Targeting the Brain Stress Systems for the Treatment of Tobacco/Nicotine Dependence: Translating Preclinical and Clinical Findings

Consideration of sex and gender differences in addiction medication response

Substance use continues to contribute to significant morbidity and mortality in the United States, for both women and men, more so than another other preventable health condition. To reduce the public health burden attributable to substances, the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism have identified that medication development for substance use disorder is a high priority research area. Furthermore, both Institutes have stated that research on sex and gender differences in substance use medication development is a critical area. The purpose of the current narrative review is to highlight how sex and gender have been considered (or not) in medication trials for substance use disorders to clarify and summarize what is known regarding sex and gender differences in efficacy and to provide direction to the field to advance medication development that is consistent with current NIH 'sex as a biological variable' (SABV) policy. To that end, we reviewed major classes of abused substances (nicotine, alcohol, cocaine, cannabis, opioids) demonstrating that, sex and gender have not been well-considered in addiction medication development research. However, when adequate data on sex and gender differences have been evaluated (i.e., in tobacco cessation), clinically significant differences in response have been identified between women and men. Across the other drugs of abuse reviewed, data also suggest sex and gender may be predictive of outcome for some agents, although the relatively low representation of women in clinical research samples limits making definitive conclusions. We recommend the incorporation of sex and gender into clinical care guidelines and improved access to publicly available sex-stratified data from medication development investigations.

The Transdiagnostic Nature of Cravings: Smoking Cessation and Food Craving in Pregnancy

OBJECTIVES

Smoking cessation prior to pregnancy is strongly encouraged due to the adverse effects of tobacco use on the developing fetus, but appears to also increase risk of excess gestational weight gain (GWG). Smoking cessation has previously been shown to cause weight gain in non-pregnant individuals, in part due to an increase in food craving frequency. Food craving frequency in pregnancy is a known predictor of excess GWG, but has not yet been examined in relation to pre-pregnancy smoking status. This study sought to test the hypothesis that pre-pregnancy smoking cessation elevates excess GWG risk via an increase in food craving frequency.

METHODS

Pregnant women (n = 82) completed measures of pre-pregnancy tobacco use and current general and specific food cravings. Gestational weight gain was calculated based on participant self-report of pre-pregnancy weight and data on weight prior to delivery culled from medical records.

RESULTS

Pre-pregnancy tobacco use was associated with significantly greater food craving frequency in pregnancy (p = .05), specifically for high-fat and fast-foods (both p < .05), compared to women who did not smoke. Emotional and physiological aspects of cravings accounted for 35% of the variance in excess GWG (p < .03).

CONCLUSIONS

Pre-pregnancy smoking appears predictive of food raving frequency in pregnancy and could thus contribute to excess GWG risk. Findings highlight the importance of incorporating strategies for managing cravings into behavioral interventions promoting healthy GWG for women endorsing pre-pregnancy tobacco use.