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Sved AF, Caggiula AR, Donny EC. Elucidating the reinforcing effects of nicotine: a tribute to Nadia Chaudhri. Psychopharmacology (Berl) 2023; 240:417-430. [PMID: 36329195 PMCID: PMC11188050 DOI: 10.1007/s00213-022-06266-7] [Citation(s) in RCA: 2] [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: 08/31/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
Nadia Chaudhri worked with us as a graduate student in the Center for Neuroscience at the University of Pittsburgh from 1999 until she earned her PhD in 2005, a time that coincided with the discovery in our lab of the dual reinforcing actions of nicotine, a concept that she played an important role in shaping. The research that was described in her doctoral thesis is among the foundational pillars of the now well-accepted notion that nicotine acts as both a primary reinforcer and an amplifier of other reinforcer stimuli. This reinforcement-enhancing action of nicotine is robust and likely to be a powerful driver of nicotine use. Below, we discuss the evidence that these two actions of nicotine - primary reinforcement and reinforcement enhancement - are distinct and dissociable, a finding that Nadia was closely associated with. We go on to address two other topics that greatly interested Nadia during that time, the generalizability of the reinforcement-enhancing action of nicotine to multiple classes of reinforcing stimuli and potential sex differences in the dual reinforcing actions of nicotine. The research has greatly expanded since Nadia's involvement, but the core ideas that she helped to develop remain central to the concept of the dual reinforcing actions of nicotine and its importance for understanding the drivers of nicotine use.
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Affiliation(s)
- Alan F Sved
- Departments of Neuroscience, Psychiatry and Psychology and the Center for Neuroscience, University of Pittsburgh, 210 Langley Hall, Pittsburgh, PA, 15260, USA.
| | - Anthony R Caggiula
- Departments of Psychology and Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15260, USA
| | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
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2
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Nieto SJ, Enders CK, Witkiewitz K, O'Malley SS, Ray LA. Combination treatment with varenicline and naltrexone reduces World Health Organization risk drinking levels. Alcohol Clin Exp Res 2022; 46:2258-2266. [PMID: 36515648 DOI: 10.1111/acer.14953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/10/2022] [Accepted: 09/23/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The U.S. Food and Drug Administration identifies abstinence and the absence of heavy drinking days as outcomes for pharmacotherapy trials for alcohol use disorder (AUD). However, many individuals with AUD struggle to achieve these outcomes, which may discourage them from seeking treatment. World Health Organization (WHO) risk drinking levels have garnered attention in the alcohol field as potential non-abstinent outcomes for AUD medication trials. Further, testing combination pharmacotherapy for AUD represents an important direction in the field, particularly using medications such as naltrexone and varenicline, which are approved for treating AUD and smoking, respectively. The objective of the current study was to test the utility of the WHO risk drinking levels as a drinking outcome in a randomized clinical trial of combined varenicline and naltrexone for smoking cessation and drinking reduction. These analyses provide additional tests of the efficacy of this combination treatment. METHODS The current study is a secondary analysis of a phase 2, randomized, double-blind clinical trial, wherein participants (N = 165) who were daily smokers and heavy drinkers were randomly assigned to receive either 2 mg/day of varenicline plus 50 mg/day of naltrexone or 2 mg/day of varenicline plus placebo for 12 weeks. Medication effects on 1- and 2-level reductions in WHO risk drinking levels were assessed at 4, 8, and 12 weeks into the active medication period. RESULTS In logistic growth curve models individuals receiving the combined treatment had greater reductions in WHO risk drinking levels than individuals taking varenicline alone when assessed at 4 weeks into the active medication period. Among individuals who were WHO high and very high risk drinkers at baseline, the largest effect sizes favoring combination treatment were at Week 4 for the WHO 2-level reduction outcome (Cohen's h = 0.202) and Week 12 for the WHO 1-level reduction outcome (Cohen's h = 0.244), although these effects did not reach statistical significance. CONCLUSIONS These findings provide evidence that combined varenicline plus naltrexone treatment is effective at reducing WHO risk drinking levels, particularly among individuals who smoke cigarettes daily and drink heavily. These results add to a growing body of literature validating reductions in WHO risk drinking levels as outcomes of alcohol medication trials.
