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Bello MS, Wang CX, Maglalang DD, Rosales R, Tidey JW, Denlinger-Apte RL, Sokolovsky AW, Colby SM, Cassidy RN. Racial/ethnic differences in the acute effects of reduced nicotine content cigarettes among adolescents who smoke. Addict Behav 2024; 160:108147. [PMID: 39243729 DOI: 10.1016/j.addbeh.2024.108147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 08/12/2024] [Accepted: 08/26/2024] [Indexed: 09/09/2024]
Abstract
OBJECTIVE Reducing the nicotine content in cigarettes decreases their addictiveness and abuse liability, including among adolescents. Whether these effects differ by race/ethnicity is unknown. This study is a secondary analysis of previously published data collected between 2014-2017. We examined racial/ethnic differences in the effects of smoking cigarettes with varying nicotine content levels on subjective effects and tobacco withdrawal among adolescents who smoke daily. METHODS Across two counterbalanced sessions, 50 adolescents recruited from Rhode Island (ages 15-19; 30 % Underrepresented Minorities [URM], 20 % Asians and Pacific Islanders [API]; 50 % Non-Hispanic Whites) self-administered a very low nicotine content (VLNC; 0.4 mg nicotine/g of tobacco) or normal nicotine content control (NNC; 15.8 mg/g) research cigarette following overnight abstinence. Subjective effects were reported post-administration and tobacco withdrawal outcomes were calculated from pre- to post-administration scores. Multilevel linear models tested main and interactive effects between cigarette nicotine content and race/ethnicity on all study outcomes. RESULTS Participants reported lower positive subjective effects and reductions in smoking urges after smoking a VLNC cigarette relative to smoking an NNC cigarette (ps < 0.01). A main effect of race/ethnicity emerged, such that API (vs. URM and White) adolescents reported lower positive subjective effects, greater craving reduction, and higher cigarette aversion after smoking, regardless of nicotine content (ps < 0.05). Significant interactions were found between race/ethnicity and nicotine content for cigarette aversion, such that API adolescents rated VLNC (vs. NNC) cigarettes as less aversive than White and URM adolescents did (p = 0.03). CONCLUSIONS Findings provide evidence that VLNC cigarettes may reduce abuse liability and tobacco withdrawal symptoms for adolescents across racial/ethnic groups and particularly for API youth.
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Affiliation(s)
- Mariel S Bello
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA.
| | - Crystal X Wang
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego, San Diego, CA, USA
| | | | - Robert Rosales
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Rachel L Denlinger-Apte
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Alexander W Sokolovsky
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Suzanne M Colby
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Rachel N Cassidy
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
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2
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Bello MS, Zhang Y, Cho J, Kirkpatrick MG, Pang RD, Oliver JA, Webb Hooper M, Barrington-Trimis JL, Ahluwalia JS, Leventhal AM. Nicotine deprivation amplifies attentional bias toward racial discrimination stimuli in African American adults who smoke cigarettes. Exp Clin Psychopharmacol 2023; 31:1023-1031. [PMID: 37535524 PMCID: PMC10837307 DOI: 10.1037/pha0000662] [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: 08/05/2023]
Abstract
High smoking prevalence and low quit smoking rates among African American adults are well-documented, but poorly understood. We tested a transdisciplinary theoretical model of psychopharmacological-social mechanisms underlying smoking among African American adults. This model proposes that nicotine's acute attention-filtering effects may enhance smoking's addictiveness in populations unduly exposed to discrimination, like African American adults, because nicotine reduces the extent to which discrimination-related stimuli capture attention, and in turn, generate distress. During nicotine deprivation, attentional biases toward discrimination may be unmasked and exacerbated, which may induce distress and perpetuate smoking. To test this model, this within-subject laboratory experiment determined whether attentional bias toward racial discrimination stimuli was amplified by nicotine deprivation in African American adults who smoked daily. Participants (N = 344) completed a computerized modified Stroop task assessing attentional interference from racial discrimination-related words during two counterbalanced sessions (nicotine sated vs. overnight nicotine deprived). The task required participants to quickly name the color of discrimination and matched neutral words. Word Type (Discrimination vs. Neutral) × Pharmacological State (Nicotine Deprived vs. Sated) effects on color naming reaction times were examined. Attentional bias toward racial discrimination-related stimuli was amplified in nicotine deprived (reaction time to discrimination minus neutral stimuli: M [95%CI] = 34.69 [29.62, 39.76] ms; d = 0.15) compared to sated (M [95%CI] = 24.88 [19.84, 29.91] ms; d = 0.11) conditions (Word Type × Pharmacological State, p < .0001). The impact of nicotine deprivation on attentional processes in the context of adverse societal conditions merit consideration in future science and intervention addressing smoking in African American adults. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Mariel S Bello
- Department of Behavioral and Social Sciences, School of Public Health, Brown University
| | - Yi Zhang
- Department of Epidemiology and Biostatistics, University of Arizona
| | - Junhan Cho
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
| | - Matthew G Kirkpatrick
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
| | - Raina D Pang
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
| | - Jason A Oliver
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center
| | | | - Jessica L Barrington-Trimis
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
| | - Jasjit S Ahluwalia
- Department of Behavioral and Social Sciences, School of Public Health, Brown University
| | - Adam M Leventhal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
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3
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Pang RD, Tucker CJ, Guillot CR, Belcher B, Kirkpatrick MG. Associations of DHEA(S) with negative and positive affect in people who smoke daily with elevated and low depression symptoms: A pilot laboratory study. Addict Behav 2023; 146:107801. [PMID: 37423068 DOI: 10.1016/j.addbeh.2023.107801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/07/2023] [Accepted: 07/02/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Individuals with depression symptoms have a harder time quitting smoking. High negative affect and low positive affect are core depression symptoms and arise following cigarette abstinence. Investigating associations of biological markers with negative and positive affect may provide valuable information about factors relevant to smoking cessation in individuals with elevated depression symptoms. METHODS Depression symptoms were measured at a baseline session. Participants then completed two counterbalanced experimental sessions (non-abstinent, abstinent) and completed measures of positive and negative affect, and provided saliva samples. Saliva samples were assayed at the Salimetrics' SalivaLab (Carlsbad, CA) using the Salimetrics Salivary Dehydroepiandrosterone (DHEA) Assay Kit (Cat. No. 1-1202) and Dehydroepiandrosterone-sulfate (DHEA-S) Assay Kit (Cat. No. 1-1252). RESULTS There were no main or interactive associations of DHEA with negative affect. However, there were significant DHEAS × experimental session and DHEAS × experimental session × depression symptom level interactions with negative affect. In the high depression symptom group, DHEAS positively associated with negative affect during the non-abstinent experimental session, but DHEAS negatively associated with negative affect during the abstinent experimental session. There were no associations of DHEA or DHEAS with positive affect. CONCLUSION This study found that DHEAS negatively associated with negative affect during cigarette abstinence in individuals with elevated depression symptoms. This is important as high negative affect during cigarette abstinence may result in a return to smoking.
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Affiliation(s)
- Raina D Pang
- Department of Population and Public Health Sciences, University of Southern California, 1845 N. Soto Street, Suite 312E, Los Angeles, CA 90032, United States; Department of Psychology, University of Southern California, SGM 50, 3620 McClintock Ave, Los Angeles, CA 90089, United States.
| | - Chyna J Tucker
- Department of Population and Public Health Sciences, University of Southern California, 1845 N. Soto Street, Suite 312E, Los Angeles, CA 90032, United States.
| | - Casey R Guillot
- Department of Psychology, University of North Texas, Terrill Hall, Denton, TX 7620, United States.
| | - Britni Belcher
- Department of Population and Public Health Sciences, University of Southern California, 1845 N. Soto Street, Suite 312E, Los Angeles, CA 90032, United States.
| | - Matthew G Kirkpatrick
- Department of Population and Public Health Sciences, University of Southern California, 1845 N. Soto Street, Suite 312E, Los Angeles, CA 90032, United States; Department of Psychology, University of Southern California, SGM 50, 3620 McClintock Ave, Los Angeles, CA 90089, United States.
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4
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Mills L, Lee JC, Boakes R, Colagiuri B. Reduction in caffeine withdrawal after open-label decaffeinated coffee. J Psychopharmacol 2023; 37:181-191. [PMID: 36628993 DOI: 10.1177/02698811221147152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Withdrawal from addictive drugs can be reduced by administering placebo deceptively, but in the clinic it is unethical to deceive the patient. Open-label placebo effects have been observed across a range of psychophysiological phenomena, and may also apply to drug withdrawal. METHOD 24-hour abstinent heavy coffee drinkers (N = 61) rated their caffeine withdrawal symptoms before being allocated to one of three groups. The Deceptive group was given decaffeinated coffee (decaf) and told it was caffeinated, the Open-Label group given decaf and told it was decaf and the Control group given water and told it was water. After 45 min, caffeine withdrawal was measured again. All participants rated their expectancies of withdrawal reduction from caffeinated coffee, decaf and water prior to being randomised and the end of the study. RESULTS There was a significant 9.5-point reduction in caffeine withdrawal in the Open-Label group (95% confidence interval (CI): 4.7, 14.3; p = 0.002), which was 8.6 points less than the Deceptive group (95%CI: 0.4, 16.8; p = 0.014) but 8.9 points greater than the Control group (95%CI: 0.6, 17.2; p = 0.012). Pre-randomisation, participants expected caffeinated coffee to reduce their withdrawal symptoms the most, followed by water and decaf, Pre-randomisation expectancy of withdrawal was only associated with amount of withdrawal reduction in the Deceptive group. CONCLUSION It appears as if open-label placebo caffeine (i.e. decaf) can reduce caffeine withdrawal symptoms, even when people do not hold a conscious expectancy it will do so. There may be ways to integrate open-label placebo procedures into clinical interventions for drug dependence without violating informed consent.
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Affiliation(s)
- Llewellyn Mills
- Discipline of Addiction Medicine, Central Clinical School, University of Sydney, NSW, Australia.,Drug and Alcohol Services, South Eastern Sydney Local Health District, NSW, Australia
| | - Jessica C Lee
- School of Psychology, University of New South Wales, NSW, Australia
| | - Robert Boakes
- School of Psychology, University of Sydney, NSW, Australia
| | - Ben Colagiuri
- School of Psychology, University of Sydney, NSW, Australia
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Tehrani H, Mahdizadeh M, Peyman N, Gholian-Aval M, Charoghchian Khorasani E, Jafari A. Exploration factors on smoking among female adolescents based on the viewpoints of Iranian adolescent girls. BMC Womens Health 2022; 22:203. [PMID: 35650621 PMCID: PMC9158312 DOI: 10.1186/s12905-022-01791-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/25/2022] [Indexed: 11/24/2022] Open
Abstract
Background In recent years, the prevalence of smoking in women has increased significantly. This study aimed to explain the effective factors in the tendency to smoke in female adolescents, employing a qualitative method of content analysis in Mashhad, Iran. Methods The data for this conventional content analysis were obtained by conducting semi‑structured interviews with 20 female adolescent smokers. For open coding, integrating codes, creating main category and subcategories, and extracting quotation associated with codes and subcategories, MAXQDA software version 10 was used. Results Based on the results of the study, one main category and six subcategories were identified to influence the decision to smoke. The main category was interconnection of psychological and gender experiences. The subcategories included self-management weakness, ignoring the side effects, gender orientation, negative psychological experiences, the attraction of cigarettes, and positive psychological experiences. Conclusion Psychological and gender factors play an important role in initiating people's behavior and tendency to smoke and smoking prevention programs in educational settings need to focus efforts around what is known about young women smokers.
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Affiliation(s)
- Hadi Tehrani
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Health Education and Health Promotion, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehrsadat Mahdizadeh
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Health Education and Health Promotion, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nooshin Peyman
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Health Education and Health Promotion, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdi Gholian-Aval
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Health Education and Health Promotion, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elham Charoghchian Khorasani
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Health Education and Health Promotion, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Jafari
- Department of Health Education and Health Promotion, School of Health, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran.
