Negative Affect, Emotional Acceptance, and Smoking Cessation

Commentary With Study Protocol: Implementation and Effectiveness of Mindfulness-Oriented Recovery Enhancement (MORE) as an Adjunct to Methadone Treatment for Opioid Use Disorder (IMPOWR-MORE)

Traditional methadone treatment (MT) for opioid use disorder (OUD) fails to systematically address the physical pain, emotion dysregulation, and reward processing deficits that co-occur with OUD, and novel interventions that address these issues are needed to improve MT outcomes. Mindfulness-Oriented Recovery Enhancement (MORE) remediates the hedonic dysregulation in brain reward systems that is associated with OUD. Our pilot and phase 2 randomized controlled trials of MORE were the first to demonstrate MORE's feasibility, acceptability, and efficacy as delivered in MT clinics; MORE significantly reduced drug use (eg, benzodiazepines, barbiturates, cocaine, marijuana, opioids, and other drugs), craving, depression, anxiety, and pain among people with OUD. However, uptake of novel, efficacious interventions like MORE may be slow in MT because time and resources are often limited. Therefore, to best address potential implementation issues and to optimize future MORE implementation and dissemination, in this study, we will utilize a Type 2, Hybrid Implementation-Effectiveness study design. We will not only evaluate MORE's effectiveness but also assess barriers and facilitators to integrating MORE into MT. MT clinicians will receive training in (1) a higher intensity MORE implementation strategy consisting of training in the full MORE treatment manual or (2) a minimal intensity implementation strategy consisting of a simple, scripted mindfulness practice (SMP) extracted from the MORE treatment manual with minimal training. We aim to: (1) using a Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, examine barriers and facilitators to implementation of MORE and SMP in MT, and evaluate strategies for optimizing training, fidelity, and engagement, (2) optimize existing MORE and SMP training and implementation toolkits, including adaptable resources that can accelerate the translation of evidence into practice, and (3) compared to usual MT, evaluate the relative effectiveness of MORE plus MT or SMP plus MT (N = 450).

Interpretation bias modification for hostility to facilitate smoking cessation in a sample with elevated trait anger: A randomized trial

Problematic anger is linked with multiple adverse smoking outcomes, including cigarette dependence, heavy smoking, and cessation failure. A smoking cessation intervention that directly targets anger and its maintenance factors may increase rates of smoking cessation. We examined the efficacy of an interpretation bias modification for hostility (IBM-H) to facilitate smoking cessation in smokers with elevated trait anger. Participants were 100 daily smokers (mean age = 38, 62% female, 55% white) with elevated anger were randomly assigned to eight computerized sessions of either IBM-H or a health and relaxation video control condition (HRVC). Participants in both conditions attempted to quit at mid-treatment. Measures of hostility, anger, and smoking were administered at pre-, mid-, post-treatment, as well as at up to three-month follow-up. Compared to HRVC, IBM-H led to greater reductions in hostile interpretation bias, both at posttreatment and follow-up. IBM-H also led to statistically significant reductions in hostility only at posttreatment, and trait anger only at three-month follow-up. Both conditions experienced reductions in smoking, although they did not differ in quit success. We discuss these findings in the context of literature on anger and smoking cessation and provide directions for future research.

Telehealth Mindfulness-Oriented Recovery Enhancement vs Usual Care in Individuals With Opioid Use Disorder and Pain: A Randomized Clinical Trial

Importance

Methadone treatment (MT) fails to address the emotion dysregulation, pain, and reward processing deficits that often drive opioid use disorder (OUD). New interventions are needed to address these factors.

Objective

To evaluate the efficacy of MT as usual (usual care) vs telehealth Mindfulness-Oriented Recovery Enhancement (MORE) plus usual care among people with an OUD and pain.

Design, Setting, and Participants

This study was a randomized clinical trial conducted from August 2020 to June 2022. Participants receiving MT for OUD and experiencing chronic pain were recruited at 5 clinics in New Jersey.

Interventions

In usual care, participants received MT, including medication and counseling. Participants receiving MORE plus usual care attended 8 weekly, 2-hour telehealth groups that provided training in mindfulness, reappraisal, and savoring in addition to usual care.

Main Outcomes and Measure

Primary outcomes were return to drug use and MT dropout over 16 weeks. Secondary outcomes were days of drug use, methadone adherence, pain, depression, and anxiety. Analyses were based on an intention-to-treat approach.

Results

A total of 154 participants (mean [SD] age, 48.5 [11.8] years; 88 female [57%]) were included in the study. Participants receiving MORE plus usual care had significantly less return to drug use (hazard ratio [HR], 0.58; 95% CI, 0.37-0.90; P = .02) and MT dropout (HR, 0.41; 95% CI, 0.18-0.96; P = .04) than those receiving usual care only after adjusting for a priori-specified covariates (eg, methadone dose and recent drug use, at baseline). A total of 44 participants (57.1%) in usual care and 39 participants (50.6%) in MORE plus usual care returned to drug use. A total of 17 participants (22.1%) in usual care and 10 participants (13.0%) in MORE plus usual care dropped out of MT. In zero-inflated models, participants receiving MORE plus usual care had significantly fewer days of any drug use (ratio of means = 0.58; 95% CI, 0.53-0.63; P < .001) than those receiving usual care only through 16 weeks. A significantly greater percentage of participants receiving MORE plus usual care maintained methadone adherence (64 of 67 [95.5%]) at the 16-week follow-up than those receiving usual care only (56 of 67 [83.6%]; χ2 = 4.49; P = .04). MORE reduced depression scores and ecological momentary assessments of pain through the 16-week follow-up to a significantly greater extent than usual care (group × time F2,272 = 3.13; P = .05 and group × time F16,13000 = 6.44; P < .001, respectively). Within the MORE plus usual care group, EMA pain ratings decreased from a mean (SD) of 5.79 (0.29) at baseline to 5.17 (0.30) at week 16; for usual care only, pain decreased from 5.19 (0.28) at baseline to 4.96 (0.29) at week 16. Within the MORE plus usual care group, mean (SD) depression scores were 22.52 (1.32) at baseline and 18.98 (1.38) at 16 weeks. In the usual care-only group, mean (SD) depression scores were 22.65 (1.25) at baseline and 20.03 (1.27) at 16 weeks. Although anxiety scores increased in the usual care-only group and decreased in the MORE group, this difference between groups did not reach significance (group × time unadjusted F2,272 = 2.10; P= .12; Cohen d = .44; adjusted F2,268 = 2.33; P = .09). Within the MORE plus usual care group, mean (SD) anxiety scores were 25.5 (1.60) at baseline and 23.45 (1.73) at 16 weeks. In the usual care-only group, mean (SD) anxiety scores were 23.27 (1.75) at baseline and 24.07 (1.73) at 16 weeks.

Conclusions and Relevance

This randomized clinical trial demonstrated that telehealth MORE was a feasible adjunct to MT with significant effects on drug use, pain, depression, treatment retention, and adherence.

Trial Registration

ClinicalTrials.gov Identifier: NCT04491968.

User Engagement With Mood-Related Content on the National Cancer Institute Smokefree.Gov Initiative Cessation Resources

AIMS

This study aimed to examine engagement with mood-related content on the Smokefree.gov Initiative's smoking cessation resources.

METHODS

Smokefree.gov website analytics (July 2018-July 2019) were analyzed for user interactions with mood content on informational webpages and interactive self-assessment tools (mood quizzes, smoking quit plans). We also examined mood feature engagement (texting or pressing a command button for mood support) among text program and app users (July 2018-July 2019).