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Affiliation(s)
- Steven J Nieto
- Department of Psychology, University of California at Los Angeles, Los Angeles, California, USA
| | - Craig K Enders
- Department of Psychology, University of California at Los Angeles, Los Angeles, California, USA
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Lara A Ray
- Department of Psychology, University of California at Los Angeles, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, California, USA
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3
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Chen G, Ghazal M, Rahman S, Lutfy K. The impact of adolescent nicotine exposure on alcohol use during adulthood: The role of neuropeptides. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2021; 161:53-93. [PMID: 34801174 DOI: 10.1016/bs.irn.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Nicotine and alcohol abuse and co-dependence represent major public health crises. Indeed, previous research has shown that the prevalence of alcoholism is higher in smokers than in non-smokers. Adolescence is a susceptible period of life for the initiation of nicotine and alcohol use and the development of nicotine-alcohol codependence. However, there is a limited number of pharmacotherapeutic agents to treat addiction to nicotine or alcohol alone. Notably, there is no effective medication to treat this comorbid disorder. This chapter aims to review the early nicotine use and its impact on subsequent alcohol abuse during adolescence and adulthood as well as the role of neuropeptides in this comorbid disorder. The preclinical and clinical findings discussed in this chapter will advance our understanding of this comorbid disorder's neurobiology and lay a foundation for developing novel pharmacotherapies to treat nicotine and alcohol codependence.
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Affiliation(s)
- G Chen
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, United States; Department of Pharmaceutical Sciences, College of Pharmacy, Western University of Health Sciences, Pomona, CA, United States
| | - M Ghazal
- Department of Pharmaceutical Sciences, College of Pharmacy, Western University of Health Sciences, Pomona, CA, United States
| | - S Rahman
- Department of Pharmaceutical Sciences, South Dakota State University, Brookings, SD, United States
| | - K Lutfy
- Department of Pharmaceutical Sciences, College of Pharmacy, Western University of Health Sciences, Pomona, CA, United States.
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4
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Guo K, Li J, Li J, Chen N, Li Y, Yang K, Li X. The effects of pharmacological interventions on smoking cessation in people with alcohol dependence: A systematic review and meta-analysis of nine randomized controlled trials. Int J Clin Pract 2021; 75:e14594. [PMID: 34228852 DOI: 10.1111/ijcp.14594] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/02/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Pharmacotherapies are widely used for smoking cessation. However, their efficacy for people with alcohol dependence remains unclear. OBJECTIVE This study aimed to explore the effects of pharmacotherapies on smoking cessation for people with alcohol dependence. METHODS Five electronic databases were searched in January 2021 for randomized controlled trials (RCTs) reporting the use of pharmacotherapies to promote smoking cessation in people with alcohol dependence. The risk of bias was assessed using the Cochrane tool. RevMan version 5.3 was used to perform meta-analyses of the changes in smoking behaviour, and the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of the evidence. RESULTS The search identified nine RCTs involving 908 smokers with alcohol dependence; eight were published in the USA and one in Canada. The risk of bias was low in three studies and unclear in the remaining six. The meta-analysis results showed that, compared with the placebo group, Varenicline had a significant effect on short-term smoking cessation (three RCTs, odds ratio [OR] = 6.27, 95% confidence interval [CI]: [2.49, 15.78], P < .05, very low certainty). Naltrexone had no significant effect on smoking cessation in short-term or long-term observations (three RCTs, OR = 0.99, 95% CI: [0.54, 1.81], P = .97, moderate certainty), and Topiramate had no significant effects (two RCTs, OR = 1.56, 95% CI: [0.67, 3.46], P > .05, low certainty). Only one trial reported that Bupropion did not affect smoking cessation. CONCLUSION Varenicline may promote smoking cessation in people with alcohol dependence. However, Naltrexone, Topiramate and Bupropion have no clear effect on increasing smoking abstinence among drinkers. The small number of studies and the low certainty of evidence indicate that the results should be interpreted cautiously.