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6
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Tucker CJ, Bello MS, Weinberger AH, D'Orazio LM, Kirkpatrick MG, Pang RD. Association of depression symptom level with smoking urges, cigarette withdrawal, and smoking reinstatement: A preliminary laboratory study. Drug Alcohol Depend 2022; 232:109267. [PMID: 35042097 DOI: 10.1016/j.drugalcdep.2022.109267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/16/2021] [Accepted: 01/06/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cigarette smoking urges, withdrawal, and smoking reinstatement may be especially relevant to people with elevated depression symptoms who smoke. This laboratory study aimed to assess relations between depression symptom level and smoking urges for reward and relief, cigarette withdrawal, and smoking reinstatement in people who smoke cigarettes daily during acute abstinence and while smoking as usual. METHODS Participants with low (n = 51) or elevated (n = 29) baseline depression symptoms underwent two counterbalanced laboratory sessions (i.e., abstinent, non-abstinent). At each session, they completed subjective measures of smoking urges for reward and relief, and withdrawal. They also completed a laboratory smoking reinstatement task measuring whether they would delay smoking and the number of cigarettes smoked. RESULTS The elevated depression symptom group reported significantly higher withdrawal (p = .01) and smoked more cigarettes than the low depression symptoms group during the smoking reinstatement task self-administration period at the abstinent session (p = .04). Smoking urges for reward and relief were not significantly different by depression symptom group. There were no significant interactions of depression and abstinence with any outcomes. CONCLUSIONS As outcomes were measured at both an abstinent and non-abstinent session, findings identify factors for people with elevated depression symptoms who smoke which may drive smoking behavior and impede smoking cessation efforts. This study provides evidence that people with elevated depression symptoms who smoke may need additional/more pharmacological or behavioral smoking cessation aids targeted at reducing withdrawal and number of cigarettes smoked.
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Affiliation(s)
- Chyna J Tucker
- Department of Preventive Medicine, University of Southern California, 2001 N. Soto St., Los Angeles, CA 90032, USA; Department of Social Welfare, University of California, Los Angeles, 3250 Public Affairs Building, Los Angeles, CA 90095, USA.
| | - Mariel S Bello
- Department of Psychology, University of Southern California, 3620 McClintock Ave., Los Angeles, CA 90089, USA; Department of Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903 USA.
| | - Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University and Department of Epidemiology, and Population Health, Albert Einstein College of Medicine, 1165 Morris Park Ave. Rousso Building, Bronx, NY 10461, USA.
| | - Lina M D'Orazio
- Department of Neurology, University of Southern California, 1520 San Pablo St. Los Angeles, CA 90033, USA.
| | - Matthew G Kirkpatrick
- Department of Preventive Medicine, University of Southern California, 2001 N. Soto St., Los Angeles, CA 90032, USA; Department of Psychology, University of Southern California, 3620 McClintock Ave., Los Angeles, CA 90089, USA.
| | - Raina D Pang
- Department of Preventive Medicine, University of Southern California, 2001 N. Soto St., Los Angeles, CA 90032, USA; Department of Psychology, University of Southern California, 3620 McClintock Ave., Los Angeles, CA 90089, USA.
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7
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Liautaud MM, Kechter A, Bello MS, Guillot CR, Oliver JA, Banks DE, D’Orazio LM, Leventhal AM. Anhedonia in tobacco withdrawal among African-American smokers. Exp Clin Psychopharmacol 2021; 29:511-523. [PMID: 34110886 PMCID: PMC8511043 DOI: 10.1037/pha0000474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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
Anhedonia-diminished interest and pleasure in response to rewards-may be a symptom of tobacco withdrawal that is understudied in priority populations. This experiment investigated the magnitude and correlates of various dimensions of anhedonia during tobacco withdrawal among African-American (AA) smokers-a population subject to health disparities. AA smokers (N = 607; ≥ 10 cigarettes/day, 37.8% female, M[SD] age = 50.0[10.6] years) completed self-report measures assessing expected pleasure from (i.e., consummatory anhedonia) and desire to engage in (i.e., anticipatory anhedonia) various types of hypothetically experienced rewards at counterbalanced 16-hr tobacco deprived and nondeprived lab visits. Other tobacco withdrawal symptom measures (e.g., craving, negative affect, hunger) were also assessed. Tobacco deprivation most robustly increased scores on a composite measure of consummatory anhedonia directed toward various reward domains (i.e., hobbies, sensory experiences, social activities; d = .32, p < .001). Deprivation modestly increased consummatory and anticipatory anhedonia directed toward sexual rewards (ds = .09-.12, ps < .02), did not significantly change anhedonia toward food rewards, and decreased anhedonia directed toward psychoactive drug rewards (i.e., increased desire for and pleasure from drugs; ds = -.21 to -.19, ps < .001). Deprivation-induced changes in anhedonia were modestly correlated with other withdrawal symptoms (average |r|s = .04-.23) and were amplified among participants with higher nicotine dependence and lower positive affect-related traits (|β|s = .10-.12, ps < .01). Some dimensions of anhedonia may be genuine expressions of acute tobacco withdrawal in AA smokers. Applying multi-dimensional anhedonia conceptualizations might advance basic knowledge and treatment of tobacco use disorder, improve smoking cessation outcomes, and address tobacco-related health disparities facing AA smokers. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Afton Kechter
- University of Southern California, Department of Preventive Medicine
| | | | | | - Jason A. Oliver
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences
| | - Devin E. Banks
- University of Missouri Saint Louis, Department of Psychological Sciences
| | | | - Adam M. Leventhal
- University of Southern California, Department of Preventive Medicine
- University of Southern California, Department of Psychology
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Bello MS, Liautaud MM, De La Cerda JT, Pang RD, Ray LA, Ahluwalia JA, Leventhal AM. Association of frequency of perceived exposure to discrimination with tobacco withdrawal symptoms and smoking lapse behavior in African Americans. Addiction 2021; 116:914-925. [PMID: 32860477 PMCID: PMC7914272 DOI: 10.1111/add.15238] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 01/23/2020] [Accepted: 08/24/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIMS Frequent experiences of discrimination could increase vulnerability to tobacco withdrawal and smoking lapse in populations subject to tobacco-related health disparities. This laboratory study (2013-17) examined whether individual differences in perceived exposure to discrimination in one's daily life predicted tobacco withdrawal symptoms and smoking lapse behavior following acute tobacco deprivation in African American smokers. DESIGN Mixed design with the between-subjects continuous variable of perceived discrimination crossed with the within-subject variable of tobacco deprivation status (deprived versus non-deprived). SETTING Academic medical center in Los Angeles, CA, USA. PARTICIPANTS African American non-treatment seeking daily cigarette smokers (n = 607, ≥ 10 cig/day). MEASUREMENTS At a baseline visit, self-reported frequency of perceived exposure to discrimination in one's daily life was measured [everyday discrimination scale (EDDS)]. At two subsequent counterbalanced experimental visits (16-hour tobacco deprivation versus ad-libitum smoking), self-report assessments of various tobacco withdrawal symptom domains [Brief Questionnaire of Smoking Urges), Wisconsin Smoking Withdrawal Scale (WSWS), Profile of Mood States (POMS), Snaith-Hamilton Pleasure Scale (SHAPS) and Current Impulsivity Scale (CIS)) and a behavioral smoking lapse analogue task were measured. FINDINGS Adjusted models demonstrated that greater frequency of perceived exposure to discrimination was associated with larger deprivation-induced increases in acute urges to smoke to alleviate negative mood, several negative mood states and subjective cognitive functioning-effect sizes were small in magnitude (βs = 0.09-0.13; Ps < 0.02). Data were inconclusive for associations between perceived exposure to discrimination and deprivation-induced changes in cravings, urges to smoke for pleasure, positive mood reduction, other symptoms or smoking reinstatement behavior. CONCLUSIONS Frequency of perceived exposure to discrimination appears to be modestly associated with increased severity of some deprivation-induced tobacco withdrawal symptoms in African American smokers.
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Affiliation(s)
- Mariel S. Bello
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Madalyn M. Liautaud
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Julianne T. De La Cerda
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Raina D. Pang
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lara A. Ray
- University of California Los Angeles, Department of Psychology, Los Angeles, CA, USA
| | - Jasjit A. Ahluwalia
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Adam M. Leventhal
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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9
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Taniguchi C, Saka H, Oze I, Nakamura S, Nozaki Y, Tanaka H. Relationship between the strength of craving as assessed by the Tobacco Craving Index and success of quitting smoking in Japanese smoking cessation therapy. PLoS One 2020; 15:e0243374. [PMID: 33284809 PMCID: PMC7721195 DOI: 10.1371/journal.pone.0243374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/19/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We previously developed the Tobacco Craving Index (TCI) to assess craving of smokers. In the present study, we validated the relationship between the TCI grade over the 5 sessions of Japanese smoking cessation therapy (SCT) and success of quitting smoking among 889 Japanese patients. METHODS The Japanese SCT consists of 5 sessions of SCT (first session and sessions 2, 4, 8 and 12 weeks later). In the TCI questionnaire, patients are asked to rate their strength of craving and frequency of craving, each on a four-point Likert scale. Patients are classified into one of four grades based on their responses (0, I, II, III, with III indicating severe craving). The TCI questionnaire was administered to each participant at each session of the SCT. This study included participants of Japanese SCT who answered the TCI at the first session of the SCT at five Japanese smoking cessation clinics. Patients who dropped out of the SCT from the second to the fifth sessions were considered to have failed smoking cessation. To elucidate how much the TCI grade predicts smoking status at the last session, we performed multivariate logistic regression analysis with adjustment for confounding factors. RESULTS Participants who had higher TCI grade(III) in the 2nd through 5th sessions showed significantly lower probability for success of quitting smoking than those who had lower TCI grades(0 or I) (adjusted odds ratio: 2nd session: 0.30, 3rd session: 0.15, 4th session: 0.06, 5th session: 0.02). CONCLUSIONS We validated the usefulness of the TCI grade for assessing probability of quitting smoking by using a large number of smoking cessation settings.
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Affiliation(s)
- Chie Taniguchi
- College of Nursing, Aichi Medical University, Nagakute-city, Aichi, Japan
- Department of Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya-city, Aichi, Japan
| | - Hideo Saka
- Department of Respiratory Medicine, Matsunami General Hospital, Hashima-gun, Gifu, Japan
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya-city, Aichi, Japan
| | - Isao Oze
- Division of Cancer Epidemiology and Prevention, Department of Preventive Medicine, Aichi Cancer Center Research Institute, Nagoya-city, Aichi, Japan
| | - Sumie Nakamura
- Department of Nursing, National Hospital Organization Nagoya Medical Center, Nagoya-city, Aichi, Japan
| | - Yasuhiro Nozaki
- Department of Respiratory Medicine, Japan Community Healthcare Organization Chukyo Hospital, Nagoya-city, Aichi, Japan
- Department of Respiratory Medicine, Tokoname Municipal Hospital, Tokoname-city, Aichi, Japan
| | - Hideo Tanaka
- Fujiidera Public Health Center of Osaka Prefecture, Fujidera-city, Osaka, Japan
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10
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Lim AC, Grodin EN, Green R, Venegas A, Meredith LR, Courtney KE, Moallem NR, Sayegh P, London ED, Ray LA. Executive function moderates naltrexone effects on methamphetamine-induced craving and subjective responses. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2020; 46:565-576. [PMID: 32343625 PMCID: PMC7920534 DOI: 10.1080/00952990.2020.1741002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/28/2020] [Accepted: 02/29/2020] [Indexed: 10/24/2022]
Abstract
Background: Emerging evidence suggests that opioid receptor antagonists, such as naltrexone, are effective pharmacotherapies for alcohol, opioid, and possibly stimulant use disorders. It is posited that naltrexone exerts its effects, in part, by increasing functional connectivity between neural reward circuitry and frontal systems implicated in executive function. Yet no studies had examined whether executive function moderates these effects. Objectives: This study examined whether a composite measure of executive function (EF) moderates the effect of naltrexone on craving for methamphetamine and subjective responses following infusion of the drug. Methods: Individuals with methamphetamine use disorder (N = 30; 27% female) completed baseline neurocognitive assessments of premorbid and executive function, and an executive function factor was computed. Participants then underwent a randomized, double-blind, cross-over study of titration with naltrexone and placebo. Participants then received a 30-mg intravenous methamphetamine infusion and completed subjective response questionnaires at 8 times in the 120 minutes post-infusion. Results: Multilevel mixed models indicated a significant EF × medication interaction, reflecting greater effects of naltrexone to decrease "desire to access the drug", "want more of the drug", "crave the drug", "feel drug effects" and "feel high" in participants with low EF compared to those with high EF (Bs = .36-1.29, SEs = .14-.17, ps<0.01). These effects remained significant after controlling for premorbid cognitive functioning, baseline responses to methamphetamine, severity of methamphetamine use, and methamphetamine-related functional problems. Conclusion: Naltrexone may be especially effective in methamphetamine-dependent individuals with low EF. Neuropsychological assessments may also provide predictive clinical utility not captured by traditional measures of substance use severity.
