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Spillane JA, Soyster P. Modeling Idiographic Longitudinal Relationships between Affect and Cigarette Use: An Ecological Momentary Assessment Study. Subst Use Misuse 2023; 58:1883-1894. [PMID: 37735802 PMCID: PMC10872632 DOI: 10.1080/10826084.2023.2257312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Background: Despite public knowledge of the adverse health effects of tobacco use, cigarettes remain widely used due to the addictive nature of nicotine. Physiologic adaptation to the presence of nicotine over time leads to unpleasant effects during withdrawal periods. Alongside these physiological effects, tobacco users often report changes in their consumption of tobacco in response to their emotional state. Objectives: We hypothesized that idiographic, or person-specific level, increases in participants' negative affect (NA) and positive affect (PA) ratings at a given time point would be associated with higher and lower craving and smoking over the following several hours, respectively. Fifty-two participants completed block randomized ecological momentary assessment surveys on their smartphones 4 times per day for 30 days, reporting from 0-100 their level of seven discrete emotions, stress, current craving, and smoking behavior. We analyzed the relationships between affect and smoking and craving using idiographic generalized linear models. Results: While some participants exhibited the hypothesized relationships, each participant varied in the strength and direction of the relationships between affect and craving/smoking. These outcomes were partially moderated at the group level by anxiety/depression at baseline, but not by level of nicotine dependence or sex. Conclusions: This suggests that the factors driving cigarette use vary significantly between individuals.
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Affiliation(s)
| | - Peter Soyster
- Department of Psychology, University of California, Berkeley, USA
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2
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Strigo IA, Murphy E, Mitchell JM, Spadoni AD. Learning from addiction: Craving of prescription opioids in chronic pain sufferers. Neurosci Biobehav Rev 2022; 142:104904. [PMID: 36202255 PMCID: PMC10917419 DOI: 10.1016/j.neubiorev.2022.104904] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 01/19/2023]
Abstract
Prescription opioids are a primary driver of opioid-related deaths. Although craving is a substantial component of OUD, the degree to which craving leads to misuse among chronic pain patients on long-term prescription opioids is unknown. A clear understanding of the factors that lead to misuse in this vulnerable population is needed for the development of safe and effective practices for opioid taper. This narrative review summarizes the relevant literature on the role of craving in addiction and chronic pain through epidemiological and behavioral studies. The first part of this review examines the role of craving in predicting opioid use/misuse in individuals with chronic pain with and without OUD. The second part covers methods on how craving is evaluated experimentally using both subjective and objective measures and provides related findings. The overall goal of this review is to facilitate the development of a population-specific description of craving in those who use opioids to control chronic pain and to describe how it may be mechanistically linked to patterns of opioid (mis)use.
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Affiliation(s)
- Irina A Strigo
- Emotion and Pain Laboratory, San Francisco Veterans Affairs Healthcare Center, 4150 Clement Street, San Francisco, CA 94121, USA; Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, USA.
| | - Emily Murphy
- Emotion and Pain Laboratory, San Francisco Veterans Affairs Healthcare Center, 4150 Clement Street, San Francisco, CA 94121, USA
| | - Jennifer M Mitchell
- Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, USA; Department of Neurology, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, USA
| | - Andrea D Spadoni
- San Diego Veterans Affairs Healthcare Center, 3350 La Jolla Village Drive, San Diego, CA 92121, USA; Department of Psychiatry, University of California San Diego, San Diego, CA 92300, USA
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3
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Londoño T, Moore JR, Guerra ZC, Heydarian NM, Castro Y. The contribution of positive affect and loneliness on readiness and self-efficacy to quit smoking among Spanish-speaking Mexican American smokers. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2022; 48:110-119. [PMID: 34932409 PMCID: PMC10763704 DOI: 10.1080/00952990.2021.1998513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The existing research on affective and interpersonal determinants of smoking cessation largely under-represents minority smokers, such as Latinos. OBJECTIVE The current study examined associations between affective and interpersonal factors with intermediary smoking cessation variables among Mexican-American smokers (N = 290; 60% male). METHODS Measures of positive and negative affect, social support, and loneliness were each examined for associations with measures of motivational readiness to quit smoking, and smoking abstinence self-efficacy. Significant predictors were entered into models simultaneously to examine their unique associations. Covariates included gender, age, and educational attainment. RESULTS Negative affect (b = .68, SE b = .14, p < .001) and loneliness (b = .20, SE b = .09, p < .05) were independently associated with motivation. Negative affect (b = .20, SE b = .06, p < .01) and positive affect (b = .34 SE b = .07, p < .001) were independently associated with self-efficacy. In the final models, only negative affect was associated with motivation (b = .68, SE b = .17, p < .001); whereas negative (b = .17, SE b = .06, p < .01) and positive (b = . 32, SE b = .07, p < .001) affect were associated with self-efficacy. CONCLUSION Results highlight the importance of resilience factors (e.g., positive affect) among Mexican-American smokers. Cessation interventions regularly target negative affect among smokers; additional focus on positive affect in cessation interventions with this population may be warranted.
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Affiliation(s)
- Tatiana Londoño
- Steve Hicks School of Social Work, The University of Texas, Austin, TX, USA
| | - John R Moore
- Steve Hicks School of Social Work, The University of Texas, Austin, TX, USA
| | - Zully C Guerra
- Steve Hicks School of Social Work, The University of Texas, Austin, TX, USA
| | | | - Yessenia Castro
- Steve Hicks School of Social Work, The University of Texas, Austin, TX, USA
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Calixte-Civil PF, Brandon TH. The Effect of Acute Interpersonal Racial Discrimination on Smoking Motivation and Behavior Among Black Smokers: an Experimental Study. J Racial Ethn Health Disparities 2020; 8:1511-1521. [PMID: 33215359 DOI: 10.1007/s40615-020-00914-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/12/2020] [Accepted: 10/27/2020] [Indexed: 12/20/2022]
Abstract
In comparison to White smokers, Black smokers are likely to report both more discrimination and less success in smoking cessation. No previous study has tested the causal relationship between an experience of racial discrimination and smoking variables associated with cessation. The goal of this study was to test the causal influence of interpersonal racial discrimination on smoking motivation (i.e., the urge to smoke cigarettes, cessation self-efficacy, and smoking behavior) using a controlled experimental design. We used a virtual ball-playing game to create a laboratory model of racial discrimination. A 2 × 2 between-subjects factorial design (inclusion/exclusion vs. ingroup/outgroup) was used to randomly assign participants to one of four groups: (1) included/ingroup, (2) included/outgroup, (3) excluded/ingroup (ostracism), and (4) excluded/outgroup (racial discrimination). Sixty-nine Black smokers were recruited from the community. Participants in the excluded conditions reported lower cessation self-efficacy than those in the included conditions. Participants in the outgroup conditions had reduced latency to smoke compared to those in the ingroup conditions. There were no main effects of social inclusion on cravings or latency to smoke and no statistically significant interactions for social inclusion × group membership. This laboratory simulation of racial discrimination shows a causal relationship between exclusion and low cessation self-efficacy, which contributes to a better understanding of influences upon smoking cessation attempts among Black smokers.