RESULTS

Mood webpage views comprised 1.5% of all Smokefree.gov webpage views. Depression quizzes represented 82.9% of quiz completions, and stress quizzes represented 0.4% of quiz completions. Stress, anxiety, and low mood were the most reported smoking triggers on quit plans. Approximately 7,000 text program users and 3,000 app users sought real-time mood support.

CONCLUSIONS

Given the importance of mood management in the smoking cessation process these findings demonstrate promising opportunities to increase the reach of mood support resources.

The contribution of positive affect and loneliness on readiness and self-efficacy to quit smoking among Spanish-speaking Mexican American smokers

BACKGROUND

The existing research on affective and interpersonal determinants of smoking cessation largely under-represents minority smokers, such as Latinos.

OBJECTIVE

The current study examined associations between affective and interpersonal factors with intermediary smoking cessation variables among Mexican-American smokers (N = 290; 60% male).

METHODS

Measures of positive and negative affect, social support, and loneliness were each examined for associations with measures of motivational readiness to quit smoking, and smoking abstinence self-efficacy. Significant predictors were entered into models simultaneously to examine their unique associations. Covariates included gender, age, and educational attainment.

RESULTS

Negative affect (b = .68, SE b = .14, p < .001) and loneliness (b = .20, SE b = .09, p < .05) were independently associated with motivation. Negative affect (b = .20, SE b = .06, p < .01) and positive affect (b = .34 SE b = .07, p < .001) were independently associated with self-efficacy. In the final models, only negative affect was associated with motivation (b = .68, SE b = .17, p < .001); whereas negative (b = .17, SE b = .06, p < .01) and positive (b = . 32, SE b = .07, p < .001) affect were associated with self-efficacy.

CONCLUSION

Results highlight the importance of resilience factors (e.g., positive affect) among Mexican-American smokers. Cessation interventions regularly target negative affect among smokers; additional focus on positive affect in cessation interventions with this population may be warranted.

A pilot randomized clinical trial of mindfulness-oriented recovery enhancement as an adjunct to methadone treatment for people with opioid use disorder and chronic pain: Impact on illicit drug use, health, and well-being

BACKGROUND

Chronic pain is highly prevalent among people in methadone maintenance treatment (MMT) for opioid use disorder and is known to be an important contributor to treatment discontinuation and opioid relapse. Mindfulness-Oriented Recovery Enhancement (MORE) is one of the few interventions developed and tested as an integrated treatment to simultaneously address both pain and illicit opioid use; however, this study is the first to evaluate MORE as an adjunct to MMT.

METHODS

Randomized individuals in MMT (N = 30) received MORE plus methadone TAU (n = 15) or methadone TAU, only (n = 15). Participants in the MORE arm received their MMT, as usual, and attended eight, weekly, two-hour MORE groups at their MMT clinics. Participants in the TAU arm received their MMT, as usual, and group or individual counseling, as required by the clinic. TAU counseling consisted of relapse prevention, cognitive-behavioral therapy, and supportive treatment. TAU participants did not receive any mindfulness-based intervention. Participants completed assessments at baseline, post-treatment (i.e., 8-weeks post-baseline), and follow-up (i.e., 16-weeks post-baseline).

RESULTS

Participants in MORE evidenced significantly fewer baseline adjusted days of illicit drug use and significantly lower levels of craving through 16-week follow-up compared to TAU. Also, Participants in MORE reported significantly lower levels of pain, physical and emotional limitations, depression, and anxiety through 16-week follow-up compared to TAU. Conversely, participants in MORE reported significantly higher levels of well-being, vitality, and social functioning through 16-week follow-up compared to TAU.

CONCLUSION

MORE could be an effective adjunct to MMT, and larger trials are warranted.

Characterizing nicotine exposure among a community sample of non-daily smokers in the United States

Background

Over one-quarter of all smokers in the United States identify as non-daily smokers and this number is projected to rise. Unlike daily smokers who typically maintain consistent levels of nicotine exposure with regular smoking, non-daily smokers have variable patterns of smoking that likely result in high intraindividual variability in nicotine intake. The current study aimed to characterize the weekly intraindividual variability in cotinine and identify smoking-related predictors in nondaily smokers.

Methods

An ecological momentary assessment of 60 non-daily smokers ages 24–57 years was conducted over a consecutive 7-day at-home protocol to log each smoking session, assessments of mood and social activity during smoking, and collection of daily saliva samples in a convenience sample from Pennsylvania, USA. Hierarchical linear regression analyses were conducted to determine the effects of smoking characteristics on total cotinine exposure measured by pharmacokinetic area under the curve and the range, maximum, and minimum cotinine values during the week controlling for demographic variables.

Results

The mean daily cotinine level was 119.2 ng/ml (SD = 168.9) with individual values that ranged from nondetectable to 949.6 ng/ml. Menthol predicted increased total cotinine levels (P < 0.05). Shorter time to the first cigarette of the day predicted significantly higher minimum (P < 0.05), maximum (P < 0.05), and total cotinine values (P < 0.05) after controlling for covariates. Negative emotions and social interactions with others were also significantly associated with higher cotinine metrics. There was no significant effect of the nicotine metabolite ratio.

Conclusions

Our findings highlight the variability in nicotine exposure across days among non-daily smokers and point to the role of smoking context in nicotine exposure. The findings suggest the need to develop better assessment methods to determine health and dependence risk and personalized cessation interventions for this heterogeneous and growing group of smokers.

The role of social support on the effects of stress and depression on African American tobacco and alcohol use

OBJECTIVES

The current study explored whether social support (SS) from family and peers, influences the relationship between depressed mood (DM) and substance use (SU). We hypothesized that SS would have a protective effect on DM, and moderate the association between DM and SU.

PARTICIPANTS AND METHODS

Analyses focused on 703 individuals from the Carolina African American Twin Study on Aging (mean age = 49.78 years, STD = 14.52; 51% female). Participants reported on past year frequency of cigarettes and alcohol consumption, depressed mood, and stressful life events. Social support (SS) was assessed on two domains (i.e., emotional and instrumental), as well as for perceived quality and quantity of each type. Hypotheses were tested using ordinal logistic regression in Mplus while controlling for socioeconomic status, age, and gender.

RESULTS

Quality of emotional support was negatively associated with drinking. Smoking, but not drinking was associated with depressed mood. While individuals with high levels of depressed mood received more support, receiving better quality emotional support was associated with fewer mood and stress symptoms. Individuals who reported receiving better quality emotional support typically smoked fewer cigarettes.

CONCLUSION

Quantity of emotional support was associated with higher levels of negative emotionality, whereas the opposite was found for quality of emotional support. Emotional support may indirectly influence smoking via depressed mood. Effecting the perceived quality of support appears to be the mechanism by which emotional support helps to reduce smoking in adult African Americans.

The Effect of Positive and Negative Affect on Early Treatment Milestones in the Context of Integrated Smoking Treatment

: Smoking is the leading cause of preventable death in the United States. Efforts have been made to develop effective, integrated smoking-cessation treatments for individuals with greater difficulty quitting, including individuals with elevated anxiety sensitivity (AS). Despite initial evidence for the efficacy of these treatments, little is understood about pretreatment predictors of early treatment milestones, including treatment initiation and response. Positive affectivity (PA) and negative affectivity (NA) are unique mood traits that may be related to early treatment milestones. Indeed, PA and NA are related to smoking and mood outcomes generally. Yet, it is presently unknown if pretreatment PA or NA predict early treatment milestones within the context of an integrated smoking-cessation treatment. The current study sought to evaluate the independent effect of PA and NA on early treatment milestones within the context of an integrated smoking-AS treatment protocol. Smoking and AS outcomes were evaluated independently. Participants included 288 (50% female; Mage = 38.66, SD = 13.67) treatment-seeking adult daily cigarette users. Results indicated that higher pretreatment NA was associated with an increased likelihood of early dropout versus responding to treatment across both outcomes (smoking: odds ratio [OR] 0.93, 95% confidence interval [CI] 0.88-0.99; AS: OR 0.92, 95% CI 0.88-0.98). Pretreatment PA did not significantly differentiate any of the groups. Overall, the present study serves as an initial investigation of the role of pretreatment NA in identifying those at greatest risk for dropping out of treatment (cf. responding to treatment).