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Affiliation(s)
- Aaron C. Lim
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Erica N. Grodin
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - ReJoyce Green
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Alexandra Venegas
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Lindsay R. Meredith
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kelly E. Courtney
- Department of Psychology, University of California, San Diego, San Diego, CA, USA
| | - Nathasha R. Moallem
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Philip Sayegh
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Edythe D. London
- Department of Psychiatry and Biobehavioral Sciences
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - Lara A. Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences
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11
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Pang RD, Guillot CR, Liautaud MM, Bello MS, Kirkpatrick MG, Huh J, Leventhal AM. Subjective effects from the first cigarette of the day vary with precigarette affect in premenopausal female daily smokers. Exp Clin Psychopharmacol 2020; 28:299-305. [PMID: 31368771 PMCID: PMC6994325 DOI: 10.1037/pha0000316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The 1st cigarette of the day is strongly tied to tobacco dependence. However, prior research has not investigated whether within-subject (WS) day-to-day fluctuations in prefirst-cigarette affect are associated with the subjective effects from the 1st cigarette of the day or whether these associations differ by smokers' average prefirst-cigarette affect. In the current study, 85 premenopausal female daily smokers completed baseline measures and 35 days of ecological momentary assessment. Prefirst-cigarette positive affect (PA) and negative affect (NA) were assessed prior to the 1st cigarette of the day and were partitioned into between-subjects (BS) and WS variables. Pleasurable and NA relief effects were assessed following the 1st cigarette of the day. On days when women reported higher than their usual prefirst-cigarette PA (WS-PA), they reported more pleasurable effects. On days when women reported higher than their usual prefirst-cigarette WS-NA, they reported greater pleasurable effects and NA relief effects. Women with higher average prefirst-cigarette NA relative to others (BS-NA), reported greater NA relief effects. Women with higher average prefirst-cigarette PA relative to others (BS-PA) reported greater pleasurable and NA relief effects from smoking. The association of within-subject affect (i.e., that day's level of NA or PA) with NA relief effects is attenuated in female smokers with higher average prefirst-cigarette NA (i.e., Prefirst-Cigarette WS Affect × Prefirst-Cigarette BS-NA interaction). Results suggest that prefirst-cigarette affect may impact the subjective effects from the 1st cigarette of the day and that the association between prefirst-cigarette affect and NA relief effects may be dampened in women with greater average precigarette NA. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Raina D. Pang
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Casey R. Guillot
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Madalyn M. Liautaud
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mariel S. Bello
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Matthew G. Kirkpatrick
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jimi Huh
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Adam M. Leventhal
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA,Department of Psychology, University of Southern California, Los Angeles, CA, USA
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12
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Hoeppner BB, Hoeppner SS, Carlon HA, Perez GK, Helmuth E, Kahler CW, Kelly JF. Leveraging Positive Psychology to Support Smoking Cessation in Nondaily Smokers Using a Smartphone App: Feasibility and Acceptability Study. JMIR Mhealth Uhealth 2019; 7:e13436. [PMID: 31271147 PMCID: PMC6636238 DOI: 10.2196/13436] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/01/2019] [Accepted: 05/18/2019] [Indexed: 01/07/2023] Open
Abstract
Background Nondaily smoking is an increasingly prevalent smoking pattern that poses substantial health risks. Objective We tested the feasibility of using a smartphone app with positive psychology exercises to support smoking cessation in nondaily smokers. Methods In this prospective, single-group pilot study, nondaily smokers (n=30) used version 1 of the Smiling Instead of Smoking (SiS) app for 3 weeks while undergoing a quit attempt. The app assigned daily happiness exercises, provided smoking cessation tools, and made smoking cessation information available. Participants answered surveys at baseline and 2, 6, 12, and 24 weeks after their chosen quit day and participated in structured user feedback sessions 2 weeks after their chosen quit day. Results App usage during the prescribed 3 weeks of use was high, with an average 84% (25.2/30) of participants using the app on any given day. App use was largely driven by completing happiness exercises (73%, 22/30) of participants per day), which participants continued to complete even after the end of the prescribed period. At the end of prescribed use, 90% (27/30) of participants reported that the app had helped them during their quit attempt, primarily by reminding them to stay on track (83%, 25/30) and boosting their confidence to quit (80%, 24/30) and belief that quitting was worthwhile (80%, 24/30). Happiness exercises were rated more favorably than user-initiated smoking cessation tools, and 80% (24/30) of participants proactively expressed in interviews that they liked them. App functionality to engage social support was not well received. Functionality to deal with risky times was rated useful but was rarely used. Within-person changes from baseline to the end of prescribed use were observed for several theorized mechanisms of behavior change, all in the expected direction: confidence increased (on a 0-100 scale, internal cues: b=16.7, 95% CI 7.2 to 26.3, P=.001; external cues: b=15.8, 95% CI 5.4 to 26.1, P=.004), urge to smoke decreased (on a 1-7 scale, b=−0.8, 95% CI −1.3 to −0.3, P=.002), and perceptions of smoking became less positive (on a 1-5 scale, psychoactive benefits: b=−0.5, 95% CI −0.9 to −0.2, P=.006; pleasure: b=−0.4, 95% CI −0.7 to −0.01, P=.03; on a 0-100 scale, importance of pros of smoking: b=−11.3, 95% CI −18.9 to −3.8, P=.004). Self-reported abstinence rates were 40% (12/30) and 53% (16/30) of participants 2 and 24 weeks post quit, respectively, with 30% (9/30) biochemically validated as abstinent 2 weeks post quit. Conclusions A smartphone app using happiness exercises to aid smoking cessation was well received by nondaily smokers. Given the high nonadherence and dropout rates for technology-delivered interventions reported in the literature, the high engagement with positive psychology exercises is noteworthy. Observed within-person changes and abstinence rates are promising and warrant further development of this app.
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Affiliation(s)
- Bettina B Hoeppner
- Recovery Research Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Susanne S Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, MA, United States
| | - Hannah A Carlon
- Recovery Research Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Giselle K Perez
- Behavioral Medicine Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Eric Helmuth
- School of Public Health, Boston University, Boston, MA, United States
| | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - John F Kelly
- Recovery Research Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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13
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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: 44] [Impact Index Per Article: 8.8] [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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14
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Notley C, Ward E, Dawkins L, Holland R, Jakes S. Vaping as an alternative to smoking relapse following brief lapse. Drug Alcohol Rev 2019; 38:68-75. [PMID: 30488650 PMCID: PMC6587865 DOI: 10.1111/dar.12876] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/14/2018] [Accepted: 10/16/2018] [Indexed: 12/05/2022]
Abstract
BACKGROUND AND AIMS E-cigarettes are the most popular aid to quitting smoking in the UK. Although many smokers quit, relapse is common. Historically, the literature has reported strong associations between tobacco smoking lapse and relapse following a quit attempt. This article aims to explore how smoking lapse is experienced by those who vape to quit smoking. DESIGN AND METHODS A purposive sample of 40 UK vapers were matched to a sampling frame from a representative sample of UK quitters. Semi-structured qualitative interviews were conducted. Data were thematically analysed iteratively situating reported experiences of smoking lapse within narrative descriptions of vaping. Iterative categorization was used as a technique to further explore a subset of data specifically focused on smoking lapse. RESULTS Analysis revealed that smoking lapse is perceived qualitatively differently when using e-cigarettes as compared to past quit attempts. Having the pleasurable alternative of vaping meant that full relapse to smoking was not inevitable. Instead, lapses were perceived as 'permissive' or 'purposive', intentional and contextualised, or for some as unintentional, with the resulting emotional response negatively reinforcing ongoing tobacco smoking abstinence. DISCUSSION AND CONCLUSIONS Our novel findings suggest that the role of tobacco smoking lapse in relation to relapse status may be theoretically redefined, drawing on data from vapers. These findings question the utility of previous theories of the role of smoking lapse in the relapse process. For ex-smokers, vaping offers a pleasurable, viable pharmacological, but also social and psychological, substitution option for smoking and potentially powerfully alters the experience and threat of any lapse.
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Affiliation(s)
- Caitlin Notley
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | - Emma Ward
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | - Lynne Dawkins
- Centre for Addictive Behaviours Research, School of Applied SciencesLondon South Bank UniversityLondonUK
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15
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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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16
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Liautaud MM, Leventhal AM, Pang RD. Happiness as a Buffer of the Association Between Dependence and Acute Tobacco Abstinence Effects in African American Smokers. Nicotine Tob Res 2018; 20:1215-1222. [PMID: 29059368 PMCID: PMC6121915 DOI: 10.1093/ntr/ntx216] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 09/25/2017] [Indexed: 11/14/2022]
Abstract
Introduction African American (AA) smokers are at disproportionate risk of tobacco dependence, utilizing smoking to regulate stress, and poor cessation outcomes. Positive emotional traits may function as coping factors that buffer the extent to which dependence increases vulnerability to adverse responses to acute tobacco abstinence (ie, tobacco withdrawal). This laboratory study examined subjective happiness (SH; dispositional orientation towards frequent and intense positive affect [PA] and life satisfaction) as a moderator of the relation between tobacco dependence and subjective and behavioral abstinence effects among AA smokers. Methods AA smokers (N = 420, 39.0% female) completed self-report measures of tobacco dependence and SH followed by two counterbalanced experimental sessions (nonabstinent vs. 16-hour abstinent) involving self-report measures of composite withdrawal, urge to smoke, and mood, and a behavioral smoking task in which participants could: (1) earn money to delay smoking reinstatement, and (2) subsequently purchase cigarettes to smoke. Results Tobacco dependence was positively associated with increased abstinence effects in composite withdrawal, urge to smoke, PA, and latency to smoking reinstatement (ps < .04). SH significantly moderated the relation between dependence and abstinence-induced increases in composite withdrawal (β = -.17, p < .001), such that the predictive power of dependence on withdrawal severity grew proportionately weaker as levels of SH increased. Conclusions SH may insulate against adverse effects of dependence on withdrawal during acute smoking abstinence, particularly withdrawal symptom clusters that are craving- and mood-based. Consideration of positive emotional traits as stress-coping factors in the dependence-withdrawal link may be warranted in research and practice with AA smokers. Implications The current study contributes to a growing body of literature examining the potentially advantageous role of positive emotional traits to smokers. We do so by identifying a relatively understudied psychological construct within tobacco research-subjective happiness-that may suppress the extent to which more severe tobacco dependence increases risk for subjective withdrawal-related distress during acute smoking abstinence in AA smokers. In doing so, the study provides a primer for future targeting of subjective happiness and other positive emotional traits as means to understand and treat acute tobacco abstinence effects among dependent AA smokers.