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Affiliation(s)
| | - Thomas H Brandon
- Department of Psychology, University of South Florida, Tampa, FL, USA
- Department of Health Outcomes and Behavior, Tobacco Research & Intervention Program, Moffitt Cancer Center & Research Institute, 4115 E. Fowler Avenue, Tampa, FL, 33617, USA
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5
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Opioid treatment for acute and chronic pain in patients with sickle cell disease. Neurosci Lett 2020; 714:134534. [DOI: 10.1016/j.neulet.2019.134534] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 09/13/2019] [Accepted: 10/01/2019] [Indexed: 12/24/2022]
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Robinson JD, Li L, Chen M, Lerman C, Tyndale RF, Schnoll RA, Hawk LW, George TP, Benowitz NL, Cinciripini PM. Evaluating the temporal relationships between withdrawal symptoms and smoking relapse. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2019; 33:105-116. [PMID: 30614717 PMCID: PMC6405298 DOI: 10.1037/adb0000434] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Smokers attempting to quit often attribute smoking relapse to negative affect, craving, and other nicotine withdrawal symptoms. In addition, there is evidence that smoking relapse can increase these symptoms, particularly negative affect. To address this issue, we analyzed data from an 11-week smoking cessation clinical trial in which smokers (n = 1,246) were randomized to receive either nicotine replacement therapy (NRT), varenicline, or placebo, combined with behavioral counseling. Using cross-lagged analyses, we examined the temporal bidirectional relationships between self-reported measures of affect, craving, and composite withdrawal symptoms and biochemically verified smoking abstinence. The relative strength of these temporal relationships was examined by comparing the explained variances of the models. The results showed that higher negative affect, craving, and composite withdrawal symptoms increased the likelihood of subsequent smoking relapse, and that smoking relapse led to subsequent increases in these same symptoms. A comparison of the explained variances found symptom predicting subsequent relapse models to be stronger than those where relapse predicted subsequent symptoms. Although the explained variance findings generally support a negative reinforcement conceptualization of nicotine dependence, the bidirectional relationship between symptoms and smoking relapse suggests that struggling with quitting smoking leads to significant negative affect, craving, and other withdrawal symptoms that do not quickly resolve. These findings highlight the importance of addressing specific symptoms within the context of smoking cessation. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Liang Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center
| | - Minxing Chen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center
| | - Caryn Lerman
- Department of Psychiatry, Annenberg School for Communication, University of Pennsylvania
| | | | | | - Larry W Hawk
- Department of Psychology, University at Buffalo, State University of New York
| | - Tony P George
- Centre for Addiction and Mental Health, University of Toronto
| | - Neal L Benowitz
- Department of Medicine, University of California, San Francisco
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Pericot-Valverde I, Secades-Villa R, Gutiérrez-Maldonado J. A randomized clinical trial of cue exposure treatment through virtual reality for smoking cessation. J Subst Abuse Treat 2019; 96:26-32. [DOI: 10.1016/j.jsat.2018.10.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 09/24/2018] [Accepted: 10/15/2018] [Indexed: 01/22/2023]
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8
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Cui Y, Engelmann JM, Xian J, Minnix JA, Lam CY, Karam-Hage M, Cinciripini PM, Robinson JD. Pharmacological intervention and abstinence in smokers undergoing cessation treatment: A psychophysiological study. Int J Psychophysiol 2018; 123:25-34. [PMID: 29223599 PMCID: PMC5759327 DOI: 10.1016/j.ijpsycho.2017.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/09/2017] [Accepted: 12/01/2017] [Indexed: 01/22/2023]
Abstract
As a composite concept, negative affect comprises various aversive emotional experiences, such as irritability and nervousness. It is a critical motivational factor that helps maintain smoking behavior, and contributes significantly to smoking cessation failure as a core withdrawal symptom. Prior research has indicated an important role of nicotinic mechanisms in negative affect processing. The most effective smoking cessation medication, varenicline, targets nicotinic acetylcholine receptors (nAChRs) as a partial agonist, while another first-line cessation medication, bupropion, has shown antagonistic effects on nAChRs. Therefore, it is possible that both medications work to reduce smoking behavior through modulating negative affect processing. To evaluate this hypothesis, we examined the impact of varenicline tartrate and bupropion hydrochloride sustained-release on electrophysiological responses to affective, cigarette-related, and neutral cues before and during smoking cessation treatment in a randomized placebo-controlled clinical trial. The participants were 206 smokers, a subset of 294 participants that were enrolled in a larger smoking cessation clinical trial who were randomly assigned to one medication group for 12weeks. Orbicularis oculi (startle eyeblink response) and corrugator supercilii facial electromyographic (EMG) reactivity toward emotional pictures (i.e., pleasant and unpleasant) in a picture-viewing task were measured before treatment and 2 and 6weeks after treatment was started. The startle and corrugator EMG activities increase with the exposure to unpleasant cues, and served as indices for negative emotional reactivity (NER). We found that after 6weeks, drug reduced startle-related NER in the varenicline group, but not in the bupropion or placebo group. Independent of medication treatment, lower baseline NER, as measured by the corrugator EMG activity, predicted a higher likelihood of smoking abstinence 1 and 3months after quitting smoking. These findings indicate the important roles of varenicline in negative affect processing and negative emotional reactivity in the course of smoking cessation.
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Affiliation(s)
- Yong Cui
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jeffrey M Engelmann
- Department of Psychiatry and Behavioral Medicine, Medial College of Wisconsin, Milwaukee, WI, United States
| | - Jonathan Xian
- Texas A&M Health Science Center College of Medicine, United States
| | - Jennifer A Minnix
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Cho Y Lam
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - Maher Karam-Hage
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Paul M Cinciripini
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jason D Robinson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
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Cook JW, Baker TB, Beckham JC, McFall M. Smoking-induced affect modulation in nonwithdrawn smokers with posttraumatic stress disorder, depression, and in those with no psychiatric disorder. JOURNAL OF ABNORMAL PSYCHOLOGY 2016; 126:184-198. [PMID: 28004948 DOI: 10.1037/abn0000247] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This research sought to determine whether smoking influences affect by means other than withdrawal reduction. Little previous evidence suggests such an effect. We surmised that such an effect would be especially apparent in posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), 2 disorders that are frequently comorbid with smoking and that involve dysregulated affect. Participants were U.S. veterans who were regular smokers (N = 159): 52 with PTSD (58% with comorbid MDD), 51 with MDD, and 56 controls with no psychiatric disorder. During 3 positive and 3 negative mood induction trials (scheduled over 2 sessions), nonwithdrawn participants smoked either a nicotine-containing cigarette (NIC+), a nicotine-free cigarette (NIC-), or held a pen. Positive and negative affect were each measured before and after mood induction. Results showed a significant 2-way interaction of Smoking Condition × Time on negative affect during the negative mood induction (F(6, 576) = 2.41, p = .03) in those with PTSD and controls. In these groups, both NIC+ and NIC-, relative to pen, produced lower negative affect ratings after the negative mood induction. There was also a 2-way interaction of Smoking Condition × Time on positive affect response to the positive mood induction among those with PTSD and controls (F(6, 564) = 3.17, p = .005) and among MDD and controls (F(6, 564) = 2.27, p = .036). Among all smokers, NIC+ enhanced the magnitude and duration of positive affect more than did NIC-. Results revealed affect modulation outside the context of withdrawal relief; such effects may motivate smoking among those with psychiatric diagnoses, and among smokers in general. (PsycINFO Database Record
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Affiliation(s)
- Jessica W Cook
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health
| | - Timothy B Baker
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health
| | | | - Miles McFall
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and Public Health
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10
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Biases in the Explore-Exploit Tradeoff in Addictions: The Role of Avoidance of Uncertainty. Neuropsychopharmacology 2016; 41:940-8. [PMID: 26174598 PMCID: PMC4650253 DOI: 10.1038/npp.2015.208] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 07/03/2015] [Accepted: 07/05/2015] [Indexed: 11/08/2022]
Abstract
We focus on exploratory decisions across disorders of compulsivity, a potential dimensional construct for the classification of mental disorders. Behaviors associated with the pathological use of alcohol or food, in alcohol use disorders (AUD) or binge-eating disorder (BED), suggest a disturbance in explore-exploit decision-making, whereby strategic exploratory decisions in an attempt to improve long-term outcomes may diminish in favor of more repetitive or exploitatory choices. We compare exploration vs exploitation across disorders of natural (obesity with and without BED) and drug rewards (AUD). We separately acquired resting state functional MRI data using a novel multi-echo planar imaging sequence and independent components analysis from healthy individuals to assess the neural correlates underlying exploration. Participants with AUD showed reduced exploratory behavior across gain and loss environments, leading to lower-yielding exploitatory choices. Obese subjects with and without BED did not differ from healthy volunteers but when compared with each other or to AUD subjects, BED had enhanced exploratory behaviors particularly in the loss domain. All subject groups had decreased exploration or greater uncertainty avoidance to losses compared with rewards. More exploratory decisions in the context of reward were associated with frontal polar and ventral striatal connectivity. For losses, exploration was associated with frontal polar and precuneus connectivity. We further implicate the relevance and dimensionality of constructs of compulsivity across disorders of both natural and drug rewards.