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Affiliation(s)
- Kangle Guo
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Jingwen Li
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Jieyun Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Nan Chen
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yanfei Li
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Kehu Yang
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Xiuxia Li
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
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King A, Fucito L. Cigarette Smoking and Heavy Alcohol Drinking: The Challenges and Opportunities for Combination Treatments. Am J Psychiatry 2021; 178:783-785. [PMID: 34516230 DOI: 10.1176/appi.ajp.2021.21070692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Andrea King
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago (King); Department of Psychiatry, Yale University, Yale Cancer Center, and Smilow Cancer Hospital at Yale-New Haven, New Haven, Conn. (Fucito)
| | - Lisa Fucito
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago (King); Department of Psychiatry, Yale University, Yale Cancer Center, and Smilow Cancer Hospital at Yale-New Haven, New Haven, Conn. (Fucito)
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6
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Ray LA, Green R, Enders C, Leventhal AM, Grodin EN, Li G, Lim A, Hartwell E, Venegas A, Meredith L, Nieto SJ, Shoptaw S, Ho D, Miotto K. Efficacy of Combining Varenicline and Naltrexone for Smoking Cessation and Drinking Reduction: A Randomized Clinical Trial. Am J Psychiatry 2021; 178:818-828. [PMID: 34080890 PMCID: PMC8999864 DOI: 10.1176/appi.ajp.2020.20070993] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Pharmacological treatments that can concomitantly address cigarette smoking and heavy drinking stand to improve health care delivery for these highly prevalent co-occurring conditions. This superiority trial compared the combination of varenicline and naltrexone against varenicline alone for smoking cessation and drinking reduction among heavy-drinking smokers. METHODS This was a phase 2 randomized double-blind clinical trial. Participants (N=165) who were daily smokers and drank heavily received either 2 mg/day of varenicline plus 50 mg/day of naltrexone or 2 mg/day of varenicline plus matched placebo pills for 12 weeks. Primary outcomes were 7-day point prevalence of nicotine abstinence (bioverified by a breath CO reading ≤5 ppm) at the 26-week follow-up and number of drinks per drinking day during the 12-week treatment phase. RESULTS Smoking abstinence at week 26 was significantly higher in the varenicline plus placebo condition than in the varenicline plus naltrexone condition (N=37 [45.1%] compared with N=22 [26.5%]). For drinks per drinking day, there was a medication effect favoring the combination of varenicline and naltrexone over varenicline alone across the 12-week treatment phase, although it did not meet the significance threshold. CONCLUSIONS These findings suggest that smoking cessation and drinking reduction can be concomitantly targeted with pharmacotherapy and that while varenicline alone may be sufficient as a smoking cessation aid in heavy-drinking smokers, the combination of varenicline and naltrexone may confer benefits with regard to drinking outcomes, particularly during the 12-week period of active medication treatment.
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Affiliation(s)
- Lara A. Ray
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA,Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA
| | - ReJoyce Green
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
| | - Craig Enders
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
| | - Adam M. Leventhal
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Erica N. Grodin
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
| | - Gang Li
- Department of Biostatistics, University of California at Los Angeles, Los Angeles, CA
| | - Aaron Lim
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
| | - Emily Hartwell
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
| | - Alex Venegas
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
| | - Lindsay Meredith
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
| | - Steven J. Nieto
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
| | - Steven Shoptaw
- Department of Family Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Diana Ho
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
| | - Karen Miotto
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA
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7
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Grodin EN, Burnette EM, Green R, Lim AC, Miotto K, Ray LA. Combined varenicline and naltrexone attenuates alcohol cue-elicited activation in heavy drinking smokers. Drug Alcohol Depend 2021; 225:108825. [PMID: 34175784 PMCID: PMC9059649 DOI: 10.1016/j.drugalcdep.2021.108825] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is a strong bidirectional relationship between the use of alcohol and cigarettes which results in various challenges for treating those who co-use both substances. While varenicline and naltrexone each have FDA-approval for nicotine and alcohol use disorder, respectively, there is evidence that their clinical benefit may extend across the two disorders. Critically, the effect of combined varenicline and naltrexone on neural reactivity to alcohol cues among heavy drinking smokers has not yet been studied. Probing the effect of the combination therapy on alcohol cue-reactivity may give insight to the mechanisms underlying its efficacy. METHODS Forty-seven heavy drinking smokers enrolled in two medication studies were randomized to receive varenicline alone (n = 11), varenicline plus naltrexone (n = 11), or placebo (n = 25). Participants completed an fMRI alcohol cue-reactivity task and rated their in-scanner alcohol craving. Whole-brain analyses examined the effect of medication on alcohol cue-elicited neural response. RESULTS Varenicline plus naltrexone attenuated alcohol cue-elicited activation in mesolimbic regions relative to varenicline alone and to placebo (Z > 2.3, p < 0.05). The combination varenicline and naltrexone group also endorsed lower in-scanner alcohol craving relative to varenicline alone group (p = 0.04). CONCLUSIONS These findings provide evidence for the benefit of combined therapy of varenicline and naltrexone over varenicline alone for the attenuation of alcohol cue-elicited neural activation. This study provides a preliminary proof-of-mechanism for this combination pharmacotherapy and suggests that naltrexone may be driving the reductions in cue-elicited alcohol craving in the brain. Further clinical studies using the combined therapy to treat heavy drinking smokers are warranted.