Mindfulness-based therapy modulates default-mode network connectivity in patients with opioid dependence

Recently, mindfulness-based programs have shown promising clinical effects in the treatment of substance-use disorders (SUD). While several studies linked mindfulness to decreased default mode network (DMN) connectivity in meditators, only a few studies investigated its effects in patients with SUD. This study aimed to detect changes in DMN connectivity in opiate dependent patients receiving mindfulness based therapy (MBT) during their first month of treatment. Data from 32 patients that were assigned to MBT or treatment as usual (TAU) groups was investigated using resting-state functional MRI at 1.5 T before and after four weeks of treatment. Independent Component Analysis was used to investigate distinct (anterior vs. posterior) DMN subsystems. Connectivity changes after treatment were related to measures of impulsivity, distress tolerance and mindfulness. Increased mindfulness scores after treatment were found in patients receiving MBT compared to TAU. Within the anterior DMN, decreased right inferior frontal cortical connectivity was detected in patients who received MBT compared to TAU. In addition, within the MBT-group decreased right superior frontal cortex connectivity was detected after treatment. Inferior frontal cortex function was significantly associated with mindfulness measures. The data suggest that MBT can be useful during abstinence from opiates. In opiate-dependent patients distinct functional connectivity changes within the DMN are associated with MBT.

A couples-focused intervention for smoking cessation during pregnancy: The study protocol of the Quit Together pilot randomized controlled trial

Tobacco smoking remains the leading global cause of preventable disease and death. Preconception and pregnancy smoking are high in Central and Eastern Europe. Quit Together is a partnership between a US university and a Romanian university, obstetrics and gynecology clinics in Romania, and other community partners in Romania. The objective of the Quit Together pilot study is to adapt, enhance and test the implementation feasibility and initial efficacy of an evidence-based pregnancy and postnatal couple intervention for smoking cessation in Romania. Quit Together builds on the Motivation and Problem Solving (MAPS) approach, enhanced by targeting the couples' smoking behavior and focusing on dyadic efficacy for smoking cessation. The study is an ongoing randomized controlled trial of 120 Romanian pregnant smokers and their partners. Participants are randomized to: 1) an intervention arm consisting, typically, of up to 8 prenatal and postnatal telephone counseling calls for the women and 4 for their partners, combining motivational strategies and problem-solving/coping skills to encourage the woman to quit smoking and the partner to support her decision; and 2) a control arm (usual care). The primary outcome is maternal biochemically verified smoking abstinence at 3 months postpartum. Quit Together has the potential to identify effective strategies to increase maternal smoking cessation during pregnancy and smoking abstinence after birth. If effective, Quit Together is expected to have a sustainable positive impact on the health of the child, mother and partner, and potentially reduced health system costs.

Emotion dysregulation and smoking among treatment-seeking smokers

INTRODUCTION

There has been increased scholarly interest in advancing the study of emotion dysregulation and substance use. However, there is limited study of emotion dysregulation in the context of smoking. The current study examined the emotion dysregulation global construct and sub facets in relation to negative affect reduction expectancies, coping motives, perceived barriers for quitting, and the severity of problems experienced during quit attempts.

METHOD

Treatment seeking smokers (n=469; 48.2% female, M_age=36.59, SD=13.58) enrolled in a smoking cessation trial and completed baseline measures of smoking cognitions and emotion dysregulation.

RESULTS

Results indicated that the emotion dysregulation global score was significantly associated with each of the smoking dependent variables. Additionally, difficulty accessing emotion regulation strategies and difficulty engaging in goal-directed behavior were significantly associated with the dependent variables.

CONCLUSION

Overall, this is the first study to evaluate relations between multidimensional facets of emotion dysregulation and clinically relevant smoking variables. Emotion dysregulation may be an important treatment target for changing smoking.

The intention to quit smoking

Purpose

From the perspective of developing countries, studies regarding the behavioral effects of quitting tobacco consumption on emerging psychological determinants are limited. The purpose of this paper is to examine the influence of emotional intelligence (EI), social norms, susceptibility and self-efficacy on the behavioral effects of quitting tobacco consumption among young smokers in developing countries.

Design/methodology/approach

By reviewing existing literature, this study developed a conceptual model to test the influences of significant psychological determinants in regards to a young smoker’s intention to quit smoking. Accordingly, a survey instrument was designed to collect data from young smokers in Bangladesh using the convenience sampling method. A total of 500 self-administered questionnaires were distributed, out of which only 400 questionnaires were used in final data analysis. This study applied partial least square structural equation modeling (PLS-SEM) to test the proposed model.

Findings

Perceived EI, perceived social norms and perceived susceptibility were found to have significant direct positive effects on intention to quit smoking. Perceived susceptibility and perceived self-efficacy were observed to have moderating effects on intention to quit smoking through perceived EI and perceived social norms respectively. However, perceived self-efficacy was not found to have any significant direct effect on intention to quit smoking.

Originality/value

This is the first study of its kind which combined EI, susceptibility, self-efficacy, and social norms in one theoretical framework to explain a young smoker’s intention to quit smoking. Also, in the context of Bangladesh and similar developing countries, there are no such studies which used the psychological components investigated in this study to predict a young smoker’s intention to quit smoking. Thus, the findings bring us closer to the goal of a tobacco-free society by allowing policy makers, NGOs, broader communities, and ultimately individual citizens to understand the psychological predictors of quitting tobacco consumption among young smokers in developing countries.

Psychometric evaluation of the Barriers to Cessation Scale

The Barriers to Cessation Scale (BCS; Macnee & Talsma, 1995a) was developed to assess global and specific perceived barriers that may interfere with the quit process. Although the BCS is widely used in the literature, little scientific work has been devoted to examining the psychometric properties of the measure. Thus, the present study sought to address this gap by evaluating the BCS in a sample of 497 treatment-seeking smokers. The current study examined the factor structure of the BCS, measurement invariance of the BCS subscales across sex and over 2 time points, and evaluated construct validity. Results indicated that the BCS was best modeled by a higher order factor structure wherein the originally proposed 3-factor solution (Addiction, External, and Internal) constituted the lower order and a global factor constituted the higher order factor. The higher order BCS structure demonstrated partial measurement invariance across sex and full measurement invariance from baseline to quit day among treatment seeking smokers. Additionally, expected relations were observed between the BCS subscales and similar and divergent constructs, and predictive validity was partially supported. The current findings provide novel empirical evidence that the BCS is a reliable measure of perceived barriers to smoking cessation across multiple domains and is related to several affective and smoking processes the may interfere with the process of quitting. (PsycINFO Database Record

Influence of Psychiatric and Personality Disorders on Smoking Cessation Among Individuals in Opiate Dependence Treatment

OBJECTIVE

We aimed to evaluate how psychiatric and personality disorders influence smoking cessation goals and attempts among people with opiate dependence who smoke. This information could aid the development of more effective cessation interventions for these individuals.

METHODS

Participants (N = 116) were recruited from two methadone clinics, completed the Millon Clinical Multiaxial Inventory-III, and were asked about their smoking behavior and quitting goals. We used the Least Absolute Shrinkage and Selection Operator (LASSO) method, a technique commonly used for studies with small sample sizes and large number of predictors, to develop models predicting having a smoking cessation goal, among those currently smoking daily, and ever making a quit attempt, among those who ever smoked.