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Affiliation(s)
- Madalyn M Liautaud
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Adam M Leventhal
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
- Department of Psychology, University of Southern California, Los Angeles, CA
| | - Raina D Pang
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
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17
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Notley C, Colllins R. Redefining smoking relapse as recovered social identity – secondary qualitative analysis of relapse narratives. JOURNAL OF SUBSTANCE USE 2018. [DOI: 10.1080/14659891.2018.1489009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Caitlin Notley
- Norwich Medical School, Norwich Research Park, University of East Anglia, Norwich, UK
| | - Rory Colllins
- Norwich Medical School, Norwich Research Park, University of East Anglia, Norwich, UK
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18
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Smiling Instead of Smoking: Development of a Positive Psychology Smoking Cessation Smartphone App for Non-daily Smokers. Int J Behav Med 2018; 24:683-693. [PMID: 28197846 DOI: 10.1007/s12529-017-9640-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The usefulness of mobile technology in supporting smoking cessation has been demonstrated, but little is known about how smartphone apps could best be leveraged. The purpose of this paper is to describe the program of research that led to the creation of a smoking cessation app for non-daily smokers, so as to stimulate further ideas to create "smart" smartphone apps to support health behavior change. METHOD Literature reviews to evaluate the appropriateness of the proposed app, content analyses of existing apps, and smoking cessation sessions with non-daily smokers (n = 38) to inform the design of the app. RESULTS The literature reviews showed that (1) smoking cessation apps are sought after by smokers, (2) positive affect plays an important role in smoking cessation, (3) short, self-administered exercises consistently bring about enduring positive affect enhancements, and (4) low treatment-seeking rates of non-daily smokers despite high motivation to quit indicate a need for novel smoking cessation support. Directed content analyses of existing apps indicated that tailoring, two-way interactions, and proactive features are under-utilized in existing apps, despite the popularity of such features. Conventional content analyses of audio-recorded session tapes suggested that difficulty in quitting was generally linked to specific, readily identifiable occasions, and that social support was considered important but not consistently sought out. CONCLUSION The "Smiling Instead of Smoking" (SIS) app is an Android app that is designed to act as a behavioral, in-the-pocket coach to enhance quitting success in non-daily smokers. It provides proactive, tailored behavioral coaching, interactive tools (e.g., enlisting social support), daily positive psychology exercises, and smoking self-monitoring.
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19
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King AC, Smith LJ, McNamara PJ, Cao D. Second Generation Electronic Nicotine Delivery System Vape Pen Exposure Generalizes as a Smoking Cue. Nicotine Tob Res 2018; 20:246-252. [PMID: 28082323 PMCID: PMC7207065 DOI: 10.1093/ntr/ntw327] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 01/03/2017] [Indexed: 11/17/2022]
Abstract
Introduction Second generation electronic nicotine delivery systems (ENDS; also known as e-cigarettes, vaporizers or vape pens) are designed for a customized nicotine delivery experience and have less resemblance to regular cigarettes than first generation "cigalikes." The present study examined whether they generalize as a conditioned cue and evoke smoking urges or behavior in persons exposed to their use. Methods Data were analyzed in N = 108 young adult smokers (≥5 cigarettes per week) randomized to either a traditional combustible cigarette smoking cue or a second generation ENDS vaping cue in a controlled laboratory setting. Cigarette and e-cigarette urge and desire were assessed pre- and post-cue exposure. Smoking behavior was also explored in a subsample undergoing a smoking latency phase after cue exposure (N = 26). Results The ENDS vape pen cue evoked both urge and desire for a regular cigarette to a similar extent as that produced by the combustible cigarette cue. Both cues produced similar time to initiate smoking during the smoking latency phase. The ENDS vape pen cue elicited smoking urge and desire regardless of ENDS use history, that is, across ENDS naїve, lifetime or current users. Inclusion of past ENDS or cigarette use as covariates did not significantly alter the results. Conclusions These findings demonstrate that observation of vape pen ENDS use generalizes as a conditioned cue to produce smoking urge, desire, and behavior in young adult smokers. As the popularity of these devices may eventually overtake those of first generation ENDS cigalikes, exposure effects will be of increasing importance. Implications This study shows that passive exposure to a second generation ENDS vape pen cue evoked smoking urge, desire, and behavior across a range of daily and non-daily young adult smokers. Smoking urge and desire increases after vape pen exposure were similar to those produced by exposure to a first generation ENDS cigalike and a combustible cigarette, a known potent cue. Given the increasing popularity of ENDS tank system products, passive exposures to these devices will no doubt increase, and may contribute to tobacco use in young adult smokers.
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Affiliation(s)
- Andrea C King
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago IL
| | - Lia J Smith
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago IL
| | - Patrick J McNamara
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago IL
| | - Dingcai Cao
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago IL
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20
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Shiffman S, Terhorst L. Intermittent and daily smokers' subjective responses to smoking. Psychopharmacology (Berl) 2017; 234:2911-2917. [PMID: 28721480 PMCID: PMC5693764 DOI: 10.1007/s00213-017-4682-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 06/27/2017] [Indexed: 11/29/2022]
Abstract
RATIONALE One third of US smokers are intermittent smokers (ITS) who do not smoke daily. Unlike daily smokers (DS), whose smoking is negatively reinforced by withdrawal relief, ITS may be motivated by immediate positive reinforcement. In contrast, incentive salience theory posits hypothesis that "liking" of drug effects fades in established users, such as DS. OBJECTIVE This study aims to compare ITS' and DS' hedonic responses to smoking. METHODS Participants were 109 ITS (smoking 4-27 days/month) and 52 DS (smoking daily 5-25 cigarettes/day), aged ≥21, smoking ≥3 years, and not quitting smoking. For 3 weeks, participants engaged in ecological momentary assessment, carrying an electronic diary that asked them to rate their most recent smoking experience on 0-100 visual analog scales (satisfaction, enjoyment [averaged as "pleasure"], feeling sick, feeling a "rush," enjoying upper respiratory sensations, and immediate craving relief). Hierarchical random effect regression analyzed 4476 ratings. RESULTS ITS found smoking pleasurable (mean = 69.7 ± 1.7 [SE]) but significantly less so than DS did (77.6 ± 2.3; p < 0.006). ITS also reported more aversive response (ITS 18.2 ± 1.4, DS 11.6 ± 2.0; p < 0.007). Even though ITS are more likely to smoke at bars/restaurants, when drinking alcohol, or when others were present, they did not report more pleasure in these settings (compared to DS). More extensive smoking experience was unrelated to craving or smoking effects among DS, but predicted greater craving, greater pleasure, and less aversion among ITS. CONCLUSIONS The findings were largely inconsistent with incentive-salience models of drug use.
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Affiliation(s)
- Saul Shiffman
- Department of Psychology, University of Pittsburgh, 130 N. Bellefield Ave., Suite 510, Pittsburgh, PA, 15213, USA.
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA 15213, USA
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21
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Zhou C, Wu L, Liu Q, An H, Jiang B, Zuo F, Zhang L, He Y. Evaluation of smoking cessation intervention in patients with chronic diseases in smoking cessation clinics. Medicine (Baltimore) 2017; 96:e7459. [PMID: 29049178 PMCID: PMC5662344 DOI: 10.1097/md.0000000000007459] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study aimed to evaluate the effects of psychological intervention and psychological plus drug intervention on smoking cessation among male smokers with single chronic diseases.A total of 509 male smokers were divided into psychological group (n = 290) and psychological plus drugs (n = 219) groups according to their will. The physicians provided free individual counseling and follow-up interviews with brief counseling for all the subjects. In addition to mental intervention, patients in psychological plus drug group also received bupropion hydrochloride or varenicline tartrate to quit smoking. Outcomes were self-reported, regarding the 7-day point prevalence on abstinence rate and continuous abstinence rates at 1-, 3-, and 6-month follow-up period. Data analyses were performed using intention-to-treat analysis and per protocol analysis.With regards to the 3 follow-up time points, 7-day point-prevalence abstinence rate in psychological plus drugs group was all higher than that in the psychological intervention group. Additionally, the 3-month continuous abstinence rate (21.4%) of the 6-month follow-up in the psychological group was not significantly higher than that (26.9%) in the psychological plus drugs group (P >.05 for all). Fagerström test score, stage of quitting smoking, perceived confidence or difficulty in quitting, and chronic disease types were independently correlated with 3-month continuous abstinence in the 6-month follow up (P <.05 for all). The results were similar between intentional analysis and protocol analysis.The psychological intervention and psychological plus drugs intervention exerted good effects on smoking cessation in a short time (1 month). Nevertheless, the advantages did not appear during long-time (6 months) follow-up.
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Affiliation(s)
- Changxi Zhou
- Department of Respiration, Chinese PLA General Hospital
| | - Lei Wu
- Department of Epidemiology, Institute of Geriatrics
| | - Qinghui Liu
- Department of Respiration, Chinese PLA General Hospital
| | - Huaijie An
- Central Laboratory of Navy General Hospital
| | | | | | - Li Zhang
- Department of Rehabilitation, Chinese PLA General Hospital, Beijing, China
| | - Yao He
- Department of Epidemiology, Institute of Geriatrics
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22
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Baumeister RF. Addiction, cigarette smoking, and voluntary control of action: Do cigarette smokers lose their free will? Addict Behav Rep 2017; 5:67-84. [PMID: 29450229 PMCID: PMC5800589 DOI: 10.1016/j.abrep.2017.01.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 01/19/2017] [Indexed: 11/30/2022] Open
Abstract
Opinions differ widely as to whether addicts lose the ability to control their behavior and employ free will. This article reviews empirical findings regarding multiple questions relevant to the issue of free will among addicted smokers: Is smoking voluntary behavior? Can people quit smoking? Why don't people quit smoking? Why do smokers relapse when they try to quit? Do addicted smokers suffer from irresistible cravings? Are there some people who cannot quit? Are there conditions that make resistance impossible? Why would they smoke knowing it can kill them? The evidence reviewed here seems most consistent with the view that smokers retain control over their actions but cannot easily stop having frequent desires to smoke.
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23
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Bello MS, Pang RD, Chasson GS, Ray LA, Leventhal AM. Obsessive-compulsive symptoms and negative affect during tobacco withdrawal in a non-clinical sample of African American smokers. J Anxiety Disord 2017; 48:78-86. [PMID: 27769664 PMCID: PMC5380588 DOI: 10.1016/j.janxdis.2016.10.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 10/01/2016] [Accepted: 10/03/2016] [Indexed: 10/20/2022]
Abstract
The association between obsessive-compulsive (OC) symptomatology and smoking is poorly understood, particularly in African Americans-a group subject to smoking- and OC-related health disparities. In a non-clinical sample of 253 African American smokers, we tested the negative reinforcement model of OC-smoking comorbidity, purporting that smokers with higher OC symptoms experience greater negative affect (NA) and urge to smoke for NA suppression upon acute tobacco abstinence. Following a baseline visit involving OC assessment, participants completed two counterbalanced experimental visits (non-abstinent vs. 16-h tobacco abstinence) involving affect, smoking urge, and nicotine withdrawal assessment. OC symptom severity predicted larger abstinence-provoked increases in overall NA, anger, anxiety, depression, fatigue, urge to smoke to suppress NA, and composite nicotine withdrawal symptom index. African American smokers with elevated OC symptoms appear to be vulnerable to negative reinforcement-mediated smoking motivation and may benefit from cessation treatments that diminish NA or the urge to quell NA via smoking.
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Affiliation(s)
- Mariel S Bello
- University of Southern California, Department of Psychology, Los Angeles, CA, USA
| | - Raina D Pang
- University of Southern California Keck School of Medicine, Department of Preventive Medicine, Los Angeles, CA, USA
| | - Gregory S Chasson
- Illinois Institute of Technology, Department of Psychology, Chicago, IL, USA
| | - Lara A Ray
- University of California Los Angeles, Department of Psychology, Los Angeles, CA, USA
| | - Adam M Leventhal
- University of Southern California, Department of Psychology, Los Angeles, CA, USA; University of Southern California Keck School of Medicine, Department of Preventive Medicine, Los Angeles, CA, USA.