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Affiliation(s)
- Erica N. Grodin
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095, United States
| | - Elizabeth M. Burnette
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095, United States,Neuroscience Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA 90095, United States
| | - ReJoyce Green
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095, United States
| | - Aaron C. Lim
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095, United States
| | - Karen Miotto
- Neuroscience Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA 90095, United States
| | - Lara A. Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095, United States,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA 90095, United States,Brain Research Institute, University of California, Los Angeles, Los Angeles, CA 90095, United States,Corresponding author at: University of California, Los Angeles, Psychology Department, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, United States. (L.A. Ray)
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8
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Domi A, Barbier E, Adermark L, Domi E. Targeting the Opioid Receptors: A Promising Therapeutic Avenue for Treatment in “Heavy Drinking Smokers”. Alcohol Alcohol 2021; 56:127-138. [DOI: 10.1093/alcalc/agaa139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 01/12/2023] Open
Abstract
Abstract
Aims
Despite a general decline in tobacco use in the last decades, the prevalence of tobacco smoking in individuals with alcohol use disorder (AUD) remains substantial (45–50%). Importantly, the co-use of both substances potentiates the adverse effects, making it a significant public health problem. Substantial evidence suggests that AUD and Tobacco use disorder (TUD) may share common mechanisms. Targeting these mechanisms may therefore provide more effective therapy. Numerous studies describe a potential role of the endogenous opioid system in both AUD and TUD. Reviewing this literature, we aim to evaluate the efficacy of molecules that target the opioid system as promising therapeutic interventions for treating alcohol and tobacco co-use disorders.
Methods
We provide a synthesis of the current epidemiological knowledge of alcohol and tobacco co-use disorders. We evaluate clinical and preclinical research that focuses on the regulation of the endogenous opioid system in alcohol, nicotine, and their interactions.
Results
The epidemiological data confirm that smoking stimulates heavy drinking and facilitates alcohol craving. Pharmacological findings suggest that treatments that are efficacious in the dual addiction provide a beneficial treatment outcome in comorbid AUD and TUD. In this regard, MOP, DOP and NOP-receptor antagonists show promising results, while the findings prompt caution when considering KOP-receptor antagonists as a treatment option in alcohol and tobacco co-use disorders.
Conclusions
Existing literature suggests a role of the opioid system in sustaining the high comorbidity rates of AUD and TUD. Molecules targeting opioid receptors may therefore represent promising therapeutic interventions in ‘heavy drinking smokers.’