RESULTS

Almost all participants reported ever smoking (n = 115, 99%); 70% (n = 80) had made a serious quit attempt in the past; 89% (n = 103) reported current daily smoking; and 59% (n = 61) had a goal of quitting smoking and staying off cigarettes. Almost all (n = 112, 97%) had clinically significant characteristics of a psychiatric or personality disorder. White race, anxiety, and a negativistic personality facet (expressively resentful) were negative predictors of having a cessation goal. Overall, narcissistic personality pattern and a dependent personality facet (interpersonally submissive) were positive predictors of having a cessation goal. Somatoform disorder, overall borderline personality pattern, and a depressive personality facet (cognitively fatalistic) were negative predictors of ever making a quit attempt. Individual histrionic (gregarious self-image), antisocial (acting out mechanism), paranoid (expressively defensive), and sadistic (pernicious representations) personality disorder facets were positive predictors of ever making a quit attempt. Each model provided good discrimination for having a smoking cessation goal or not (C-statistic of .76, 95% CI [0.66, 0.85]) and ever making a quit attempt or not (C-statistic of .79, 95% CI [0.70, 0.88]).

CONCLUSIONS

Compared to existing treatments, smoking cessation treatments that can be tailored to address the individual needs of people with specific psychiatric disorders or personality disorder traits may better help those in opiate dependence treatment to set a cessation goal, attempt to quit, and eventually quit smoking.

Effects of experimental negative affect manipulations on ad libitum smoking: a meta-analysis

AIMS

To quantify the effect of negative affect (NA), when manipulated experimentally, upon smoking as measured within laboratory paradigms. Quantitative meta-analyses tested the effects of NA versus neutral conditions on (1) latency to smoke and (2) number of puffs taken.

METHODS

Twelve experimental studies tested the influence of NA induction, relative to a neutral control condition (n = 1190; range = 24-235). Those providing relevant data contributed to separate random-effects meta-analyses to examine the effects of NA on two primary smoking measures: (1) latency to smoke (nine studies) and (2) number of puffs taken during ad libitum smoking (11 studies). Hedge's g was calculated for all studies through the use of post-NA cue responses relative to post-neutral cue responses. This effect size estimate is similar to Cohen's d, but corrects for small sample size bias.

RESULTS

NA reliably decreased latency to smoke (g = -0.14; CI = -0.23 to -0.04; P = 0.007) and increased number of puffs taken (g = 0.14; CI = 0.02 to 0.25; P = 0.02). There was considerable variability across studies for both outcomes (I(2)  = 51 and 65% for latency and consumption, respectively). Potential publication bias was indicated for both outcomes, and adjusted effect sizes were smaller and no longer statistically significant.

CONCLUSIONS

In experimental laboratory studies of smokers, negative affect appears to reduce latency to smoking and increase number of puffs taken, but this could be due to publication bias.

Modeling naturalistic craving, withdrawal, and affect during early nicotine abstinence: A pilot ecological momentary assessment study

Despite the critical role of withdrawal, craving, and positive affect (PA) and negative affect (NA) in smoking relapse, relatively little is known about the temporal and predictive relationship between these constructs within the first day of abstinence. This pilot study aims to characterize dynamic changes in withdrawal, craving, and affect over the course of early abstinence using ecological momentary assessment. Beginning immediately after smoking, moderate and heavy smoking participants (n = 15 per group) responded to hourly surveys assessing craving, withdrawal, NA, and PA. Univariate and multivariate multilevel random coefficient modeling was used to describe the progression of craving, withdrawal/NA, and PA and to test correlations between these constructs at the subject level over the course of early abstinence. Heavy smokers reported greater craving from 1-4 hr of abstinence and greater withdrawal/NA after 3 or more hours as compared with moderate smokers. Level of withdrawal/NA was strongly positively associated with craving, and PA was negatively correlated with craving; however, the temporal dynamics of these correlations differed substantially. The association between withdrawal/NA and craving decreased over early abstinence, whereas the reverse was observed for PA. These findings can inform experimental studies of nicotine abstinence as well as their clinical applications to smoking cessation efforts. In particular, these results help to elucidate the role of PA in nicotine abstinence by demonstrating its independent association with nicotine craving over and above withdrawal/NA. If supported by future studies, these findings can refine experimental methods and clinical approaches for smoking cessation.

Tobacco use trajectories among a large cohort of treated smokers with posttraumatic stress disorder

INTRODUCTION

This study identified distinct tobacco use trajectories across 18months in 943 veteran smokers with posttraumatic stress disorder (PTSD) in order to describe quit and relapse patterns, examine associations between trajectory groups on baseline characteristics and cessation service utilization, and explore group differences in mental health outcomes.

METHODS

Veterans who participated in a multisite, randomized trial of integrated smoking cessation care were grouped using k-means clustering based on reported daily tobacco use between baseline and 18months. Four trajectory clusters were identified: no reduction (62%), temporary reduction (11%), late sustained reduction (9%) and early sustained reduction (18%).

RESULTS

Median quit times in the early, late, temporary, and no reduction groups were 451, 141.5, 97, and 2days, respectively. Compared to the early reduction group, the temporary reduction group exhibited higher baseline depression (p<0.01) and anxiety (p<0.01), but did not differ in treatment received, with both groups attending significantly more cessation visits (p<0.001) and more likely to receive recommended pharmacotherapy (p<0.001) than the no reduction group between baseline and 6months. The early reduction group exhibited lower depression relative to the no reduction (p<0.01) and temporary reduction (p<0.01) groups across all assessments between baseline and 18months. Differences were not observed between groups in depressive or PTSD symptom change over time between baseline and 18months.

CONCLUSIONS

Tobacco use trajectories among treated smokers with PTSD vary distinctly. Characteristics of identified subgroups may lead to targeted interventions among smokers with PTSD and potentially other psychiatric disorders.

Smoking history, and not depression, is related to deficits in detection of happy and sad faces

INTRODUCTION

Previous research has demonstrated that chronic cigarette smoking and major depressive disorder (MDD) are each associated with cognitive decrements. Further, these conditions co-occur commonly, though mechanisms in the comorbid condition are poorly understood. There may be distinct, additive, or overlapping factors underlying comorbid cigarette smoking and MDD. The present study investigated the impact of smoking and MDD on executive function and emotion processing.

METHODS

Participants (N=198) were grouped by diagnostic category (MDD and healthy controls, HC) and smoking status (ever-smokers, ES and never-smokers, NS). Participants completed the Facial Emotion Perception Test (FEPT), a measure of emotional processing, and the parametric Go/No-go task (PGNG), a measure of executive function.

RESULTS

FEPT performance was analyzed using ANCOVA with accuracy and reaction time as separate dependent variables. Repeated measures MANCOVA was conducted for PGNG with performance measure and task level as dependent variables. Analyses for each task included diagnostic and smoking group as independent variables, and gender was controlled for. Results for FEPT reveal that lower overall accuracy was found for ES relative to NS, though MDD did not differ from HC. Post-hoc analyses revealed that ES were poorer at identifying happy and sad, but not fearful or angry, faces. For PGNG, poorer performance was observed in MDD relative to HC in response time to Go targets, but there were no differences for ES and NS. Interaction of diagnosis and smoking group was not observed for performance on either task.

CONCLUSIONS

The results of this study provide preliminary evidence for distinctive cognitive decrements in smokers and individuals with depression.