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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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Tulloch HE, Pipe AL, Clyde MJ, Reid RD, Els C. The Quit Experience and Concerns of Smokers With Psychiatric Illness. Am J Prev Med 2016; 50:709-718. [PMID: 26711162 DOI: 10.1016/j.amepre.2015.11.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 10/19/2015] [Accepted: 11/11/2015] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The purpose of this study is to better understand the quit experience and concerns of smokers with psychiatric illness (i.e., major depressive, anxiety, psychotic and bipolar disorders) in comparison with those without psychiatric illness. METHODS Smokers (N=732) with (n=430, 59%) and without psychiatric illness, recruited between June 2010 and March 2013 to participate in the FLEX (Flexible and Extended Dosing of Nicotine Replacement Therapy [NRT] and Varenicline in Comparison to Fixed-Dose NRT for Smoking Cessation) smoking-cessation trial, completed questionnaires assessing previously used cessation aids and reasons for relapse, and motivation and concerns about their upcoming quit attempt. These supplementary data analyses were conducted in May 2015. RESULTS The most commonly used cessation methods during previous attempts were nicotine replacement therapy (66.4%), cold turkey (59.7%), and bupropion (34.7%); no group differences were identified. Stress was the most common precipitator of relapse during previous attempts in all groups (43.6%), particularly among participants with depression and anxiety. Health was the most common motivation for the upcoming quit attempt (91%), followed by family/social pressures (28.1%) and cost (27.9%, particularly by smokers with psychotic disorders). Common pre-cessation concerns for the complete sample included: cravings (27.6%), stress (26.7%), and fear of failure (26%); participants with psychotic and anxiety disorders were most concerned about cravings, whereas the latter two concerns were more prominent for individuals with anxiety. CONCLUSIONS Findings reveal differences in the quit histories and concerns of smokers with or without psychiatric illness. Smokers with psychiatric illness are particularly vulnerable to relapse at times of stress and negative affect; interventions that emphasize alternative coping strategies and facilitate mood management are required.
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Affiliation(s)
- Heather E Tulloch
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; School of Psychology, University of Ottawa, Ottawa, Ontario, Canada;.
| | - Andrew L Pipe
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Matthew J Clyde
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Robert D Reid
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Charl Els
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
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Di Ciano P, Guranda M, Lagzdins D, Tyndale RF, Gamaleddin I, Selby P, Boileau I, Le Foll B. Varenicline-Induced Elevation of Dopamine in Smokers: A Preliminary [(11)C]-(+)-PHNO PET Study. Neuropsychopharmacology 2016; 41:1513-20. [PMID: 26442600 PMCID: PMC4832011 DOI: 10.1038/npp.2015.305] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/02/2015] [Accepted: 09/20/2015] [Indexed: 01/26/2023]
Abstract
Varenicline, a nicotinic partial agonist, is the most effective treatment for tobacco use disorder. However, its mechanism of action is still unclear and may involve stimulating dopaminergic transmission. Here we used PET imaging with [(11)C]-(+)-PHNO to explore for the first time the impact of varenicline on dopamine transmission in the D2-rich striatum and D3-rich extra-striatal regions and its relationship with craving, withdrawal and smoking. Eleven treatment-seeking smokers underwent two PET scans with [(11)C]-(+)-PHNO, each following 12-h overnight smoking abstinence both prior to receiving varenicline and following 10-11 days of varenicline treatment (ie, at steady-state drug levels). Subjective measures of craving and urges to smoke were also assessed on the days of the PET scans. Varenicline treatment significantly reduced [(11)C]-(+)-PHNO binding in the dorsal caudate (p=0.008) and reduced some craving measures. These findings provide the first evidence that varenicline is able to increase DA levels in the human brain, a factor that may contribute to its therapeutic efficacy.
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Affiliation(s)
- Patricia Di Ciano
- Translational Addiction Research Laboratory, CAMH, Toronto, ON, Canada
| | - Mihail Guranda
- Translational Addiction Research Laboratory, CAMH, Toronto, ON, Canada
| | - Dina Lagzdins
- Translational Addiction Research Laboratory, CAMH, Toronto, ON, Canada
| | - Rachel F Tyndale
- Pharmacogenetics Laboratory, CAMH, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, CAMH, Toronto, ON, Canada
| | - Islam Gamaleddin
- Translational Addiction Research Laboratory, CAMH, Toronto, ON, Canada
- Institute of Environmental Studies and Research, Ain Shams University, Cairo, Egypt
| | - Peter Selby
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Ambulatory Care and Structured Treatment Program, CAMH, Toronto, ON, Canada
- Dalla Lana School of Public Health, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Isabelle Boileau
- Campbell Family Mental Health Research Institute, CAMH, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Addiction Imaging Group, Research Imaging Centre, CAMH, Toronto, ON, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, CAMH, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, CAMH, Toronto, ON, Canada
- Ambulatory Care and Structured Treatment Program, CAMH, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Masefield S, Powell P, Jiménez-Ruiz C, Hajek P, Lewis K, Andreas S, Tønnesen P, van Schayck O, Gratziou C, Dautzenberg B, Tonstad S, Hering T, Nardini S, Fletcher M. Recommendations to improve smoking cessation outcomes from people with lung conditions who smoke. ERJ Open Res 2016; 2:00009-2016. [PMID: 27730185 PMCID: PMC5005168 DOI: 10.1183/23120541.00009-2016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 03/28/2016] [Indexed: 01/29/2023] Open
Abstract
This study aimed to gain insight into the impact of lung conditions on smoking behaviour and smoking cessation, and identify recommendations for smoking cessation and professional-patient communications. The study was led by the European Lung Foundation in collaboration with the European Respiratory Society Task Force on "Statement on smoking cessation on COPD and other pulmonary diseases and in smokers with comorbidities who find it difficult to quit". A web-based observational cross-sectional questionnaire was developed from a patient-centered literature review. Topics covered were: cohort characteristics; perspectives on smoking cessation; interactions with healthcare professionals; and recommendations to improve cessation outcomes. The questionnaire was disseminated via existing patient and professional networks and social media channels. The survey was available online for a period of 4 months in 16 languages. The data were analysed as a whole, not by country, with thematic analysis of the open responses. Common characteristics were: male (54%); age 40-55 years (39%); 11-20 cigarettes a day (39%); smokes within 30 min of waking (61%); and has made 1-5 cessation attempts in the previous 12 months (54%). 59% had tried cessation treatments, but, of these, 55% had not found any treatments helpful. Recommendations were: earlier intervention; discussion of the patient's smoking beliefs, behaviours and motivation; giving constructive advice; understanding addiction; informed decision-making; and treatment options. Areas for new and further research have been highlighted through exploring the smoking cessation perspectives and recommendations of people with lung conditions in Europe who smoke.
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Affiliation(s)
| | | | | | - Peter Hajek
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Keir Lewis
- Prince Philip Hospital and Swansea College of Medicine, Dept of Respiratory Medicine, Wales, UK
| | - Stefan Andreas
- Dept of Cardiology and Pneumology, Lungenfachklinik Immenhausen, Immenhausen, Germany
| | | | - Onno van Schayck
- Care and Public Health Research Institute (Caphri), Maastricht University, General Practice, Maastricht, The Netherlands
| | | | | | - Serena Tonstad
- Department of Preventive Cardiology, Ulleval University Hospital, Oslo, Norway
| | - Thomas Hering
- Stellvertretender Vorsitzender des Bundesverbandes der Pneumologen, Lungenarztpraxis Tegel, Berlin, Germany
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Ashare RL, Kimmey BA, Rupprecht LE, Bowers ME, Hayes MR, Schmidt HD. Repeated administration of an acetylcholinesterase inhibitor attenuates nicotine taking in rats and smoking behavior in human smokers. Transl Psychiatry 2016; 6:e713. [PMID: 26784967 PMCID: PMC5068882 DOI: 10.1038/tp.2015.209] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/08/2015] [Accepted: 10/30/2015] [Indexed: 01/14/2023] Open
Abstract
Tobacco smoking remains the leading cause of preventable death worldwide and current smoking cessation medications have limited efficacy. Thus, there is a clear need for translational research focused on identifying novel pharmacotherapies for nicotine addiction. Our previous studies demonstrated that acute administration of an acetylcholinesterase inhibitor (AChEI) attenuates nicotine taking and seeking in rats and suggest that AChEIs could be repurposed for smoking cessation. Here, we expand upon these findings with experiments designed to determine the effects of repeated AChEI administration on voluntary nicotine taking in rats as well as smoking behavior in human smokers. Rats were trained to self-administer intravenous infusions of nicotine (0.03 mg kg(-1) per 0.59 ml) on a fixed-ratio-5 schedule of reinforcement. Once rats maintained stable nicotine taking, galantamine or donepezil was administered before 10 consecutive daily nicotine self-administration sessions. Repeated administration of 5.0 mg kg(-1) galantamine and 3.0 mg kg(-1) donepezil attenuated nicotine self-administration in rats. These effects were reinforcer-specific and not due to adverse malaise-like effects of drug treatment as repeated galantamine and donepezil administration had no effects on sucrose self-administration, ad libitum food intake and pica. The effects of repeated galantamine (versus placebo) on cigarette smoking were also tested in human treatment-seeking smokers. Two weeks of daily galantamine treatment (8.0 mg (week 1) and 16.0 mg (week 2)) significantly reduced smoking rate as well as smoking satisfaction and reward compared with placebo. This translational study indicates that repeated AChEI administration reduces nicotine reinforcement in rats and smoking behavior in humans at doses not associated with tolerance and/or adverse effects.
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Affiliation(s)
- R L Ashare
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - B A Kimmey
- Center for Neurobiology and Behavior, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - L E Rupprecht
- Translational Neuroscience Program, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - M E Bowers
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - M R Hayes
- Translational Neuroscience Program, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - H D Schmidt
- Center for Neurobiology and Behavior, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
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Park SJ, Yi B, Lee HS, Oh WY, Na HK, Lee M, Yang M. To quit or not: Vulnerability of women to smoking tobacco. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART C, ENVIRONMENTAL CARCINOGENESIS & ECOTOXICOLOGY REVIEWS 2016; 34:33-56. [PMID: 26669465 DOI: 10.1080/10590501.2015.1131539] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Tobacco smoking is currently on the rise among women, and can pose a greater health risk. In order to understand the nature of the increase in smoking prevalence among women, we focused on the vulnerability of women to smoking behaviors--smoking cessation or tobacco addiction--and performed a systematic review of the socioeconomic and intrinsic factors as well as tobacco ingredients that affect women's susceptibility to smoking tobacco. We observed that nicotine and other tobacco components including cocoa-relatives, licorice products, and menthol aggravate tobacco addiction in women rather than in men. Various genetic and epigenetic alterations in dopamine pathway and the pharmaco-kinetics and -dynamic factors of nicotine also showed potential evidences for high susceptibility to tobacco addiction in women. Therefore, we suggest systemic approaches to prevent tobacco smoking-related health risks, considering gene-environment-gender interaction.