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Schwantes-An TH, Zhang J, Chen LS, Hartz SM, Culverhouse RC, Chen X, Coon H, Frank J, Kamens HM, Konte B, Kovanen L, Latvala A, Legrand LN, Maher BS, Melroy WE, Nelson EC, Reid MW, Robinson JD, Shen PH, Yang BZ, Andrews JA, Aveyard P, Beltcheva O, Brown SA, Cannon DS, Cichon S, Corley RP, Dahmen N, Degenhardt L, Foroud T, Gaebel W, Giegling I, Glatt SJ, Grucza RA, Hardin J, Hartmann AM, Heath AC, Herms S, Hodgkinson CA, Hoffmann P, Hops H, Huizinga D, Ising M, Johnson EO, Johnstone E, Kaneva RP, Kendler KS, Kiefer F, Kranzler HR, Krauter KS, Levran O, Lucae S, Lynskey MT, Maier W, Mann K, Martin NG, Mattheisen M, Montgomery GW, Müller-Myhsok B, Murphy MF, Neale MC, Nikolov MA, Nishita D, Nöthen MM, Nurnberger J, Partonen T, Pergadia ML, Reynolds M, Ridinger M, Rose RJ, Rouvinen-Lagerström N, Scherbaum N, Schmäl C, Soyka M, Stallings MC, Steffens M, Treutlein J, Tsuang M, Wall TL, Wodarz N, Yuferov V, Zill P, Bergen AW, Chen J, Cinciripini PM, Edenberg HJ, Ehringer MA, Ferrell RE, Gelernter J, Goldman D, Hewitt JK, Hopfer CJ, Iacono WG, Kaprio J, Kreek MJ, Kremensky IM, Madden PAF, McGue M, Munafò MR, Philibert RA, Rietschel M, Roy A, Rujescu D, Saarikoski ST, Swan GE, Todorov AA, Vanyukov MM, Weiss RB, Bierut LJ, Saccone NL. Association of the OPRM1 Variant rs1799971 (A118G) with Non-Specific Liability to Substance Dependence in a Collaborative de novo Meta-Analysis of European-Ancestry Cohorts. Behav Genet 2016; 46:151-69. [PMID: 26392368 PMCID: PMC4752855 DOI: 10.1007/s10519-015-9737-3] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 08/17/2015] [Indexed: 12/20/2022]
Abstract
The mu1 opioid receptor gene, OPRM1, has long been a high-priority candidate for human genetic studies of addiction. Because of its potential functional significance, the non-synonymous variant rs1799971 (A118G, Asn40Asp) in OPRM1 has been extensively studied, yet its role in addiction has remained unclear, with conflicting association findings. To resolve the question of what effect, if any, rs1799971 has on substance dependence risk, we conducted collaborative meta-analyses of 25 datasets with over 28,000 European-ancestry subjects. We investigated non-specific risk for "general" substance dependence, comparing cases dependent on any substance to controls who were non-dependent on all assessed substances. We also examined five specific substance dependence diagnoses: DSM-IV alcohol, opioid, cannabis, and cocaine dependence, and nicotine dependence defined by the proxy of heavy/light smoking (cigarettes-per-day >20 vs. ≤ 10). The G allele showed a modest protective effect on general substance dependence (OR = 0.90, 95% C.I. [0.83-0.97], p value = 0.0095, N = 16,908). We observed similar effects for each individual substance, although these were not statistically significant, likely because of reduced sample sizes. We conclude that rs1799971 contributes to mechanisms of addiction liability that are shared across different addictive substances. This project highlights the benefits of examining addictive behaviors collectively and the power of collaborative data sharing and meta-analyses.