Web-based acceptance and commitment therapy smoking cessation treatment for smokers with depressive symptoms

OBJECTIVE

Smokers with depressive symptoms have more difficulty quitting smoking than the general population of smokers. The present study examines a web-based treatment using acceptance and commitment therapy (ACT) for smokers with depressive symptoms. The study aimed to determine participant receptivity to the intervention and its effects on smoking cessation, acceptance of internal cues, and depressive symptoms.

METHODS

Smokers who had positive screening results for depressive symptoms at baseline (n = 94) were selected from a randomized controlled trial (N = 222) comparing web-based ACT for smoking cessation (WebQuit.org) with Smokefree.gov. Forty-five participants (48%) completed the three-month follow-up.

RESULTS

Compared to Smokefree.gov, WebQuit participants spent significantly more time on site (p =.001) and had higher acceptance of physical cravings (p =.033). While not significant, WebQuit participants were more engaged and satisfied with their program and were more accepting of internal cues overall. There was preliminary evidence that WebQuit participants had higher quit rates (20% versus 12%) and lower depressive symptoms at follow-up (45% versus 56%) than those in Smokefree.gov.

CONCLUSIONS

This was the first study of web-based ACT for smoking cessation among smokers with depressive symptoms, with promising evidence of receptivity, efficacy, impact on a theory-based change process, and possible secondary effects on depression. A fully powered trial of the ACT WebQuit.org intervention specifically for depressed smokers is needed. This was part of a clinical trial registered as NCT#01166334 at www.clinicaltrials.gov .

Childhood maltreatment and the persistence of smoking: a longitudinal study among adults in the US

The current study examined the relationship between childhood maltreatment-emotional, physical, and severe physical maltreatment-and the initiation and persistence of smoking. Data were drawn from the Midlife Development in the United States (MIDUS) Survey Waves 1 and 2. Frequency of childhood emotional, physical, and severe physical maltreatment (never, rare, intermittent, frequent) reported at Wave 1 was examined in relation to ever smoking, smoking daily, and persistent daily smoking at Waves 1 and 2. Logistic regression analyses were used to calculate odds ratios (with 95% confidence intervals), which were then adjusted for potential confounders. Childhood emotional, physical, and severe physical maltreatment were associated with increased odds of ever smoking, smoking daily, and persistent smoking at Waves 1 and 2. The majority of these associations remained significant after adjusting for confounding variables. These results suggest a history of trauma may play a prominent role in recalcitrant cigarette smoking and suggest that the success rates of treatments for smoking cessation may be improved by integrating trauma treatment where appropriate.

Effects of depressive symptoms on antecedents of lapses during a smoking cessation attempt: an ecological momentary assessment study

AIMS

To investigate pathways through which momentary negative affect and depressive symptoms affect risk of lapse during smoking cessation attempts.

DESIGN

Ecological momentary assessment was carried out during 2 weeks after an unassisted smoking cessation attempt. A 3-month follow-up measured smoking frequency.

SETTING

Data were collected via mobile devices in German-speaking Switzerland.

PARTICIPANTS

A total of 242 individuals (age 20-40, 67% men) reported 7112 observations.

MEASUREMENTS

Online surveys assessed baseline depressive symptoms and nicotine dependence. Real-time data on negative affect, physical withdrawal symptoms, urge to smoke, abstinence-related self-efficacy and lapses.

FINDINGS

A two-level structural equation model suggested that on the situational level, negative affect increased the urge to smoke and decreased self-efficacy (β = 0.20; β = -0.12, respectively), but had no direct effect on lapse risk. A higher urge to smoke (β = 0.09) and lower self-efficacy (β = -0.11) were confirmed as situational antecedents of lapses. Depressive symptoms at baseline were a strong predictor of a person's average negative affect (β = 0.35, all P < 0.001). However, the baseline characteristics influenced smoking frequency 3 months later only indirectly, through influences of average states on the number of lapses during the quit attempt.

CONCLUSIONS

Controlling for nicotine dependence, higher depressive symptoms at baseline were associated strongly with a worse longer-term outcome. Negative affect experienced during the quit attempt was the only pathway through which the baseline depressive symptoms were associated with a reduced self-efficacy and increased urges to smoke, all leading to the increased probability of lapses.

Ex-smokers are happier than current smokers among Chinese adults in Hong Kong

AIM

To investigate the cross-sectional association between smoking and happiness in Chinese adults in Hong Kong.

DESIGN, SETTING AND PARTICIPANTS

Telephone surveys were conducted between 2009 and 2012, with 4553 randomly sampled Chinese adults (male 54%, mean age 58.3 years) in Hong Kong.

MEASUREMENTS

Happiness was measured using the four-item Subjective Happiness Scale (SHS) and single-item Global Happiness Item (GHI). Smoking status was categorized as current smokers (7.7%%), ex-smokers (6.5%, 93% quit for >6 months) and never smokers (85.8%). Linear and ordinal logistic regressions were used to calculate adjusted β-coefficients for SHS and proportional adjusted odds ratios (aOR) for GHI in relation to smoking.

FINDINGS

Compared with current smokers, ex-smokers enjoyed greater happiness according to both SHS (adjusted β = 0.16, P < 0.05) and GHI (aOR = 1.52, P < 0.05) measurements, but current and never smokers were similar. Among current smokers, the number of cigarettes smoked was not associated with happiness, but the lack of any attempt to quit was associated significantly with greater happiness (adjusted β = 0.31 for SHS, aOR = 1.82 for GHI) compared with smokers who had tried to quit but not succeeded. Smokers not intending to quit in the next 6 months had higher odds of happiness (GHI) than those wanting to quit within 6 months (aOR = 1.86, P < 0.05).

CONCLUSIONS

Ex-smokers in Hong Kong are happier than current smokers and never smokers, whose happiness measurements are similar. Causal associations have yet to be established.

Modeling complexity of EMA data: time-varying lagged effects of negative affect on smoking urges for subgroups of nicotine addiction

INTRODUCTION

Ecological momentary assessments (EMA) are increasingly used in studies of smoking behavior. Through EMA, examination of lagged relationships is particularly useful for establishing a temporal order of events and for identifying types and timing of risk factors. The time-varying effect model (TVEM) handles EMA data challenges and addresses unique questions about the time-varying effects.

METHODS

Generalized TVEM was applied to EMA data from a smoking cessation study to investigate a "time-varying lagged" effect of negative affect on high smoking urges. Participants included 224 smokers with a smoking history of 23.1 years (SD = 9.8) smoking 27.3 cigarettes per day (SD = 10.7), which provided 11,394 EMAs following a quit attempt and prior to a smoking lapse.

RESULTS

The effect of negative affect was found to vary as a function of a time lag, with stronger immediate effects: estimated odds ratio (OR) of 2.7 for the lower nicotine-dependence group (time to first morning cigarette > 5 min, 57.6%) and OR of 2.4 for the higher nicotine-dependence group (≤ 5 min). The magnitude of the effect persisted up to 7 hr while decreasing over time.

CONCLUSIONS

This analysis confirmed the importance of negative affect as a precursor of smoking urges while showing that the magnitude of the effect varies over time. An assumption of a constant lagged effect may bias estimates of the relationships and fail to provide a comprehensive outlook of the relational dynamics.

The association between changes in alternative reinforcers and short-term smoking cessation

BACKGROUND

While more than 50% of smokers make a serious quit attempt each year, less than 10% quit permanently. Evidence from studies of adolescent smoking and other substances of abuse suggest that alternative reinforcers, a construct of Behavioral Economic Theory, may contribute to the likelihood of smoking cessation in adults. This study examined the behavioral economics of smoking cessation within a smoking cessation clinical trial and evaluated how depressive symptoms and behavioral economic variables are associated with smoking cessation.