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Affiliation(s)
- Se-Jung Park
- a Research Center for Cell Fate Control, College of Pharmacy, Sookmyung Women's University , Seoul , Republic of Korea
| | - Bitna Yi
- b Department of Neurosurgery , Stanford University School of Medicine , Stanford , California , USA
| | - Ho-Sun Lee
- a Research Center for Cell Fate Control, College of Pharmacy, Sookmyung Women's University , Seoul , Republic of Korea
| | - Woo-Yeon Oh
- a Research Center for Cell Fate Control, College of Pharmacy, Sookmyung Women's University , Seoul , Republic of Korea
| | - Hyun-Kyung Na
- a Research Center for Cell Fate Control, College of Pharmacy, Sookmyung Women's University , Seoul , Republic of Korea
| | - Minjeong Lee
- a Research Center for Cell Fate Control, College of Pharmacy, Sookmyung Women's University , Seoul , Republic of Korea
| | - Mihi Yang
- a Research Center for Cell Fate Control, College of Pharmacy, Sookmyung Women's University , Seoul , Republic of Korea
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Bello MS, Pang RD, Cropsey KL, Zvolensky MJ, Reitzel LR, Huh J, Leventhal AM. Tobacco Withdrawal Amongst African American, Hispanic, and White Smokers. Nicotine Tob Res 2015; 18:1479-87. [PMID: 26482061 DOI: 10.1093/ntr/ntv231] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 10/01/2015] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Persistent tobacco use among racial and ethnic minority populations in the United States is a critical public health concern. Yet, potential sources of racial/ethnic disparities in tobacco use remain unclear. The present study examined racial/ethnic differences in tobacco withdrawal-a clinically-relevant underpinning of tobacco use that has received sparse attention in the disparities literature-utilizing a controlled laboratory design. METHODS Daily smokers (non-Hispanic African American [n = 178], non-Hispanic white [n = 118], and Hispanic [n = 28]) attended two counterbalanced sessions (non-abstinent vs. 16-hour abstinent). At both sessions, self-report measures of urge, nicotine withdrawal, and affect were administered and performance on an objective behavioral task that assessed motivation to reinstate smoking was recorded. Abstinence-induced changes (abstinent scores vs. non-abstinent scores) were analyzed as a function of race/ethnicity. RESULTS Non-Hispanic African American smokers reported greater abstinence-induced declines in several positive affect states in comparison to other racial/ethnic groups. Relative to Hispanic smokers, non-Hispanic African American and non-Hispanic white smokers displayed larger abstinence-provoked increases in urges to smoke. No racial/ethnic differences were detected for a composite measure of nicotine withdrawal symptomatology, negative affect states, and motivation to reinstate smoking behavior. CONCLUSIONS These results suggest qualitative differences in the expression of some components of tobacco withdrawal across three racial/ethnic groups. This research helps shed light on bio-behavioral sources of tobacco-related health disparities, informs the application of smoking cessation interventions across racial/ethnic groups, and may ultimately aid the overall effort towards reducing the public health burden of tobacco addiction in minority populations. IMPLICATIONS The current study provides some initial evidence that there may be qualitative differences in the types of tobacco withdrawal symptoms experienced among non-Hispanic African American, Hispanic, and non-Hispanic white smokers. Extending this line of inquiry may elucidate mechanisms involved in tobacco-related health disparities and ultimately aid in reducing the public health burden of smoking in racial/ethnic minority populations.
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Affiliation(s)
- Mariel S Bello
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Raina D Pang
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Karen L Cropsey
- Department of Psychiatry, University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | | | - Lorraine R Reitzel
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX
| | - Jimi Huh
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Adam M Leventhal
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA; Department of Psychology, University of Southern California, Los Angeles, CA;
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Aguirre CG, Madrid J, Leventhal AM. Tobacco withdrawal symptoms mediate motivation to reinstate smoking during abstinence. JOURNAL OF ABNORMAL PSYCHOLOGY 2015; 124:623-34. [PMID: 25961814 PMCID: PMC4573778 DOI: 10.1037/abn0000060] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Withdrawal-based theories of addiction hypothesize that motivation to reinstate drug use following acute abstinence is mediated by withdrawal symptoms. Experimental tests of this hypothesis in the tobacco literature are scant and may be subject to methodological limitations. This study utilized a robust within-subject laboratory experimental design to investigate the extent to which composite tobacco withdrawal symptomatology level and 3 unique withdrawal components (i.e., low positive affect, negative affect, and urge to smoke) mediated the effect of smoking abstinence on motivation to reinstate smoking. Smokers (≥10 cigarettes per day; N = 286) attended 2 counterbalanced sessions at which abstinence duration was differentially manipulated (1 hr vs. 17 hr). At both sessions, participants reported current withdrawal symptoms and subsequently completed a task in which they were monetarily rewarded proportional to the length of time they delayed initiating smoking, with shorter latency reflecting stronger motivation to reinstate smoking. Abstinence reduced latency to smoking initiation and positive affect and increased composite withdrawal symptom level, urge, and negative affect. Abstinence-induced reductions in latency to initiating smoking were mediated by each withdrawal component, with stronger effects operating through urge. Combined analyses suggested that urge, negative affect, and low positive affect operate through empirically unique mediational pathways. Secondary analyses suggested similar effects on smoking quantity, few differences among specific urge and affect subtypes, and that dependence amplifies some abstinence effects. This study provides the first experimental evidence that within-person variation in abstinence impacts motivation to reinstate drug use through withdrawal. Urge, negative affect, and low positive affect may reflect unique withdrawal-mediated mechanisms underlying tobacco addiction.
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Farris SG, Zvolensky MJ, Schmidt NB. Smoking-specific experiential avoidance cognition: explanatory relevance to pre- and post-cessation nicotine withdrawal, craving, and negative affect. Addict Behav 2015; 44:58-64. [PMID: 25146128 PMCID: PMC4320024 DOI: 10.1016/j.addbeh.2014.07.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 07/17/2014] [Accepted: 07/25/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Negative-reinforcement based cognitive processes have been implicated in the maintenance of cigarette smoking. Given the expectation that smoking will attenuate aversive internal experiences, smokers may be particularly unwilling to experience or remain in contact with smoking-related distress (i.e., experiential avoidance). Yet, there is little known about a cognitive-based process termed smoking-specific experiential avoidance with regard to withdrawal, craving, or negative affect during a quit attempt. METHOD Data were collected from adult daily smokers (n = 259) participating in a larger smoking cessation trial. Pre- and post-quit experiences of nicotine withdrawal, craving, and negative affect were examined in terms of cognitive-based smoking-specific experimental avoidance, measured by the Avoidance and Inflexibility Scale (AIS). RESULTS Results indicated that baseline smoking-specific experiential avoidance was associated with greater overall levels of withdrawal, craving, and negative affect at treatment initiation (pre-cessation). Reductions in smoking-specific experiential avoidance from baseline to quit day were associated with increased likelihood of quit day abstinence. Such reductions were also predictive of lower levels of nicotine withdrawal, craving, and negative affect on quit day. Also, less reduction in experiential avoidance was associated with experiencing greater withdrawal in the early phase of quitting. DISCUSSION The impact of cognitive-based experiential avoidance pertaining to smoking impacts both pre- and post-cessation experiences in terms of negative affect, withdrawal, and smoking cravings and may represent an important treatment target.
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Affiliation(s)
- Samantha G Farris
- University of Houston, Department of Psychology, 126 Heyne Building, Houston, TX 77024, United States
| | - Michael J Zvolensky
- University of Houston, Department of Psychology, 126 Heyne Building, Houston, TX 77024, United States; The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, 1155 Pressler Street, Houston, TX 77030, United States.
| | - Norman B Schmidt
- Florida State University, Department of Psychology, 1107 W Call St., Tallahassee, FL 32304, United States
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33
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Veilleux JC, Skinner KD. Smoking, food, and alcohol cues on subsequent behavior: A qualitative systematic review. Clin Psychol Rev 2015; 36:13-27. [DOI: 10.1016/j.cpr.2015.01.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 12/06/2014] [Accepted: 01/04/2015] [Indexed: 10/24/2022]
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Leventhal AM, Zvolensky MJ. Anxiety, depression, and cigarette smoking: a transdiagnostic vulnerability framework to understanding emotion-smoking comorbidity. Psychol Bull 2015; 141:176-212. [PMID: 25365764 PMCID: PMC4293352 DOI: 10.1037/bul0000003] [Citation(s) in RCA: 349] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Research into the comorbidity between emotional psychopathology and cigarette smoking has often focused upon anxiety and depression's manifest symptoms and syndromes, with limited theoretical and clinical advancement. This article presents a novel framework to understanding emotion-smoking comorbidity. We propose that transdiagnostic emotional vulnerabilities-core biobehavioral traits reflecting maladaptive responses to emotional states that underpin multiple types of emotional psychopathology-link various anxiety and depressive psychopathologies to smoking. This framework is applied in a review and synthesis of the empirical literature on 3 transdiagnostic emotional vulnerabilities implicated in smoking: (a) anhedonia (Anh; diminished pleasure/interest in response to rewards), (b) anxiety sensitivity (AS; fear of anxiety-related sensations), and (c) distress tolerance (DT; ability to withstand distressing states). We conclude that Anh, AS, and DT collectively (a) underpin multiple emotional psychopathologies, (b) amplify smoking's anticipated and actual affect-enhancing properties and other mechanisms underlying smoking, (c) promote progression across the smoking trajectory (i.e., initiation, escalation/progression, maintenance, cessation/relapse), and (d) are promising targets for smoking intervention. After existing gaps are identified, an integrative model of transdiagnostic processes linking emotional psychopathology to smoking is proposed. The model's key premise is that Anh amplifies smoking's anticipated and actual pleasure-enhancing effects, AS amplifies smoking's anxiolytic effects, and poor DT amplifies smoking's distress terminating effects. Collectively, these processes augment the reinforcing properties of smoking for individuals with emotional psychopathology to heighten risk of smoking initiation, progression, maintenance, cessation avoidance, and relapse. We conclude by drawing clinical and scientific implications from this framework that may generalize to other comorbidities.
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Affiliation(s)
- Adam M Leventhal
- Department of Psychology, Keck School of Medicine, University of Southern California
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Audrain-McGovern J, Leventhal AM, Strong DR. The Role of Depression in the Uptake and Maintenance of Cigarette Smoking. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2015; 124:209-43. [PMID: 26472531 PMCID: PMC7518154 DOI: 10.1016/bs.irn.2015.07.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Cigarette smoking and depression both account for significant morbidity, mortality, and economic burden. The prevalence of both smoking and depression increase across mid-to-late adolescence and show high rates of comorbidity. While little is known about why smoking is disproportionately higher among depressed adolescents than adolescents without depression, emerging research has begun to offer some initial insights. The high rates of comorbidity between depression and smoking emphasize the importance of identifying intervention targets to inform smoking prevention efforts for this high-risk group. Interventions during adolescence may lessen the prevalence of depression-prone adult smokers. Depression is over-represented among adult smokers and contributes to lower smoking cessation rates. Negative mood management and pharmacotherapy have been the central focus of smoking cessation interventions for depression-prone populations to date. Converging lines of research highlight novel smoking cessation targets such as the maintenance of positive mood and reward regulation. Smoking cessation research in depression-prone smokers is critical to identify efficacious treatments that will ultimately decrease the excess smoking burden for this population.
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Affiliation(s)
- Janet Audrain-McGovern
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Adam M Leventhal
- Departments of Preventive Medicine and Psychology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - David R Strong
- Department of Family Medicine and Public Health, University of California, San Diego, California, USA
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Hoeppner BB, Kahler CW, Gwaltney CJ. Relationship between momentary affect states and self-efficacy in adolescent smokers. Health Psychol 2014; 33:1507-17. [PMID: 25020151 PMCID: PMC4250296 DOI: 10.1037/hea0000075] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Relapse to smoking after making a quit attempt is both common and rapid in adolescent smokers. Momentary self-efficacy (SE)-that is, momentary shifts in one's confidence in the ability to abstain from smoking-predicts the occurrence and timing of relapse among adolescent smokers. Therefore, it is important to identify factors that are associated with changes in momentary SE early in a quit attempt. This study examined the relationship between affect states (including positive, negative, and nicotine withdrawal states) and momentary SE at various stages of a quit attempt. METHOD Adolescent daily smokers interested in making a quit attempt (n = 202) completed ecological momentary assessments (EMA) each day for 1 week leading up to and 2 weeks after a quit attempt. In each assessment, they reported current SE and affect state. RESULTS RESULTS of linear mixed models indicated that most of the examined affect states were related to momentary SE. Contrary to expectation, they were related to momentary SE both immediately before and after the quit attempt. Moderation effects were observed for select affect states, where higher baseline SE was related to lower momentary SE in the presence of increasing negative high activation, boredom, and difficulty concentrating. CONCLUSIONS Our findings suggest that both positive and negative affect states are related to SE, and that thereby positive affect enhancement may be a promising, underutilized treatment target.