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Affiliation(s)
- Tae-Hwi Schwantes-An
- Department of Genetics, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8232, St. Louis, MO, 63110, USA
- Genometrics Section, Computational and Statistical Genomics Branch, Division of Intramural Research, National Human Genome Research Institute, US National Institutes of Health (NIH), Baltimore, MD, 21224, USA
| | - Juan Zhang
- Department of Genetics, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8232, St. Louis, MO, 63110, USA
- Key Laboratory of Brain Function and Disease, School of Life Sciences, Chinese Academy of Sciences, University of Science and Technology of China, Hefei, Anhui, 230026, China
| | - Li-Shiun Chen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Sarah M Hartz
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Robert C Culverhouse
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Xiangning Chen
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Hilary Coon
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, 84108, USA
| | - Josef Frank
- Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, 68159, Mannheim, Germany
| | - Helen M Kamens
- Institute for Behavioral Genetics, University of Colorado, Boulder, CO, 80309, USA
- Department of Integrative Physiology, University of Colorado, Boulder, CO, 80309, USA
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Bettina Konte
- Department of Psychiatry, Universitätsklinikum Halle (Saale), 06112, Halle (Saale), Germany
| | - Leena Kovanen
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, 00271, Finland
| | - Antti Latvala
- Department of Public Health, University of Helsinki, Helsinki, 00014, Finland
| | - Lisa N Legrand
- Department of Psychology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Brion S Maher
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Whitney E Melroy
- Institute for Behavioral Genetics, University of Colorado, Boulder, CO, 80309, USA
- Department of Integrative Physiology, University of Colorado, Boulder, CO, 80309, USA
| | - Elliot C Nelson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Mark W Reid
- Oregon Research Institute, Eugene, OR, 97403, USA
| | - Jason D Robinson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Pei-Hong Shen
- Section of Human Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, 20892, USA
| | - Bao-Zhu Yang
- Department of Psychiatry, Yale University, New Haven, CT, 06516, USA
| | | | - Paul Aveyard
- Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, United Kingdom
| | - Olga Beltcheva
- Department of Medical Chemistry and Biochemistry, Molecular Medicine Center, Medical University-Sofia, 1431, Sofia, Bulgaria
| | - Sandra A Brown
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA
| | - Dale S Cannon
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, 84108, USA
| | - Sven Cichon
- Department. of Genomics, Life and Brain Center, Institute of Human Genetics, University of Bonn, Bonn, 53127, Germany
- Division of Medical Genetics, Department of Biomedicine, University Hospital Basel, University of Basel, Basel, 4003, Switzerland
| | - Robin P Corley
- Institute for Behavioral Genetics, University of Colorado, Boulder, CO, 80309, USA
| | - Norbert Dahmen
- Ökumenisches Hainich-Klinikum, Mühlhausen/Thüringen, Germany
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, 2031, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, 3010, Australia
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | | | - Ina Giegling
- Department of Psychiatry, Universitätsklinikum Halle (Saale), 06112, Halle (Saale), Germany
| | - Stephen J Glatt
- Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
| | - Richard A Grucza
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Jill Hardin
- Center for Health Sciences, Biosciences Division, SRI International, Menlo Park, CA, 94025, USA
| | - Annette M Hartmann
- Department of Psychiatry, Universitätsklinikum Halle (Saale), 06112, Halle (Saale), Germany
| | - Andrew C Heath
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Stefan Herms
- Department. of Genomics, Life and Brain Center, Institute of Human Genetics, University of Bonn, Bonn, 53127, Germany
- Division of Medical Genetics, Department of Biomedicine, University Hospital Basel, University of Basel, Basel, 4003, Switzerland
| | - Colin A Hodgkinson
- Section of Human Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, 20892, USA
| | - Per Hoffmann
- Department. of Genomics, Life and Brain Center, Institute of Human Genetics, University of Bonn, Bonn, 53127, Germany
- Division of Medical Genetics, Department of Biomedicine, University Hospital Basel, University of Basel, Basel, 4003, Switzerland
| | - Hyman Hops
- Oregon Research Institute, Eugene, OR, 97403, USA
| | - David Huizinga
- Institute of Behavioral Science, University of Colorado, Boulder, CO, 80309, USA
| | - Marcus Ising
- Max-Planck-Institute of Psychiatry, 80804, Munich, Germany
| | - Eric O Johnson
- Behavioral Health Research Division, Research Triangle Institute International, Durham, NC, 27709, USA
| | - Elaine Johnstone
- Department of Oncology, University of Oxford, Oxford, OX3 7DQ, United Kingdom
| | - Radka P Kaneva
- Department of Medical Chemistry and Biochemistry, Molecular Medicine Center, Medical University-Sofia, 1431, Sofia, Bulgaria
| | - Kenneth S Kendler
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Falk Kiefer
- Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, 68159, Mannheim, Germany
| | - Henry R Kranzler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ken S Krauter
- Institute for Behavioral Genetics, University of Colorado, Boulder, CO, 80309, USA
- Molecular, Cellular, and Developmental Biology, University of Colorado, Boulder, CO, 80309, USA
| | - Orna Levran
- Laboratory of the Biology of Addictive Diseases, The Rockefeller University, New York, 10065, USA
| | - Susanne Lucae
- Max-Planck-Institute of Psychiatry, 80804, Munich, Germany
| | - Michael T Lynskey
- Addictions Department, Institute of Psychiatry, King's College London, London, SE5 8BB, UK
| | | | - Karl Mann
- Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, 68159, Mannheim, Germany
| | - Nicholas G Martin
- Department of Genetic Epidemiology, Queensland Institute of Medical Research, Brisbane, QLD, 4029, Australia
| | - Manuel Mattheisen
- Department. of Genomics, Life and Brain Center, Institute of Human Genetics, University of Bonn, Bonn, 53127, Germany
- Harvard School of Public Health, Boston, MA, 02115, USA
- Aarhus University, Aarhus, 8000, Denmark
| | - Grant W Montgomery
- Department of Genetic Epidemiology, Queensland Institute of Medical Research, Brisbane, QLD, 4029, Australia
| | | | - Michael F Murphy
- Childhood Cancer Research Group, University of Oxford, Oxford, OX3 7LG, UK
| | - Michael C Neale
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Momchil A Nikolov
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Department of Medical Chemistry and Biochemistry, Molecular Medicine Center, Medical University-Sofia, 1431, Sofia, Bulgaria
| | - Denise Nishita
- Center for Health Sciences, Biosciences Division, SRI International, Menlo Park, CA, 94025, USA
| | - Markus M Nöthen
- Department. of Genomics, Life and Brain Center, Institute of Human Genetics, University of Bonn, Bonn, 53127, Germany
| | - John Nurnberger
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Timo Partonen
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, 00271, Finland
| | - Michele L Pergadia
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Maureen Reynolds
- Department of Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Monika Ridinger
- Department of Psychiatry, University Medical Center Regensburg, University of Regensburg, 8548, Regensburg, Germany
- Psychiatric Hospital, Konigsfelden, Windisch, Switzerland
| | - Richard J Rose
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, 47405, USA
| | - Noora Rouvinen-Lagerström
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, 00271, Finland
| | - Norbert Scherbaum
- Addiction Research Group at the Department of Psychiatry and Psychotherapy, LVR Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Christine Schmäl
- Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, 68159, Mannheim, Germany
| | - Michael Soyka
- Department of Psychiatry, University of Munich, 3860, Munich, Germany
- Private Hospital Meiringen, Meiringen, Switzerland
| | - Michael C Stallings
- Institute for Behavioral Genetics, University of Colorado, Boulder, CO, 80309, USA
- Department of Psychology & Neuroscience, University of Colorado, Boulder, CO, 80309, USA
| | - Michael Steffens
- Research Department, Federal Institute for Drugs and Medical Devices (BfArM), Kurt-Georg-Kiesinger-Allee 3, 53175, Bonn, Germany
| | - Jens Treutlein
- Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, 68159, Mannheim, Germany
| | - Ming Tsuang
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA
| | - Tamara L Wall
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA
| | - Norbert Wodarz
- Department of Psychiatry, University Medical Center Regensburg, University of Regensburg, 8548, Regensburg, Germany
| | - Vadim Yuferov
- Laboratory of the Biology of Addictive Diseases, The Rockefeller University, New York, 10065, USA
| | | | - Andrew W Bergen
- Center for Health Sciences, Biosciences Division, SRI International, Menlo Park, CA, 94025, USA
| | - Jingchun Chen
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Paul M Cinciripini
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Howard J Edenberg
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Marissa A Ehringer
- Institute for Behavioral Genetics, University of Colorado, Boulder, CO, 80309, USA
- Department of Integrative Physiology, University of Colorado, Boulder, CO, 80309, USA
| | - Robert E Ferrell
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Joel Gelernter
- Department of Psychiatry, Yale University, New Haven, CT, 06516, USA
- Department of Genetics, Yale University, New Haven, CT, 06516, USA
- Department of Neurobiology, Yale University, New Haven, CT, 06516, USA
| | - David Goldman
- Section of Human Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, 20892, USA
| | - John K Hewitt
- Institute for Behavioral Genetics, University of Colorado, Boulder, CO, 80309, USA
- Department of Psychology & Neuroscience, University of Colorado, Boulder, CO, 80309, USA
| | - Christian J Hopfer
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - William G Iacono
- Department of Psychology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Jaakko Kaprio
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, 00271, Finland
- Department of Public Health, University of Helsinki, Helsinki, 00014, Finland
- Institute for Molecular Medicine FIMM, University of Helsinki, 00014, Helsinki, Finland
| | - Mary Jeanne Kreek
- Laboratory of the Biology of Addictive Diseases, The Rockefeller University, New York, 10065, USA
| | - Ivo M Kremensky
- Department of Medical Chemistry and Biochemistry, Molecular Medicine Center, Medical University-Sofia, 1431, Sofia, Bulgaria
| | - Pamela A F Madden
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Matt McGue
- Department of Psychology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Marcus R Munafò
- MRC Integrative Epidemiology Unit, UK Centre for Tobacco and Alcohol Studies, and School of Experimental Psychology, University of Bristol, Bristol, BS8 1TU, UK
| | | | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, 68159, Mannheim, Germany
| | - Alec Roy
- Psychiatry Service, Department of Veteran Affairs, New Jersey VA Health Care System, East Orange, NJ, 07018, USA
| | - Dan Rujescu
- Department of Psychiatry, Universitätsklinikum Halle (Saale), 06112, Halle (Saale), Germany
| | - Sirkku T Saarikoski
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, 00271, Finland
| | - Gary E Swan
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, 94304, USA
| | - Alexandre A Todorov
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Michael M Vanyukov
- Department of Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Robert B Weiss
- Department of Human Genetics, University of Utah School of Medicine, Salt Lake City, UT, 84112, USA
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Nancy L Saccone
- Department of Genetics, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8232, St. Louis, MO, 63110, USA.