METHODS

A sample of 469 smokers, enrolled in an effectiveness trial that provided counseling and 8 weeks of 21 mg nicotine patches, was analyzed. Alternative reinforcers (substitute and complementary reinforcers) and depressive symptoms were examined in relation to 7-day point prevalence abstinence, verified with breath carbon monoxide, 8 weeks after the quit date.

RESULTS

Controlling for covariates associated with cessation (nicotine dependence, age of smoking initiation, patch adherence), participants who were abstinent at week 8 showed significantly higher substitute reinforcers at all time-points, compared to those who were smoking (p's<.05). Participants who were abstinent at week 8 showed lower complementary reinforcers and depressive symptoms at all time-points, compared to those who were smoking, but significant differences were confined to week 8 (p's<.01). There was no significant interaction between alternative reinforcers and depressive symptoms across the 8 weeks on week 8 abstinence.

CONCLUSIONS

These results support continued examination of Behavioral Economic Theory in understanding adult smoking cessation in order to inform future treatments and guidelines.

Influence of affective manipulations on cigarette craving: a meta-analysis

BACKGROUND AND AIMS

Retrospective self-report and observational studies have yielded inconsistent findings regarding the capacity of negative affect (NA) to increase smoking motivation among dependent samples. Controlled laboratory studies offer an alternative paradigm for testing the role of affective state upon smoking motivation. The aim of the current study was to quantify cue-provoked cravings produced by affective manipulations in the published literature, and to identify theoretical and methodological moderators.

METHODS

We conducted a systematic literature search to identify experimental studies that manipulated NA or positive affect (PA), and assessed post-manipulation craving. Separate random-effects meta-analyses examined NA and PA cues as predictors of self-reported craving. Self-reported affect (NA and PA), nicotine deprivation, gender, nicotine dependence, order of cue presentation, single versus multi-item craving assessment and affect induction method were tested as moderators of affective cue-induced craving.

RESULTS

NA manipulations produced a medium effect [g = 0.47; confidence interval (CI) = 0.31-0.63] on craving, but no main effects were found for PA manipulations (g = 0.05; CI = -0.09 to 0.20) on craving. Self-reported NA moderated the extent to which NA and PA manipulations elicited craving (P < 0.02 for each). That is, more effective NA manipulations produced greater cravings, and PA manipulations reduced cravings when they reduced NA.

CONCLUSIONS

Laboratory studies indicate that negative, but not positive, affect is a situational determinant of cravings to smoke among dependent smokers. Adverse emotional states increase craving to smoke among dependent smokers, but positive emotional states do not consistently reduce craving to smoke.

Associations between coping, affect, and social support among low-income African American smokers

OBJECTIVE

Previous research has documented disparities in smoking cessation between African Americans and Caucasians. Many low-income African American smokers face a range of circumstances that may inhibit effective coping during quit attempts, yet previous research has not considered factors that influence coping in this population. This study examined (a) affect (positive and negative) and (b) perceived social support in association with coping strategies.

METHODS

The baseline assessment of African American smokers (N = 168) enrolled in a randomized controlled trial included the Positive and Negative Affect Schedule, the Multidimensional Scale of Perceived Social Support, and the Brief COPE. A factor analysis of the Brief COPE resulted in two factors, adaptive and maladaptive strategies.

RESULTS

Participants were mostly single (64%), women (61%), with ≥12 years of education (68%), and low-income. They were middle aged (M = 46.1, SD = 8.7), smoked 21.8 (SD = 13.3) cigarettes/day for 24.3 (SD = 11) years, and were moderately nicotine dependent. Results demonstrated that adaptive coping was positively correlated with positive affect and social support. Maladaptive coping was positively correlated with negative affect, and inversely related to positive affect and social support. Multivariate analyses revealed that positive affect and social support were independently associated with adaptive coping strategies. In contrast, maladaptive coping was independently associated with negative affect, but not social support.

CONCLUSIONS

Interventions that harness positive resources, such as social support and positive mood, may facilitate adaptive coping. Also, addressing negative affect among low-income African American smokers may be important to reduce maladaptive coping strategies.

The role of mindfulness skills in terms of distress tolerance: a pilot test among adult daily smokers

BACKGROUND AND OBJECTIVES

Low distress tolerance is associated with difficulties quitting smoking. Mindfulness is associated with improved cessation outcomes and may be one method by which to increase distress tolerance. The purpose of the current study was to examine the relationship between mindfulness skills and distress tolerance among regular smokers.

METHODS

Daily smokers (n=125; Mage=37.5, 70% male) completed self-report measures assessing smoking and emotions.

RESULTS

After controlling for age, gender, and nicotine dependence, and education the mindfulness skills of acting with awareness and accepting without judgment significantly predicted distress tolerance.

DISCUSSION AND CONCLUSIONS

For smokers, being able to pay attention to present moment vents and accept negative events without judgment is associated with a greater ability to withstand such events.

SCIENTIFIC SIGNIFICANCE

These findings suggest that mindfulness-based approaches to smoking cessation may be effective because of improvements in distress tolerance. However, future prospective and laboratory-based studies are needed to better understand the mindfulness-distress tolerance link among smokers.

Craving to quit: psychological models and neurobiological mechanisms of mindfulness training as treatment for addictions

Humans suffer heavily from substance use disorders and other addictions. Despite much effort that has been put into understanding the mechanisms of the addictive process, treatment strategies have remained suboptimal over the past several decades. Mindfulness training, which is based on ancient Buddhist models of human suffering, has recently shown preliminary efficacy in treating addictions. These early models show remarkable similarity to current models of the addictive process, especially in their overlap with operant conditioning (positive and negative reinforcement). Further, they may provide explanatory power for the mechanisms of mindfulness training, including its effects on core addictive elements, such as craving, and the underlying neurobiological processes that may be active therein. In this review, using smoking as an example, we will highlight similarities between ancient and modern views of the addictive process, review studies of mindfulness training for addictions and their effects on craving and other components of this process, and discuss recent neuroimaging findings that may inform our understanding of the neural mechanisms of mindfulness training.

Der „Affective Style Questionnaire (ASQ)”: Deutsche Adaption und Validitäten

Zusammenfassung. Der Affective Style Questionnaire (ASQ) wurde aus dem Englischen übersetzt und an einer studentischen Stichprobe (N = 640) validiert. Der ASQ ist ein Selbstbeurteilungsinstrument bestehend aus 20 Items, in dem drei allgemeine Emotionsregulationsstile erfasst werden: Unterdrücken, Anpassen/Neubewerten und Akzeptieren. Die faktorielle Struktur wurde mithilfe des ESEM-Verfahrens (Exploratory Structural Equation Modeling) überprüft. Die Ergebnisse konnten die Faktorenstruktur der englischen Vorlage bestätigen. Die Testgütekriterien, die Konstruktvalidität und demographische Einflüsse wurden untersucht. Die internen Konsistenzen erwiesen sich als zufriedenstellend (Unterdrücken-Skala: α = .84; Anpassen-Skala: α = .75; Akzeptieren-Skala: α = .72), was ebenfalls sehr nahe an den Werten der Originalstudie liegt. Die Subskalen wiesen hypothesenkonforme Zusammenhänge zu bestehenden Verfahren aus dem Forschungsbereich „Emotionsregulation” auf. Der deutschsprachige ASQ ist ein ökonomisches Instrument in einem Bereich, in dem es erst sehr wenige validierte Verfahren gibt. Kein bestehendes Verfahren erfasst die drei genannten Stile in zufriedenstellender Weise gemeinsam. Mögliche Einsatzbereiche sind in der gesunden Allgemeinbevölkerung und nach weiterer Validierung auch in klinischen Populationen anzusehen.