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Affiliation(s)
- Bettina B. Hoeppner
- Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA 02114, USA
| | - Christopher W. Kahler
- Department of Behavioral and Social Sciences and the Center for Alcohol and Addiction Studies, Box GS121-4, Brown School of Public Health, Providence, RI 02912, USA
| | - Chad J. Gwaltney
- Department of Behavioral and Social Sciences and the Center for Alcohol and Addiction Studies, Box GS121-4, Brown School of Public Health, Providence, RI 02912, USA
- ERT, Inc., Philadelphia, PA, 19103
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Pericot-Valverde I, Secades-Villa R, Gutiérrez-Maldonado J, García-Rodríguez O. Effects of systematic cue exposure through virtual reality on cigarette craving. Nicotine Tob Res 2014; 16:1470-7. [PMID: 24962558 PMCID: PMC4342674 DOI: 10.1093/ntr/ntu104] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 05/21/2014] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Cigarette cravings have been associated with less successful attempts to quit smoking and a greater likelihood of relapse after smoking cessation. Background craving refers to a relatively steady and continuous experience of craving, while cue-induced craving refers to phases of intense craving triggered by cues associated with smoking. Cue exposure treatment (CET) involves repeated exposure to stimuli associated with substance use in order to reduce craving responses. However, mixed results have been found regarding the effect of CET on both types of craving. The aim of this study was to assess the effect of systematic virtual reality cue exposure treatment (VR-CET) on background and cue-induced cravings. METHODS Participants were 48 treatment-seeking smokers. The VR-CET consisted of prolonged exposure sessions to several interactive virtual environments. The VR-CET was applied once a week over 5 weeks. An individualized hierarchy of exposure was drawn up for each patient starting from the easiest virtual environment. Background and cue-induced cravings were recorded in each session. RESULTS Cue-induced craving decreased over each session as a result of prolonged exposure. VR-CET also reduced cue-induced and background cravings across the 5 sessions, showing a cumulative effect across the exposure sessions. CONCLUSIONS Our results evidenced the utility of VR-CET in reducing both types of cigarette craving. A combination of CET through VR with psychological treatments may improve current treatments for smoking cessation.
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Affiliation(s)
| | | | - José Gutiérrez-Maldonado
- Department of Personality, Assessment, and Psychological Treatments, University of Barcelona, Barcelona, Spain
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Agrawal A, Madden PA, Bucholz KK, Heath AC, Lynskey MT. Initial reactions to tobacco and cannabis smoking: a twin study. Addiction 2014; 109:663-71. [PMID: 24325652 PMCID: PMC3951663 DOI: 10.1111/add.12449] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 07/02/2013] [Accepted: 12/02/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Initial subjective reactions to cannabis and tobacco, broadly classified as positive or negative, have previously been explored for their associations with onset and maintenance of subsequent abuse/dependence. We examine (i) the factorial architecture of self-reported initial reactions to cannabis and tobacco; (ii) whether these factors associate with concurrently reported age at onset of DSM-IV diagnosis of nicotine dependence and cannabis abuse/dependence; and (iii) estimate heritable variation in and covariation between the factors. DESIGN Factorial and exploratory structural equation modeling was conducted to examine the factor structure of initial reactions. Cox proportional hazards modeling was employed to examine their association with time to onset of diagnosis of DSM-IV nicotine dependence and cannabis abuse/dependence. Classical twin modeling, using univariate and multivariate models, was used to parse variance in each factor (and the covariance between factors) to their additive genetic, shared environmental and non-shared environmental sources. SETTING AND PARTICIPANTS General population sample of Caucasian female twins aged 18-32 years, with a life-time history of tobacco [n = 2393] and cannabis [n = 1445] use. MEASUREMENT Self-report of initial subjective reactions to tobacco (cigarettes) and cannabis the first time they were used and time to onset of life-time history of DSM-IV diagnosis of abuse (cannabis) and dependence (cannabis or nicotine). FINDINGS Factors representing putatively positive and negative reactions to cannabis and tobacco emerged. Initial reactions to tobacco were associated with onset of DSM-IV diagnosis of nicotine dependence and cannabis abuse/dependence while initial reactions to cannabis were associated with onset of DSM-IV diagnosis of cannabis abuse/dependence alone. Genetic factors played a moderate role in each factor (heritability of 27-35%, P < 0.05), with the remaining variance attributed to individual-specific environment. Covariation across the factors indexing positive and negative initial reactions was attributable to genetic sources (0.18-0.58, P < 0.05) and to overlapping individual-specific environmental factors (-0.16 to 0.36, P < 0.05). CONCLUSIONS Initial subjective reactions to tobacco are associated with onset of DSM-IV diagnosis of nicotine dependence and cannabis abuse/dependence while initial subjective reactions to cannabis are only associated with onset of diagnosis of DSM-IV cannabis abuse/dependence. Genetic and environmental factors underpin the overlap across the factors representing initial reactions, both positive and negative.
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Affiliation(s)
- Arpana Agrawal
- Washington University School of Medicine, Dept. of Psychiatry, 660 S. Euclid, CB 8134, Saint Louis, MO 63110
| | - Pamela A.F. Madden
- Washington University School of Medicine, Dept. of Psychiatry, 660 S. Euclid, CB 8134, Saint Louis, MO 63110
| | - Kathleen K. Bucholz
- Washington University School of Medicine, Dept. of Psychiatry, 660 S. Euclid, CB 8134, Saint Louis, MO 63110
| | - Andrew C. Heath
- Washington University School of Medicine, Dept. of Psychiatry, 660 S. Euclid, CB 8134, Saint Louis, MO 63110
| | - Michael T. Lynskey
- Washington University School of Medicine, Dept. of Psychiatry, 660 S. Euclid, CB 8134, Saint Louis, MO 63110,Addictions Department, Institute of Psychiatry, King’s College London, London, UK
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Bidwell LC, Ameringer KJ, Leventhal AM. Associations of attention-deficit hyperactivity disorder symptom dimensions with smoking deprivation effects in adult smokers. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2014; 28:182-92. [PMID: 24731115 PMCID: PMC4183136 DOI: 10.1037/a0035369] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Identifying relations of attention deficit hyperactivity disorder (ADHD) symptom dimensions to individual facets of the tobacco withdrawal syndrome could elucidate the mechanisms linking ADHD and regular smoking. This study examined the unique relations of inattention (IN) and hyperactivity-impulsivity (HI) symptom dimensions of ADHD to a variety of tobacco withdrawal symptoms. One hundred thirty-two community-dwelling adult smokers recruited without regard to ADHD status completed a self-report measure of ADHD symptoms experienced over the past 6 months at a baseline visit. At two subsequent experimental sessions (one following overnight tobacco deprivation and one nondeprived; order counterbalanced), participants completed measures of tobacco withdrawal symptoms, mood, and desire to smoke. Preliminary analyses showed that higher levels of IN and HI symptoms were both associated with higher levels of negative affect and concentration difficulties during nondeprived ("baseline") states (ps < .01). Over and above nondeprived ratings, higher levels of HI symptoms were associated with larger deprivation-induced increases in negative affect, concentration problems, and desire to smoke, particularly for negative affect relief, during deprived states (ps < .01). ADHD symptoms, particularly HI symptoms, are associated with more severe exacerbations in abstinence-induced withdrawal symptoms, which could be an important mechanism of ADHD-smoking comorbidity. These findings suggest the need for clinical studies examining the role of these unique and potentially more severe withdrawal profiles experienced by smokers with high-levels of ADHD symptoms in smoking reinstatement and cessation outcomes.
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Affiliation(s)
- L. Cinnamon Bidwell
- Center for Alcohol and Addition Studies, Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI
- Division of Behavioral Genetics, Department of Psychiatry, Rhode Island Hospital, Providence, RI
| | - Katherine J. Ameringer
- University of Southern California, Keck School of Medicine, Departments of Preventive Medicine and Psychology, Los Angeles, CA 90033
| | - Adam M. Leventhal
- University of Southern California, Keck School of Medicine, Departments of Preventive Medicine and Psychology, Los Angeles, CA 90033
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Kahler CW, Spillane NS, Day A, Clerkin E, Parks A, Leventhal AM, Brown RA. Positive Psychotherapy for Smoking Cessation: Treatment Development, Feasibility and Preliminary Results. THE JOURNAL OF POSITIVE PSYCHOLOGY 2014; 9:19-29. [PMID: 24683417 PMCID: PMC3964803 DOI: 10.1080/17439760.2013.826716] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Low positive and high negative affect predict low rates of smoking abstinence among smokers making a quit attempt. Positive Psychotherapy can both increase positive affect and decrease negative affect and therefore may be a useful adjunct to behavioral smoking counseling. The purpose of the present study was to assess the feasibility and acceptability of a Positive Psychotherapy for Smoking Cessation (PPT-S) intervention that integrates standard smoking cessation counseling with nicotine patch and a package of positive psychology interventions. We delivered PPT-S to 19 smokers who were low in positive affect at baseline. Rates of session attendance and satisfaction with treatment were high, and most participants reported using and benefiting from the positive psychology interventions. Almost one-third of participants (31.6%) sustained smoking abstinence for 6 months after their quit date. Future studies to assess the relative efficacy of PPT-S compared to standard smoking cessation treatment are warranted.
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Affiliation(s)
- Christopher W. Kahler
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Box G-S121-4, Providence, RI, 02912
| | - Nichea S. Spillane
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Box G-S121-4, Providence, RI, 02912
| | - Anne Day
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Box G-S121-4, Providence, RI, 02912
| | - Elise Clerkin
- Miami University, Department of Psychology, Oxford, OH 45056
| | - Acacia Parks
- Hiram College, Department of Psychology, Hiram, OH 44234
| | - Adam M. Leventhal
- Departments of Preventive Medicine and Psychology, University of Southern California Keck School of Medicine, Los Angeles, CA 90033
| | - Richard A. Brown
- Alpert Medical School of Brown University and Butler Hospital, Providence, RI, 02906
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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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42
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Leventhal AM, Ameringer KJ, Osborn E, Zvolensky MJ, Langdon KJ. Anxiety and depressive symptoms and affective patterns of tobacco withdrawal. Drug Alcohol Depend 2013; 133:324-9. [PMID: 23896304 PMCID: PMC4049140 DOI: 10.1016/j.drugalcdep.2013.06.015] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 05/07/2013] [Accepted: 06/07/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND The complex concordance and discordance across and within anxiety and depressive symptoms complicates understanding of the relation between emotional symptoms and manifestations of tobacco withdrawal. The goal of this study was to parse the broad variation in anxiety and depressive symptoms into conceptually discrete components and explore their relative predictive influence on affective patterns of acute tobacco withdrawal. METHODS We employed a within-participant experimentally manipulated tobacco abstinence design involving: (i) a baseline visit at which past-week depression and anxiety symptoms were assessed and (ii) two counterbalanced experimental visits-one after ad lib smoking and one after 16-h of tobacco abstinence-at which state affect was assessed. Participants were community-dwelling adults (N=187) smoking 10+ cig/day for at least two years without an active mood disorder. RESULTS Anxiety-related general distress symptoms (e.g., tension, nervousness) predicted greater abstinence-induced increases in various negative affective states but not changes in positive affect (βs .17-.33). Depression-related general distress symptoms (e.g., sadness, worthlessness) predicted greater abstinence-induced increases in acute depressed affect only (βs .24-.25). Anhedonic symptoms (e.g., diminished interest, lack of pleasure) predicted larger abstinence-induced decreases in acute positive affect only (βs .17-.20). Anxious Arousal symptoms (e.g., shakiness, heart racing) predicted larger abstinence-induced increases in fatigue and depressive affect (βs .15-.24). CONCLUSION Different components of anxiety and depressive symptoms are associated with unique affective patterns of acute tobacco withdrawal. These results provide insight into the affective mechanisms underlying tobacco dependence and could inform smoking cessation treatment approaches tailored to individuals with emotional distress.