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Cui Y, Tang R, Lam CY, Cinciripini PM, Robinson JD. The influence of personality traits on smokers' affect, withdrawal and cessation intervention outcome. Addict Behav 2016; 54:7-11. [PMID: 26656672 DOI: 10.1016/j.addbeh.2015.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 11/20/2015] [Accepted: 11/25/2015] [Indexed: 10/22/2022]
Abstract
The personality traits of harm avoidance (HA), novelty seeking (NS), and reward dependence (RD), as measured by the Tridimensional Personality Questionnaire (TPQ), have been linked to smoking behavior. The extent to which these traits are associated with smoking withdrawal and cessation outcome is unclear. We sought to address this question among 131 treatment-seeking smokers who were randomly assigned to either a smoking cessation treatment (four 30-min behavioral counseling sessions) or a control condition. We found that HA was positively associated with baseline depressive symptoms, baseline negative affect, and post-quit withdrawal, and negatively associated with positive affect at both baseline and post-quit. Additionally, we found that smokers with higher HA scores were more likely to be abstinent. NS was negatively associated with post-quit positive affect and positively associated with post-quit negative affect and withdrawal. RD was not found to be related to any outcome measures. Our findings suggest that, despite experiencing greater baseline and post-quit negative affect, smokers higher in trait harm avoidance are more likely to quit smoking. The treatment and theoretical ramifications of these findings are discussed.
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Cui Y, Robinson JD, Engelmann JM, Lam CY, Minnix JA, Karam-Hage M, Wetter DW, Dani JA, Kosten TR, Cinciripini PM. Reinforcement sensitivity underlying treatment-seeking smokers' affect, smoking reinforcement motives, and affective responses. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2015; 29:300-311. [PMID: 25621416 DOI: 10.1037/adb0000050] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Nicotine dependence has been suggested to be related to reinforcement sensitivity, which encompasses behavioral predispositions either to avoid aversive (behavioral inhibition) or to approach appetitive (behavioral activation) stimuli. Reinforcement sensitivity may shape motives for nicotine use and offer potential targets for personalized smoking cessation therapy. However, little is known regarding how reinforcement sensitivity is related to motivational processes implicated in the maintenance of smoking. Additionally, women and men differ in reinforcement sensitivity, and such difference may cause distinct relationships between reinforcement sensitivity and motivational processes for female and male smokers. In this study, the authors characterized reinforcement sensitivity in relation to affect, smoking-related reinforcement motives, and affective responses, using self-report and psychophysiological measures, in over 200 smokers before treating them. The Behavioral Inhibition/Activation Scales (BIS/BAS; Carver & White, 1994) was used to measure reinforcement sensitivity. In female and male smokers, BIS was similarly associated with negative affect and negative reinforcement of smoking. However, positive affect was positively associated with BAS Drive scores in male smokers, and this association was reversed in female smokers. BIS was positively associated with corrugator electromyographic reactivity toward negative stimuli and left frontal electroencephalogram alpha asymmetry. Female and male smokers showed similar relationships for these physiological measures. These findings suggest that reinforcement sensitivity underpins important motivational processes (e.g., affect), and gender is a moderating factor for these relationships. Future personalized smoking intervention, particularly among more dependent treatment-seeking smokers, may experiment to target individual differences in reinforcement sensitivity. (PsycINFO Database Record
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Affiliation(s)
- Yong Cui
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center
| | - Jason D Robinson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center
| | - Jeffrey M Engelmann
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center
| | - Cho Y Lam
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center
| | - Jennifer A Minnix
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center
| | - Maher Karam-Hage
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center
| | - David W Wetter
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center
| | - John A Dani
- Department of Neuroscience, University of Pennsylvania
| | - Thomas R Kosten
- Graduate Program in Translational Biology and Molecular Medicine, Baylor College of Medicine
| | - Paul M Cinciripini
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center
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Michalowski A, Erblich J. Reward dependence moderates smoking-cue- and stress-induced cigarette cravings. Addict Behav 2014; 39:1879-83. [PMID: 25133977 DOI: 10.1016/j.addbeh.2014.07.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 07/29/2014] [Accepted: 07/30/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Cigarette cravings following exposure to smoking cues in a smoker's environment are thought to play an important role in cessation failure. The possibility that dispositional factors may impact cue-induced cravings, though intriguing, has received little attention. According to Cloninger's Tridimensional Personality Theory, factors such as reward dependence (RD), harm avoidance (HA), and novelty seeking (NS) may figure prominently in risk for addiction, as well as relapse, in individuals attempting to abstain from drug and alcohol use. Particularly interesting in this regard is the possibility that smokers with higher levels of RD, who are especially sensitive to reward signals, will have heightened craving reactions to smoking cues. METHODS To that end, non-treatment-seeking nicotine dependent smokers (n=96, mean age=41.1, 47% African American, 17% Caucasian, 22% Hispanic, 19.3cigs/day, FTND=7.5) underwent a classic experimental cue-induction, during which they were exposed to imagery of: (1) smoking, (2) neutral, and (3) stress cues, and reported their cigarette cravings (0-100) before and after each exposure. Participants also completed the Tridimensional Personality Questionnaire. RESULTS Not surprisingly, smoking and stress cues (but not neutral cues) elicited significant elevations in craving (p's<0.0001). Consistent with study hypothesis, smokers who scored higher on RD had stronger craving reactions to both smoking cues (p<.02) and stress cues (p<.03). CONCLUSIONS Findings raise the possibility that dispositional characteristics, in particular, reward dependence, influence smoking by potentiating reactions to environmental smoking cues. Furthermore, the similar effects of RD on stress-induced craving suggest that both cue-and stress-induced cravings may be influenced by a common underlying disposition.