Depressive mood and tobacco use: moderating effects of gender and emotional attention

INTRODUCTION

Depressive symptomatology is a predictive variable of tobacco use. The objective of the present study was to evaluate the influence that this symptomatology has on tobacco use when moderated by emotional attention.

METHODS

A total of 289 participants (127 males, 162 females) completed a survey to measure perceived emotional intelligence, depressive symptomatology, tobacco use and sociodemographic variables. Results were analyzed using a multiple regression model that included self-perceived emotional attention as a moderating variable.

RESULTS

In women, an interaction was found between depressive symptomatology and gender for predicting the number of cigarettes smoked (t=2.45; p=.01), but not in men (t=-.74; p=.45). This interaction was moderated by emotional attention (t=2.83; p=.005), such that women with medium and high levels of attention consumed a larger number of cigarettes.

CONCLUSIONS

In women, the effect of depressive symptomatology on tobacco use was moderated by the amount of attention that women paid to those symptoms. Such a moderating effect of attention was not observed in men. We recommend that smoking cessation programs incorporate interventions designed specifically for women, in particular to help them manage depressive symptomatology.

Associations of discrimination and violence with smoking among emerging adults: differences by gender and sexual orientation

INTRODUCTION

Lesbian, gay, and bisexual (i.e., sexual minority) populations have higher smoking prevalence than their heterosexual peers, but there is a lack of empirical study into why such disparities exist. This secondary analysis of data sought to examine associations of discrimination and violence victimization with cigarette smoking within sexual orientation groups.

METHODS

Data from the Fall 2008 and Spring 2009 National College Health Assessments were truncated to respondents of 18-24 years of age (n = 92,470). Since heterosexuals comprised over 90% of respondents, a random 5% subsample of heterosexuals was drawn, creating a total analytic sample of 11,046. Smoking status (i.e., never-, ever-, and current smoker) was regressed on general (e.g., not sexual orientation-specific) measures of past-year victimization and discrimination. To examine within-group differences, two sets of multivariate ordered logistic regression analyses were conducted: one set of models stratified by sexual orientation and another set stratified by gender-by-sexual-orientation groups.

RESULTS

Sexual minorities indicated more experiences of violence victimization and discrimination when compared with their heterosexual counterparts and had nearly twice the current smoking prevalence of heterosexuals. After adjusting for age and race, lesbians/gays who were in physical fights or were physically assaulted had higher proportional odds of being current smokers when compared with their lesbian/gay counterparts who did not experience those stressors.

CONCLUSIONS

When possible, lesbian/gay and bisexual groups should be analyzed separately, as analyses revealed that bisexuals had a higher risk profile than lesbians/gays. Further research is needed with more nuanced measures of smoking (e.g., intensity), as well as examining if victimization may interact with smoking cessation.

Mindfulness training for smoking cessation: results from a randomized controlled trial

BACKGROUND

Cigarette smoking is the leading cause of preventable death in the world, and long-term abstinence rates remain modest. Mindfulness training (MT) has begun to show benefits in a number of psychiatric disorders, including depression, anxiety and more recently, in addictions. However, MT has not been evaluated for smoking cessation through randomized clinical trials.

METHODS

88 treatment-seeking, nicotine-dependent adults who were smoking an average of 20cigarettes/day were randomly assigned to receive MT or the American Lung Association's freedom from smoking (FFS) treatment. Both treatments were delivered twice weekly over 4 weeks (eight sessions total) in a group format. The primary outcomes were expired-air carbon monoxide-confirmed 7-day point prevalence abstinence and number of cigarettes/day at the end of the 4-week treatment and at a follow-up interview at week 17.

RESULTS

88% of individuals received MT and 84% of individuals received FFS completed treatment. Compared to those randomized to the FFS intervention, individuals who received MT showed a greater rate of reduction in cigarette use during treatment and maintained these gains during follow-up (F=11.11, p=.001). They also exhibited a trend toward greater point prevalence abstinence rate at the end of treatment (36% vs. 15%, p=.063), which was significant at the 17-week follow-up (31% vs. 6%, p=.012).

CONCLUSIONS

This initial trial of mindfulness training may confer benefits greater than those associated with current standard treatments for smoking cessation.

Smoking withdrawal in smokers with and without posttraumatic stress disorder

INTRODUCTION

Previous research on smoking withdrawal in posttraumatic stress disorder (PTSD) has been limited by the use of retrospective and observational methods and has lacked repeated assessments on the first day of abstinence and evaluation of the conditioned effects of smoking.

METHODS

Smokers with (n = 17; 59% female) and without (n = 30; 17% female) PTSD completed 3 randomly ordered experimental sessions using a 2 (group: PTSD vs. non-PTSD) × 3 (smoking condition: usual brand vs. nicotine free vs. no smoking) design. Before the smoking manipulation, participants completed self-report measures of smoking urges and withdrawal, followed by withdrawal assessment after the smoking manipulation.

RESULTS

Compared with smokers without PTSD, smokers with PTSD exhibited higher craving (χ₁² = 16.60, p < .001) and habit withdrawal (χ₁² = 10.38, p = .001) following overnight abstinence. PTSD smokers also exhibited worsening negative affect throughout the morning when not smoking a cigarette (χ₁² = 11.30, p = .004). After smoking, smokers with PTSD reported diminished relief from craving (χ₁² = 6.49, p = .011), negative affect (χ₁² = 4.51, p = .034), arousal (χ₁² = 6.46, p = .011), and habit withdrawal (χ₁² = 7.22, p = .007), relative to smokers without PTSD.

CONCLUSIONS

Results of this preliminary investigation suggested that after overnight abstinence, PTSD smokers experienced worse withdrawal symptoms and greater urges to smoke for both positive and negative reinforcement. Research on smoking withdrawal early in the course of smoking abstinence in PTSD could inform interventions targeting abstinence early in the quit attempt.

Anxiety, depression and methods of stress coping in patients with nicotine dependence syndrome

BACKGROUND

Nicotinism is the most common addiction in Poland. Nicotine dependence is the cause of numerous behavioral diseases, including ischemic heart disease, neoplasms and chronic obstructive pulmonary disease. A question arises whether a tendency to anxiety and depressive reactions, as well as the strategies of coping with stressful situations, is involved in the clinical presentation of this addiction.

MATERIAL/METHODS

The study was conducted in a group of 88 nicotine addicts without serious systemic comorbidities and in 84 healthy subjects. All the participants were assessed with Beck Depression Inventory (BDI), Spielberger State-Trait Anxiety Inventory (STAI) and the Coping Inventory for Stressful Situations (CISS).

RESULTS

The mean intensity of anxiety as a trait and anxiety as a state, as well as its level, were found to differ between the groups (Sten 6.28±1.52 and 4.86±1.05, p=0,0000 for the trait, and 6.09±1.25 and 4.92±1.29, p=0.0000, for the state, respectively). Similarly, depression was demonstrated to be more intensive in nicotine addicts than in healthy subjects (12.76 points ±4.77 vs. 10.76±4.83, p=0.007). Among the 5 scales assessed by CISS, smokers demonstrated higher prevalence of emotion-oriented coping than controls (standard 9 6.27±1.70 in smokers vs. 5.67±1.57, p=0.019) and involvement in distracting activities (5.84±1.48 vs. 5.28±1.46, p=0.014).

CONCLUSIONS

The obtained results indicate that anxiety and depression, as well as differences in coping with stress situations, distinguish nicotine addicts from non-smokers.