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Affiliation(s)
- Adam M. Leventhal
- University of Southern California Keck School of Medicine, Department of Preventive Medicine, Los Angeles, CA, 90033, USA,University of Southern California, Department of Psychology, Los Angeles, CA, 90033, USA
| | - Katherine J. Ameringer
- University of Southern California Keck School of Medicine, Department of Preventive Medicine, Los Angeles, CA, 90033, USA
| | - Elly Osborn
- University of Washington School of Medicine, Seattle, WA, 98105 USA
| | - Michael J. Zvolensky
- University of Houston, Department of Psychology, Houston, TX, 77004,USA,University of Texas M.D. Anderson Cancer Center, Department of Behavioral Science, Houston, TX, 77230, USA
| | - Kirsten J. Langdon
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, 02912, USA
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Tidey JW, Colby SM, Xavier EMH. Effects of smoking abstinence on cigarette craving, nicotine withdrawal, and nicotine reinforcement in smokers with and without schizophrenia. Nicotine Tob Res 2013; 16:326-34. [PMID: 24113929 DOI: 10.1093/ntr/ntt152] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Schizophrenia is associated with a high prevalence of cigarette smoking. The aims of this study were to compare smokers with schizophrenia (SS) and control smokers without psychiatric illness (CS) on (a) cigarette craving and nicotine withdrawal symptom severity during a 72-hr smoking abstinence period; (b) nicotine reinforcement, before and after abstinence; and (c) latency to smoking lapse following abstinence. We also explored mediators of smoking lapse in SS and CS. METHODS SS (n = 28) and CS (n = 27) underwent a nicotine versus denicotinized cigarette puff choice task before and after a 72-hr period of smoking abstinence that was experimentally controlled by providing cash reinforcement contingent on biochemical verification of abstinence. Twenty-four hours after the second choice task, participants could receive a low-value reinforcer if they had continued to abstain since the previous day. Those who remained abstinent were recontacted a week later to determine time of their smoking lapse. RESULTS SS reported more severe cigarette craving and nicotine withdrawal symptoms throughout the 72-hr abstinence period, had greater nicotine preference after abstinence, and lapsed back to smoking significantly sooner than CS. The relationship between group and smoking lapse latency was mediated by baseline depression and nicotine withdrawal symptom severity but not by effects of abstinence on craving or nicotine reinforcement. CONCLUSIONS Overall, these results indicate that negative affect is a key contributor to poor smoking cessation outcomes among those with schizophrenia.
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Affiliation(s)
- Jennifer W Tidey
- Department of Psychiatry and Human Behavior, Center for Alcohol and Addiction Studies, Brown University, Providence, RI
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Pang RD, Leventhal AM. Sex differences in negative affect and lapse behavior during acute tobacco abstinence: a laboratory study. Exp Clin Psychopharmacol 2013; 21:269-76. [PMID: 23834551 PMCID: PMC3962304 DOI: 10.1037/a0033429] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [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
Heightened negative affect during acute tobacco abstinence in women relative to men could be an important factor underlying sex differences in smoking motivation. However, little controlled experimental work addresses this hypothesis. The current study investigated sex differences in withdrawal-related negative affect, time to start smoking on a lab analogue smoking lapse task, and the interrelation between sex, withdrawal-related negative affect, and smoking lapse behavior. Following a baseline session, current smokers (women: n = 68, men: n = 131) attended two counterbalanced lab sessions (16 hours smoking abstinence and ad libitum smoking) during which they completed self-report measures of mood and withdrawal symptoms followed by a laboratory analogue smoking lapse task. In this task participants are monetarily rewarded for delaying smoking. Performance on this task serves as an analogue model of smoking lapse behavior by measuring smoker's capability to resist temptation to smoke under conditions where abstinence is advantageous. Females showed greater abstinence induced increases in composite negative affect as well as several particular negative affect states (i.e., POMS Anger, Anxiety, Depression, and Confusion, ps < .05) but no differences in abstinence induced changes in other forms of affect or craving. Females also exhibited marginally greater abstinence induced decreases in their willingness to delay smoking for money (p = .10), which was mediated by abstinence induced increases in anger (p < .05). These results suggest that differential sensitivity to abstinence induced negative affect, particularly anger, could underlie sex specific smoking patterns. Negative affect during tobacco abstinence may be an important factor for understanding and treating nicotine addiction in women.
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Affiliation(s)
- Raina D Pang
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA 90033, USA.
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45
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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: 127] [Impact Index Per Article: 11.5] [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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A double blind, placebo-controlled study of the effects of post-retrieval propranolol on reconsolidation of memory for craving and cue reactivity in cocaine dependent humans. Psychopharmacology (Berl) 2013; 226:721-37. [PMID: 23460266 PMCID: PMC3637960 DOI: 10.1007/s00213-013-3039-3] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 02/20/2013] [Indexed: 10/27/2022]
Abstract
RATIONALE/OBJECTIVES This study examined the effects of propranolol vs. placebo, administered immediately after a "retrieval" session of cocaine cue exposure (CCE), on craving and physiological responses occurring 24 h later during a subsequent "test" session of CCE. It was hypothesized that compared to placebo-treated cocaine-dependent (CD) individuals, propranolol-treated CD individuals would evidence attenuated craving and physiological reactivity during the test session. Secondarily, it was expected that group differences identified in the test session would be evident at a 1-week follow-up CCE session. Exploratory analyses of treatment effects on cocaine use were also performed at follow-up. METHODS CD participants received either 40 mg propranolol or placebo immediately following a "retrieval" CCE session. The next day, participants received a "test" session of CCE that was identical to the "retrieval" session except no medication was administered. Participants underwent a "follow-up" CCE session 1 week later. Craving and other reactivity measures were obtained at multiple time points during the CCE sessions. RESULTS Propranolol- vs. placebo-treated participants evidenced significantly greater attenuation of craving and cardiovascular reactivity during the test session. Analysis of the follow-up CCE session data did not reveal any group differences. Although there was no evidence of treatment effects on cocaine use during follow-up, this study was insufficiently powered to rigorously evaluate differential cocaine use. CONCLUSIONS This double-blind, placebo-controlled laboratory study provides the first evidence that propranolol administration following CCE may modulate memories for learning processes that subserve cocaine craving/cue reactivity in CD humans. Alternative interpretations of the findings were considered, and implications of the results for treatment were noted.
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Schneiderhan ME. Two case reports of smoking behavior changes after self-initiated e-cigarette use and tobacco smoking cessation. Ment Health Clin 2012. [DOI: 10.9740/mhc.n129682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: The purpose of this report is to increase the clinician's understanding of electronic nicotine-delivery systems (ENDS) by describing similar observations of two subjects “forgetting” to use self-initiated ENDS.
Observations: A 51 year old Caucasian female with severe persistent mental illness reported continued tobacco abstinence and “forgetting” to use the ENDS at week 24 and continued tobacco abstinence beyond week 52. Also, a 42 year old Caucasian healthy male with continued tobacco abstinence and “forgetting” to use the ENDS after approximately 14 weeks remained abstinent of conventional cigarettes beyond 52 weeks.
Discussion: ENDS do not continually produce smoke like conventional cigarettes; the absence of continuous smoke may not compel the user to continue inhaling. ENDS differ from conventional cigarettes because of the on-off feature of the device, requiring the user to inhale to activate a battery-powered nicotine delivery system (atomizer).
Conclusion: Additional research is needed to verify the impact of ENDS on smoking behavior in smoking cessation. Clinicians should monitor but not yet recommend the initial use of ENDS for smoking cessation until the FDA imposes regulations on ENDS companies to ensure consistency of labeling of ingredient amounts and the overall safety of the products.
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Affiliation(s)
- Mark E. Schneiderhan
- 1University of Minnesota College of Pharmacy, Duluth, Department of Pharmacy Practice and Pharmaceutical Sciences
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Sofuoglu M, Herman AI, Li Y, Waters AJ. Galantamine attenuates some of the subjective effects of intravenous nicotine and improves performance on a Go No-Go task in abstinent cigarette smokers: a preliminary report. Psychopharmacology (Berl) 2012; 224:413-20. [PMID: 22700039 PMCID: PMC3636552 DOI: 10.1007/s00213-012-2763-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Accepted: 05/31/2012] [Indexed: 02/08/2023]
Abstract
RATIONALE Galantamine (GAL), a reversible and competitive inhibitor of acetylcholinesterase, is used clinically in the treatment of Alzheimer's dementia. Some preclinical and clinical studies support the potential efficacy of cholinesterase inhibitors for smoking cessation, although their effects on the behavioral and physiological responses to nicotine have not been examined. The goal of this study was to characterize GAL's actions on multiple outcomes, including withdrawal severity and cognitive performance, as well as subjective and physiological responses to nicotine administered intravenously. METHODS A total of 12 smokers participated in a double-blind, placebo-controlled, crossover study. Smokers had two 4-day treatment periods, assigned in random sequence, to GAL (8 mg/day) or placebo treatment. On day 4 of each treatment phase, smokers had an experimental session in which they received an intravenous (IV) dose of saline or 1 mg/70 kg nicotine, 1 h apart, in a random order. RESULTS GAL attenuated the self-reported rating of "craving for cigarettes" and prevented decrements in performance in a Go/No-Go task. In response to IV nicotine, GAL treatment attenuated the self-report ratings of "like the drug effects," "good drug effects," "bad drug effects," and "stimulated." CONCLUSIONS These findings support the potential utility of GAL as a treatment for smoking cessation.
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Affiliation(s)
- Mehmet Sofuoglu
- School of Medicine, Department of Psychiatry, VA Connecticut Healthcare System, Yale University, 950 Campbell Ave, Bldg 36/116A4, West Haven, CT, USA.
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Wong M, Krajisnik A, Truong L, Lisha NE, Trujillo M, Greenberg JB, Kahler CW, Zvolensky MJ, Leventhal AM. Anxiety sensitivity as a predictor of acute subjective effects of smoking. Nicotine Tob Res 2012; 15:1084-90. [PMID: 23144083 DOI: 10.1093/ntr/nts208] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Anxiety sensitivity (i.e., AS; the degree to which one believes that anxiety and its related sensations are harmful) is a stable trait that is associated with habitual smoking. Yet, the mechanisms linking AS and smoking are unclear. A promising hypothesis is that high-AS individuals are more sensitive to the acute subjective reinforcing effects of smoking and are, therefore, more prone to tobacco dependence. This study examined trait AS as a predictor of several subjective effects of cigarette smoking. METHODS Adult non-treatment-seeking smokers (N = 87; 10+ cigarettes/day) completed a measure of AS during a baseline session. Prior to a subsequent experimental session, participants were asked to smoke normally before their appointment. At the outset of that visit, each participant smoked a single cigarette of their preferred brand in the laboratory. Self-report measures of affect and cigarette craving were completed before and after smoking, and post-cigarette subjective effect ratings were provided. RESULTS AS predicted greater increases in positive affect from pre- to post-cigarette (β = .30, p = .006) as well as greater smoking satisfaction and psychological reward (β = .23 to .48, ps < .03). Each of these effects remained statistically significant after adjusting for anxiety symptom severity. AS did not predict the degree of negative affect and craving suppression or post-cigarette aversive effects. CONCLUSIONS These findings suggest that positive reinforcement mechanisms may be particularly salient etiological processes that maintain smoking in high-AS individuals.
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Affiliation(s)
- Matthew Wong
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
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Rapid nicotine clearance is associated with greater reward and heart rate increases from intravenous nicotine. Neuropsychopharmacology 2012; 37:1509-16. [PMID: 22334123 PMCID: PMC3327855 DOI: 10.1038/npp.2011.336] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The ratio of nicotine metabolites (trans-3'-hydroxycotinine (3HC) to cotinine) correlates with nicotine clearance. In previous studies, high nicotine metabolite ratio (NMR) predicted poor outcomes for smoking cessation treatment with nicotine patch. The underlying mechanisms that associate NMR with treatment outcomes have not been fully elucidated. A total of 100 smokers were divided into quartiles based on their baseline plasma NMR. Following overnight abstinence, smokers received saline followed by escalating intravenous doses of nicotine (0.5 and 1.0 mg/70 kg) given 30 min apart. The effects of nicotine on subjective, plasma cortisol, heart rate, and systolic and diastolic blood pressure measures were obtained. Smokers in the first NMR quartile (slower metabolizers) had lower Fagerstrom Test for Nicotine Dependence (FTND) scores, suggesting lower levels of dependence. In contrast, smokers in the fourth NMR quartile (faster metabolizers) reported greater craving for cigarettes following overnight abstinence from smoking and reported greater ratings of nicotine-induced good drug effects, drug liking, and wanting more drug. Higher NMR was also associated with greater heart rate increases in response to nicotine. These results suggest that enhanced nicotine reward and cigarette craving may contribute to the poor treatment response in smokers with high NMR. These findings warrant further investigation, especially in treatment-seeking smokers undergoing cessation treatment.
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