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Cook JW, Piper ME, Leventhal AM, Schlam TR, Fiore MC, Baker TB. Anhedonia as a component of the tobacco withdrawal syndrome. JOURNAL OF ABNORMAL PSYCHOLOGY 2014; 124:215-25. [PMID: 25384069 DOI: 10.1037/abn0000016] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Animal research suggests that anhedonia is a tobacco withdrawal symptom, but this topic has not been addressed definitively in research with humans. This research sought to determine whether anhedonia is (a) an element of the tobacco withdrawal syndrome in humans and (b) an impediment to successful tobacco cessation. Data were from 1,175 smokers (58.3% women; 85.5% White) participating in a randomized double-blind, placebo-controlled trial of smoking cessation pharmacotherapies. Ecological momentary assessments for 5 days before and 10 days after the target quit day were used to assess anhedonia and other established withdrawal symptoms. Consistent with drug withdrawal, anhedonia showed an inverted-U pattern of change in response to tobacco cessation and was associated with the severity of other withdrawal symptoms and tobacco dependence. Postquit anhedonia was associated with decreased latency to relapse (hazard ratio = 1.09, 95% confidence interval [CI] [1.02, 1.17]) and with lower 8-week point-prevalence abstinence (odds ratio = .91, 95% CI [.86, .97])-relations that remained significant when other withdrawal symptoms were included as predictors. Finally, nicotine replacement therapy nearly fully suppressed the increase in abstinence-related anhedonia (β = -.66, p < .001), suggesting agonist suppression of withdrawal. Results suggest that anhedonia is a unique and motivationally significant element of the tobacco withdrawal syndrome in humans. These results have implications for defining and assessing tobacco use disorder and for understanding and treating tobacco addiction.
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Affiliation(s)
| | | | - Adam M Leventhal
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California
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Castro Y, Cano MÁ, Businelle MS, Correa-Fernández V, Heppner WL, Mazas CA, Wetter DW. A cross-lagged path analysis of five intrapersonal determinants of smoking cessation. Drug Alcohol Depend 2014; 137:98-105. [PMID: 24529688 PMCID: PMC3986920 DOI: 10.1016/j.drugalcdep.2014.01.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 01/13/2014] [Accepted: 01/14/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Prominent theories of drug use underscore the importance of considering the inter-relationships (e.g., reciprocal relations, indirect effects) of determinants of drug use behavior. In the area of smoking, few studies have examined multiple determinants of cessation in this way, and in prospective analyses. The current study is an examination of the prospective cross-lagged relationships among five intrapersonal determinants of cessation. METHODS Data from a longitudinal cohort study on racial differences in the process of smoking cessation were used to examine reciprocal relations among abstinence motivation, abstinence self-efficacy, positive affect, negative affect, and craving. Each of these five measures assessed on the quit day were regressed onto the same measures assessed 1-2 weeks pre-quit. The relationships of these variables at quit day with 1-week post-quit abstinence from smoking were also examined. RESULTS When the five variables were examined simultaneously in a cross-lagged path analysis, motivation and self-efficacy, and self-efficacy and positive affect showed cross-lagged relations. Only self-efficacy on the quit day uniquely predicted 1-week post quit abstinence. There were significant indirect effects of motivation and positive affect on cessation via self-efficacy. CONCLUSIONS The current study reaffirms the importance of motivation and self-efficacy in smoking cessation, and suggests that positive affect may play a role in smoking cessation.
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Affiliation(s)
- Yessenia Castro
- School of Social Work, The University of Texas at Austin, 1 University Station, D3500, Austin, TX 78712, United States.
| | - Miguel Ángel Cano
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Unit 1440, PO Box 301402, Houston, TX 77230, United States
| | - Michael S Businelle
- Division of Health Promotion and Behavioral Science, The University of Texas School of Public Health Dallas Regional Campus, 5323 Harry Hines Building, V8.112, Dallas, TX 75390-9128, United States
| | - Virmarie Correa-Fernández
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Unit 1440, PO Box 301402, Houston, TX 77230, United States
| | - Whitney L Heppner
- Department of Psychological Science, Georgia College and State University, 1-03 Arts & Sciences Building, Milledgeville, GA 31061, United States
| | - Carlos A Mazas
- Memorial Brain and Behavior Center, 915 Gessner Rd Suite 550. 770242527 Houston, TX, USA
| | - David W Wetter
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Unit 1440, PO Box 301402, Houston, TX 77230, United States
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Prospective Evaluation of Factors Predicting Nicotine Withdrawal Symptoms Among Korean Americans. J Smok Cessat 2014; 2014. [PMID: 26413165 DOI: 10.1017/jsc.2014.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION This study examined factors predicting nicotine withdrawal symptoms following quitting among Korean American smokers who were receiving counseling and nicotine replacement therapy. METHODS The sample comprised 90 Korean American smokers selected from a two-arm randomised controlled trial of a smoking cessation intervention (culturally adapted versus treatment as usual). Nicotine withdrawal symptoms were assessed weekly for the first four weeks from the target quit day, using the Minnesota Nicotine Withdrawal Scale (MNWS). Only those who participated in two or more weekly assessments of the symptoms were included. RESULTS Among the nine withdrawal symptoms listed in the MNWS, craving and disturbed sleep decreased over time whereas the remaining symptoms had no significant effect of time. Women or individuals who perceived greater risks of quitting smoking reported more withdrawal symptoms after controlling for abstinence status. Although withdrawal symptoms did not change, on average, with time, the rates of change varied randomly across individuals. Women reported more withdrawal symptoms in the first week after quitting and showed a higher rate of decline of the symptoms over time than men. CONCLUSIONS Korean American smokers who are women or who perceive greater risks of quitting smoking may require more intensive treatment to effectively deal with post-quit withdrawal symptoms.
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Leventhal AM, Greenberg JB, Trujillo MA, Ameringer KJ, Lisha NE, Pang RD, Monterosso J. Positive and negative affect as predictors of urge to smoke: temporal factors and mediational pathways. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2013; 27:262-7. [PMID: 23506367 DOI: 10.1037/a0031579] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Elucidating interrelations between prior affective experience, current affective state, and acute urge to smoke could inform affective models of addiction motivation and smoking cessation treatment development. This study tested the hypothesis that prior levels of positive (PA) and negative (NA) affect predict current smoking urge via a mediational pathway involving current state affect. We also explored if tobacco deprivation moderated affect-urge relations and compared the effects of PA and NA on smoking urge to one another. At a baseline session, smokers reported affect experienced over the preceding few weeks. At a subsequent experimental session, participants were randomly assigned to 12-hr tobacco deprived (n = 51) or nondeprived (n = 69) conditions and reported state affect and current urge. Results revealed a mediational pathway whereby prior NA reported at baseline predicted state NA at the experimental session, which in turn predicted current urge. This mediational pathway was found primarily for an urge subtype indicative of urgent need to smoke and desire to smoke for NA relief, was stronger in the deprived (vs. nondeprived) condition, and remained significant after controlling for PA. Prior PA and current state PA were inversely associated with current urge; however, these associations were eliminated after controlling for NA. These results cohere with negative reinforcement models of addiction and with prior research and suggest that: (a) NA plays a stronger role in smoking motivation than PA; (b) state affect is an important mechanism linking prior affective experience to current urge; and (c) affect management interventions may attenuate smoking urge in individuals with a history of affective disturbance.