Role of sensitivity to anxiety symptoms in responsiveness to mindfulness versus suppression strategies for coping with smoking cravings

Mindfulness strategies for managing cravings involve present-moment, nonjudgmental awareness of cravings without acting on them, while suppression involves pushing cravings out of awareness. Few studies have investigated individual differences in responding to these strategies. The current study examined whether individual differences in anxiety sensitivity moderate responsiveness to mindfulness versus suppression for coping with smoking cravings. Participants (N=61) utilized a mindfulness or suppression strategy to manage cravings during cue exposure to cigarettes and were evaluated for self-efficacy 7 days later. Greater anxiety sensitivity after cue exposure was associated with increased self-efficacy in the suppression condition. This suggests that anxiety-sensitive individuals who utilize suppression may cope better with cravings, at least in the early days after learning these strategies.

Tobacco smoking as a risk factor for depression. A 26-year population-based follow-up study

BACKGROUND

A key question regarding the documented association between smoking and depression is whether it reflects a causal influence of smoking on depression; however, only a limited number of longitudinal studies exist in the literature, all of which have relatively short time frames. The purpose was to prospectively assess the risk of depression according to daily tobacco consumption in a Danish longitudinal study.

METHODS

A prospective cohort study, the Copenhagen City Heart Study (n = 18,146), was analyzed with up to 26 years of follow-up. It contains three updated data sets on tobacco consumption and potential confounding factors. The study population was linked to Danish hospital registers to detect registrations with depression. Individuals with depression before baseline were excluded.

RESULTS

Women smoking more than 10 g of tobacco per day were at significantly increased risk of depression compared to women who did not smoke. The adjusted risk of depression among women smoking 11-20 g per day was 1.74 (CI:1.33-2.27) and 2.17 (CI:1.45-3.26) among women smoking more than 20 g per day. For men, there was an increased risk of depression for those smoking more than 20 g per day (HR = 1.90; CI:1.05-3.44). All tests for linear trend were significant (all p < 0.01). The estimates remained significant in sensitivity analyses aiming to eliminate reverse causation, and in analyses based on a reduced sample without individuals with chronic diseases or psychiatric disorders other than depression.

CONCLUSION

The study suggests that smoking is associated with increased risk of developing depression. This underlines the potentially harmful consequences of smoking for mental health and supports efforts to prevent and stop smoking.

Sexual Objectification and Substance Abuse in Young Adult Women

Objectification Theory (Fredrickson & Roberts, 1997) provides an important perspective for understanding the experiences of women living in a culture that sexualizes and objectifies the female body. The purpose of this study was to examine the relationships between interpersonal sexual objectification experiences and women’s substance abuse in a sample of 289 young adult women. Findings indicate that both everyday (e.g., body evaluation) and extreme (i.e., sexual victimization) forms of sexual objectification experiences were positively correlated with alcohol, nicotine, and other drug abuse. Furthermore, the findings provide support for a theorized mediated model in which sexual objectification is linked to women’s substance abuse both directly and indirectly via self-objectification, body shame, and depression.

Cognitive reappraisal and expressive suppression emotion regulation strategies in cigarette smokers

INTRODUCTION

Negative affect is an important psychological factor in the promotion and maintenance of cigarette smoking, though the underlying factors that account for this relationship remain to be determined. One possible mechanism may be smokers' emotion regulation strategies. Preliminary research among adolescents and young adults suggests that greater utilization of expressive suppression versus cognitive reappraisal is associated with higher rates of smoking initiation. There is limited research, however, on the role of emotion regulation strategies in smoking maintenance in adult smokers.

METHODS

Data from participants in a laboratory study (N = 121) were used to examine whether utilization of cognitive reappraisal and/or expressive suppression were related to smoking characteristics and subjective (i.e., mood, urge to smoke ratings) and behavioral reactions (i.e., Emotional Stroop Task performance, smoking behavior) to a mood induction procedure. Data were evaluated for the full sample and subsample who endorsed current depressive symptoms (n = 46).

RESULTS

Frequent reappraisal was associated with weaker expectancies that smoking alleviates unpleasant feelings, greater positive mood, and fewer depressive symptoms. In contrast, frequent suppression was related to longer smoking history and greater attentional bias to smoking cues on an Emotional Stroop Task. Among the depressed subsample, reappraisal moderated the effect of mood condition on smoking duration, number of cigarette puffs, and carbon monoxide boost.

CONCLUSIONS

These results provide preliminary support that emotion regulation strategies may be associated with motivational correlates of smoking as well as actual smoking behavior among depressed smokers.

Development of an acceptance-based coping intervention for alcohol dependence relapse prevention

Both psychological and neurobiological findings lend support to the long-standing clinical observation that negative affect is involved in the development and maintenance of alcohol dependence, and difficulty coping with negative affect is a common precipitant of relapse after treatment. Although many current approaches to relapse prevention emphasize change-based strategies for managing negative cognitions and affect, acceptance-based strategies for preventing relapse to alcohol use are intended to provide methods for coping with distress that are fundamentally different from, though in theory complementary to, approaches that emphasize control and change. This paper describes the development of Acceptance-Based Coping for Relapse Prevention (ABCRP), a new intervention for alcohol-dependent individuals who are within 6 months of having quit drinking. Results of preliminary testing indicate that the intervention is feasible with this population; and a small uncontrolled pilot study (N = 23) showed significant (P < .01) improvements in self-reported negative affect, emotional reactivity, perceived stress, positive affect, psychological well-being, and mindfulness level, as well as a trend (P = .06) toward reduction in craving severity between pre- and postintervention assessments. The authors conclude that this acceptance-based intervention seems feasible and holds promise for improving affect and reducing relapse in alcohol-dependent individuals, warranting further research.

Emotional intelligence and addictions: a systematic review

Since the millennium, an expanding number of research articles have examined the relationship between emotional intelligence (EI) and physical and mental health. The relationship between EI and addictive disorders has, however, remained relatively well-hidden. We therefore systematically reviewed and critically evaluated the literature on this relationship. We identified 51 articles on the topic of which 36 fulfilled our inclusion criteria. Results indicate that a lower level of EI is associated with more intensive smoking, alcohol use, and illicit drug use and two components of EI play a key role in addictions: "decoding and differentiation of emotions" and "regulation of emotions."

Nicotine withdrawal produces a decrease in extracellular levels of dopamine in the nucleus accumbens that is lower in adolescent versus adult male rats

The behavioral effects of nicotine withdrawal are lower in adolescent versus adult rats. However, the neurochemical mechanisms that mediate these developmental differences are unknown. Previous studies have shown that extracellular levels of dopamine in the nucleus accumbens (NAcc) are reduced in adult rats experiencing withdrawal. This study compared dopamine levels in the NAcc of male adolescent and adult rats experiencing nicotine withdrawal. Animals were prepared with subcutaneous pumps that delivered an equivalent nicotine dose in these age groups. Following 13 days of nicotine exposure, rats were implanted unilaterally with microdialysis probes into the NAcc and ipsilateral ventral tegmental area (VTA). The next day, dialysate levels were collected following systemic administration of the nicotinic-receptor antagonist mecamylamine to precipitate withdrawal. Mecamylamine produced an average % decrease in NAcc dopamine that was lower in adolescents (20%) versus adults (44%). Similar developmental differences were observed with the dopaminergic (DOPAC and HVA) but not serotonergic (5-HIAA) metabolites. A follow-up study compared NAcc dopamine in adolescent and adult rats receiving intra-VTA administration of bicuculline, which reduces gamma-aminobutyric acid (GABA) inhibition of dopamine transmission. The results revealed that blockade of GABA(A) receptors in the VTA produced a two-fold increase in NAcc dopamine of adults but not adolescents. These results provide a potential mechanism involving dopamine that mediates developmental differences in nicotine withdrawal. Specifically, they suggest that GABA systems are underdeveloped during adolescence and this reduced inhibition of dopamine neurons in the VTA may lead to reduced decreases in NAcc dopamine of young animals experiencing withdrawal.