotine from its vehicle in the standard two-lever operant procedure. In antagonism tests, small doses of ethanol (0.25-0.5 g/kg) were injected either 5 or 50 min before nicotine. Both doses of ethanol partially antagonized the nicotine cue regardless of the pre-treatment time. Ethanol attenuated also inhibitory effects of nicotine on the rate of responding. Suppression of the cueing effects of nicotine was noted even 60 min after the injection of 0.25 g/kg ethanol, i.e. at the time point when the blood ethanol level was close to zero. Ethanol-induced antagonism of the nicotine cue disappeared when longer time (110 min) was allowed to elapse between the ethanol (0.5 g/kg) and nicotine injection. Concluding, the present results may indicate that the effects of ethanol on nicotine discrimination are not primarily related to blood ethanol levels.

Quantification of recent smoking behaviour using proton transfer reaction-mass spectrometry (PTR-MS)

Smoking is the most important single risk factor in current public health. Surveillance of exposure to tobacco smoke may be accomplished using environmental monitoring or in-vivo tests for smoking biomarkers. Acetonitrile exhaled in human breath has been described as a potential marker mirroring recent smoking behavior. The aim of this study was to determine exhaled acetonitrile levels in a sample of 268 volunteers (48 smokers, 220 non-smokers) attending a local health fair. Breath specimens were collected into inert sample bags, with parallel collection of ambient air. Subsequently, all samples were analysed using proton transfer reaction-mass spectrometry (PTR-MS). Smokers had elevated levels of exhaled acetonitrile compared with non-smokers (p<0.001). Analysis using the receiver-operating-characteristic curve demonstrated that smoking can be predicted with a sensitivity of 79% and a specificity of 91%, using a cut-off concentration of 20.31 parts per billion of acetonitrile. This first field survey of exhaled acetonitrile in a large group of test persons demonstrates the feasibility of a rapid and non-invasive test for recent exposure to tobacco. We conclude that analysis of exhaled-breath acetonitrile may serve as a method of determining recent active smoking behaviour.