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Affiliation(s)
- Adam M Leventhal
- Departments of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA 90033, USA.
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19
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Heckman BW, Kovacs MA, Marquinez NS, Meltzer LR, Tsambarlis ME, Drobes DJ, Brandon TH. Influence of affective manipulations on cigarette craving: a meta-analysis. Addiction 2013; 108:2068-78. [PMID: 23795674 PMCID: PMC3830730 DOI: 10.1111/add.12284] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 12/14/2012] [Accepted: 06/18/2013] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS Retrospective self-report and observational studies have yielded inconsistent findings regarding the capacity of negative affect (NA) to increase smoking motivation among dependent samples. Controlled laboratory studies offer an alternative paradigm for testing the role of affective state upon smoking motivation. The aim of the current study was to quantify cue-provoked cravings produced by affective manipulations in the published literature, and to identify theoretical and methodological moderators. METHODS We conducted a systematic literature search to identify experimental studies that manipulated NA or positive affect (PA), and assessed post-manipulation craving. Separate random-effects meta-analyses examined NA and PA cues as predictors of self-reported craving. Self-reported affect (NA and PA), nicotine deprivation, gender, nicotine dependence, order of cue presentation, single versus multi-item craving assessment and affect induction method were tested as moderators of affective cue-induced craving. RESULTS NA manipulations produced a medium effect [g = 0.47; confidence interval (CI) = 0.31-0.63] on craving, but no main effects were found for PA manipulations (g = 0.05; CI = -0.09 to 0.20) on craving. Self-reported NA moderated the extent to which NA and PA manipulations elicited craving (P < 0.02 for each). That is, more effective NA manipulations produced greater cravings, and PA manipulations reduced cravings when they reduced NA. CONCLUSIONS Laboratory studies indicate that negative, but not positive, affect is a situational determinant of cravings to smoke among dependent smokers. Adverse emotional states increase craving to smoke among dependent smokers, but positive emotional states do not consistently reduce craving to smoke.
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Affiliation(s)
- Bryan W. Heckman
- Department of Psychology, University of South Florida, 4202 E. Fowler Avenue, PCD4118G, Tampa, FL 33620 USA,Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, 4115 E. Fowler Avenue, Tampa, Florida 33617 USA
| | - Michelle A. Kovacs
- Department of Psychology, University of South Florida, 4202 E. Fowler Avenue, PCD4118G, Tampa, FL 33620 USA,Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, 4115 E. Fowler Avenue, Tampa, Florida 33617 USA
| | - Nicole S. Marquinez
- Department of Psychology, University of South Florida, 4202 E. Fowler Avenue, PCD4118G, Tampa, FL 33620 USA,Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, 4115 E. Fowler Avenue, Tampa, Florida 33617 USA
| | - Lauren R. Meltzer
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, 4115 E. Fowler Avenue, Tampa, Florida 33617 USA
| | - Maria E. Tsambarlis
- Department of Psychology, University of South Florida, 4202 E. Fowler Avenue, PCD4118G, Tampa, FL 33620 USA
| | - David J. Drobes
- Department of Psychology, University of South Florida, 4202 E. Fowler Avenue, PCD4118G, Tampa, FL 33620 USA,Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, 4115 E. Fowler Avenue, Tampa, Florida 33617 USA
| | - Thomas H. Brandon
- Department of Psychology, University of South Florida, 4202 E. Fowler Avenue, PCD4118G, Tampa, FL 33620 USA,Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, 4115 E. Fowler Avenue, Tampa, Florida 33617 USA
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20
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Hendricks PS, Leventhal AM. Abstinence-related expectancies predict smoking withdrawal effects: implications for possible causal mechanisms. Psychopharmacology (Berl) 2013; 230:363-73. [PMID: 23812761 PMCID: PMC3934826 DOI: 10.1007/s00213-013-3169-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 05/23/2013] [Indexed: 10/26/2022]
Abstract
RATIONALE Despite the decades-long emphasis on withdrawal in leading models of addiction, the causal mechanisms driving smoking withdrawal effects are not well known. This gap in the knowledge base has stalled theory and treatment development for smoking dependence. OBJECTIVES As cognitive factors have been largely neglected as predictors of withdrawal, the current study sought to examine how smokers' abstinence-related expectancies relate to withdrawal symptomatology. METHODS Adult smokers (N = 180; ≥10 cigarettes/day) participated in two counterbalanced experimental sessions involving either 16 h of abstinence or smoking as usual. At baseline, participants completed three withdrawal-related scales of the Smoking Abstinence Questionnaire (Withdrawal, Optimistic Outcomes, and Weight Gain scales), a self-report measure of smokers' abstinence-related expectancies. During experimental sessions, participants completed a number of instruments that covered the range of smoking withdrawal effects (i.e., negative affect, urge/craving to smoke, diminished positive affect, concentration difficulty, hunger, and physiological symptoms). RESULTS Even after controlling for the influence of demographic characteristics and cigarette dependence, smokers' abstinence-related expectancies were meaningful predictors of abstinence-induced changes in various withdrawal symptoms (mean adjusted standardized β = 0.22). Stronger expectancies for withdrawal and weight gain predicted more severe withdrawal effects, whereas stronger expectancies for optimistic outcomes predicted less severe withdrawal effects. CONCLUSIONS These findings are consistent with the notion that expectancies actively shape future experience and are the first to support the suggestion that smokers' abstinence-related expectancies may be causal agents of withdrawal symptomatology. Future research is required to more conclusively determine whether abstinence-related expectancies mold withdrawal effects.
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Affiliation(s)
- Peter S. Hendricks
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, 227L Ryals Public Health Building, 1665 University Blvd., Birmingham, AL 35294, USA
| | - Adam M. Leventhal
- Departments of Preventive Medicine and Psychology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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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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22
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Veilleux JC, Conrad M, Kassel JD. Cue-induced cigarette craving and mixed emotions: a role for positive affect in the craving process. Addict Behav 2013; 38:1881-9. [PMID: 23380484 DOI: 10.1016/j.addbeh.2012.12.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 09/28/2012] [Accepted: 12/07/2012] [Indexed: 11/17/2022]
Abstract
Craving is an important component of nicotine addiction, and extant research has demonstrated a clear link between cue-induced craving and negative affect, with mixed results in the positive affect domain. The current study was designed to test the idea that cue-reactive craving might be associated with a mixed emotional process, or the simultaneous experience of positive and negative affect. Participants were 86 non-deprived regular smokers and tobacco chippers who provided simultaneous ratings of positive and negative affect during cue exposure to pleasant, unpleasant, neutral and cigarette cues. Results indicated that self-reported craving was elevated in response to cigarette cues compared to other valenced cue types and craving was higher to pleasant cues than either neutral or unpleasant cues. Mixed emotional responses were higher to cigarette cues than other cue types. In addition, mixed emotional responses to cigarette cues predicted craving even after controlling for smoker type, difficulties regulating negative emotion, baseline craving level and mixed emotional responses to neutral cues. As the first study to investigate mixed emotions and cigarette craving, our results highlight the importance of examining the relationship between cue-reactive craving and emotional response using models of emotion that allow for measurement of nuanced emotional experience. In addition, our findings suggest that positive affect processes may indeed play a role in craving among non-deprived smokers.
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Affiliation(s)
- Jennifer C Veilleux
- Department of Psychological Science, University of Arkansas, Fayetteville, AR 72701, USA.
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Baker TB, Piper ME, Schlam TR, Cook JW, Smith SS, Loh WY, Bolt D. Are tobacco dependence and withdrawal related amongst heavy smokers? Relevance to conceptualizations of dependence. JOURNAL OF ABNORMAL PSYCHOLOGY 2012; 121:909-21. [PMID: 22642839 PMCID: PMC3560396 DOI: 10.1037/a0027889] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Measured tobacco dependence is typically only modestly related to tobacco withdrawal severity among regular smokers making a quit attempt. The weak association between dependence and withdrawal is notable because it conflicts with core theories of dependence and because both measures predict cessation outcomes, suggesting they both index a common dependence construct. This study used data from a smoking cessation comparative effectiveness trial (N = 1504) to characterize relations of tobacco dependence with craving and negative affect withdrawal symptoms using multiple dependence measures and analytic methods to detect both additive and interactive effects and to determine whether withdrawal meaningfully mediates the influence of dependence on smoking cessation. We conclude: (a) Although univariate analyses suggest dependence and withdrawal measures are only modestly interrelated, more powerful analytic techniques show they are, in fact, meaningfully related and their shared variance is associated with cessation likelihood; (b) there are clear differences between craving and negative affective withdrawal symptoms, with the former more related to smoking heaviness and the latter related to trait measures of negative affect; moreover, craving more strongly mediates dependence effects on cessation; and (c) both craving and negative affect withdrawal symptoms are strongly related to a pattern of regular smoking that is sensitive to the passage of time and powerfully affected by smoking cues. These findings support models that accord an important role for associative processes and withdrawal symptoms, especially craving, in drug dependence. The findings also support the use of withdrawal variables as criteria for the evaluation of dependence measures.
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Affiliation(s)
- Timothy B Baker
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe Street, Madison, WI 53711, USA.
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Cook JW, Fucito LM, Piasecki TM, Piper ME, Schlam TR, Berg KM, Baker TB. Relations of alcohol consumption with smoking cessation milestones and tobacco dependence. J Consult Clin Psychol 2012; 80:1075-85. [PMID: 22963593 DOI: 10.1037/a0029931] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Alcohol consumption is associated with smoking cessation failure in both community and clinical research. However, little is known about the relation between alcohol consumption and smoking cessation milestones (i.e., achieving initial abstinence, avoiding lapses and relapse). Our objective in this research was to examine the relations between pretreatment alcohol consumption patterns (non/infrequent drinker, moderate drinker, binge drinker) and smoking cessation milestones and tobacco dependence. METHOD Data were collected from 1,504 smokers (58.2% women; 83.9% White; mean age = 44.67 years, SD = 11.08) making an aided smoking cessation attempt as part of a clinical trial. Alcohol consumption pattern was determined with the Composite International Diagnostic Interview. Tobacco dependence was assessed with the Wisconsin Inventory of Smoking Dependence Motives (WISDM). RESULTS Alcohol consumption pattern was significantly associated with initial cessation and lapse, and these findings remained after controlling for the effects of treatment, race, gender, and cigarettes per day. Relative to moderate drinkers, both non/infrequent drinkers and binge drinkers were less likely to achieve initial cessation (p < .05), and binge drinkers were more likely to lapse (p < .01). When drinking categories were compared on tobacco dependence indices, results showed that relative to moderate drinkers, non/infrequent drinkers scored higher on several WISDM Primary Dependence Motives subscales (Tolerance, Loss of Control, and Automaticity) and binge drinkers scored higher on WISDM Secondary Dependence Motives subscales (Cue Exposure and Social-Environmental Goads). CONCLUSIONS Non/infrequent drinkers' smoking cessation difficulties may be particularly related to core features of tobacco dependence, whereas binge drinkers' difficulties may be related to environmental and social influences.
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Affiliation(s)
- Jessica W Cook
- University of Wisconsin School of Medicine and Public Health.
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Lam CY, Robinson JD, Versace F, Minnix JA, Cui Y, Carter BL, Wetter DW, Cinciripini PM. Affective reactivity during smoking cessation of never-quitters as compared with that of abstainers, relapsers, and continuing smokers. Exp Clin Psychopharmacol 2012; 20:139-50. [PMID: 22039752 PMCID: PMC3381955 DOI: 10.1037/a0026109] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Much effort has been devoted to examining the differences in postcessation affective experience between smoking abstainers and relapsers. However, little attention has been given to the affective changes of smokers who, despite their motivation to quit, fail to achieve even a brief period of abstinence. Using affect-modulated startle response and self-report questionnaires, we measured the postcessation affective changes of 115 smokers (60 men, 55 women) who participated in a laboratory investigation of affective reactivity during smoking cessation. Among our participants, 34 were abstainers (16 men, 18 women), 16 were never-quitters (8 men, 8 women), 19 were relapsers (8 men, 11 women), and 46 were controls (28 men, 18 women). We found a significant Stimulus Valence × Session × Group interaction effect on startle responses, which suggested that while abstainers, relapsers, and control exhibited the prototypical affect-modulated startle response across postcessation sessions, never-quitters displayed an atypical response pattern in which emotional pictures no longer modulated the startle response. Never-quitters also reported increasingly higher negative and lower positive affect across postcessation sessions. Using affect-modulated startle response and self-report questionnaires, this study found a significant difference in the affective reactivity between smokers who could and smokers who could not establish an initial abstinence of 24 hours.
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Affiliation(s)
- Cho Y Lam
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX 77230-1439, USA.
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Baker TB, Breslau N, Covey L, Shiffman S. DSM criteria for tobacco use disorder and tobacco withdrawal: a critique and proposed revisions for DSM-5. Addiction 2012; 107:263-75. [PMID: 21919989 PMCID: PMC3246568 DOI: 10.1111/j.1360-0443.2011.03657.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS This paper aims to identify appropriate criteria for tobacco dependence assessment, evaluate relevant research and suggest revisions that may be incorporated into DSM-5. METHODS Desirable conceptual and psychometric features of tobacco dependence assessments were identified, including the types of outcomes against which such assessment should be validated. DSM-IV criteria were matched against these criteria and compared with other dependence measures. RESULTS DSM-IV criteria were found to be ambiguous, little used in tobacco research, and have relatively low predictive validity. Other dependence measures were found to have greater validity in the prediction of important dependence features such as relapse likelihood. Strength of urges to smoke on typical smoking days and during abstinence, markers of nicotine intake or frequency of smoking and latency to smoke soon after waking were found to be useful dependence measures. CONCLUSION The use and utility of DSM-5 will be enhanced by eliminating most DSM-IV criteria and adding new ones based on smoking pattern, smoking heaviness, and the severity of craving during periods of smoking and withdrawal.
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Affiliation(s)
- Timothy B. Baker
- Department of Medicine, Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health
| | - Naomi Breslau
- Department of Epidemiology, Michigan State University
| | - Lirio Covey
- Professor of Clinical Psychology in Psychiatry, Columbia University Medical Center, Research Scientist, New York State Psychiatric Institute
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