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Affiliation(s)
- Ana Domi
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy University of Gothenburg, Box 410, Gothenburg 405 30, Sweden
| | - Estelle Barbier
- Center for Social and Affective Neuroscience, Linköping University, Campus US, Entrance 65, Linköping 581 85, Sweden
| | - Louise Adermark
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy University of Gothenburg, Box 410, Gothenburg 405 30, Sweden
| | - Esi Domi
- Center for Social and Affective Neuroscience, Linköping University, Campus US, Entrance 65, Linköping 581 85, Sweden
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Chandler CM, Maggio SE, Peng H, Nixon K, Bardo MT. Effects of ethanol, naltrexone, nicotine and varenicline in an ethanol and nicotine co-use model in Sprague-Dawley rats. Drug Alcohol Depend 2020; 212:107988. [PMID: 32387915 PMCID: PMC7293937 DOI: 10.1016/j.drugalcdep.2020.107988] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/18/2020] [Accepted: 03/18/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND As alcohol and nicotine use disorders are entwined, it may be possible to develop a single medication to treat both. We previously developed a model for ethanol (EtOH) and nicotine co-use in female selectively bred alcohol-preferring (P) rats. To model co-use in a genetically diverse population, we adapted the model to outbred Sprague-Dawley rats of both sexes and assessed the effect of drug pretreatments. METHODS In phase 1, rats were trained in a 2-bottle choice between water and a sweetened or unsweetened EtOH solution in operant chambers. In phase 2, rats were trained in nicotine self-administration under an increasing fixed ratio (FR) schedule with 2 bottles containing water or saccharin-sweetened EtOH also available. In phase 3, rats were pretreated with EtOH (0.5, 1.5 g/kg), naltrexone (0.3 mg/kg), nicotine (0.2, 0.6 mg/kg), varenicline (3.0 mg/kg) or vehicle before the session. RESULTS Sweetening the EtOH solution was required to obtain pharmacologically relevant levels of consumption in Phase 1, with males showing increased sweetened EtOH preference compared to females. In Phase 2, increasing the FR requirement for nicotine decreased nicotine infusions, but increased EtOH consumption. In Phase 3, EtOH, naltrexone, and nicotine failed to alter EtOH consumption; however, varenicline decreased both EtOH and nicotine intake. CONCLUSIONS The co-use model was successfully adapted to Sprague-Dawley rats by adding saccharin to the EtOH solution. In contrast to previous results in P rats, varenicline reduced both EtOH and nicotine intake, indicating it may be a useful monotherapy for co-use in a genetically diverse population.
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Affiliation(s)
- Cassie M Chandler
- Department of Psychology, University of Kentucky, 106 B, Kastle Hall, Lexington, KY 40536, USA
| | - Sarah E Maggio
- Department of Psychology, University of Kentucky, 106 B, Kastle Hall, Lexington, KY 40536, USA
| | - Hui Peng
- Department of Pharmaceutical Sciences, University of Kentucky, Lexington, KY 40536, USA
| | - Kimberly Nixon
- Division of Pharmacology and Toxicology, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Michael T Bardo
- Department of Psychology, University of Kentucky, 106 B, Kastle Hall, Lexington, KY 40536, USA.
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10
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Kahler CW, Cohn AM, Costantino C, Toll BA, Spillane NS, Graham AL. A Digital Smoking Cessation Program for Heavy Drinkers: Pilot Randomized Controlled Trial. JMIR Form Res 2020; 4:e7570. [PMID: 32348286 PMCID: PMC7308890 DOI: 10.2196/formative.7570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/29/2020] [Accepted: 03/29/2020] [Indexed: 11/29/2022] Open
Abstract
Background Heavy drinking (HD) is far more common among smokers compared with nonsmokers and interferes with successful smoking cessation. Alcohol-focused smoking cessation interventions delivered by counselors have shown promise, but digital versions of these interventions—which could have far greater population reach—have not yet been tested. Objective This pilot randomized controlled trial aimed to examine the feasibility, acceptability, and effect sizes of an automated digital smoking cessation program that specifically addresses HD using an interactive web-based intervention with an optional text messaging component. Methods Participants (83/119, 69.7% female; 98/119, 82.4% white; mean age 38.0 years) were daily smokers recruited on the web from a free automated digital smoking cessation program (BecomeAnEX.org, EX) who met the criteria for HD: women drinking 8+ drinks/week or 4+ drinks on any day and men drinking 15+ drinks/week or 5+ drinks on any day. Participants were randomized to receive EX with standard content (EX-S) or an EX with additional content specific to HD (EX-HD). Outcomes were assessed by web-based surveys at 1 and 6 months. Results Participants reported high satisfaction with the website and the optional text messaging component. Total engagement with both EX-S and EX-HD was modest, with participants visiting the website a median of 2 times, and 52.9% of the participants enrolled to receive text messages. Participants in both the conditions showed substantial, significant reductions in drinking across 6 months of follow-up, with no condition effects observed. Although smoking outcomes tended to favor EX-HD, the condition effects were small and nonsignificant. A significantly smaller proportion of participants in EX-HD reported having a lapse back to smoking when drinking alcohol (7/58, 16%) compared with those in EX-S (18/61, 41%; χ21=6.2; P=.01). Conclusions This is the first trial to examine a digital smoking cessation program tailored to HD smokers. The results provide some initial evidence that delivering such a program is feasible and may reduce the risk of alcohol-involved smoking lapses. However, increasing engagement in this and other web-based interventions is a crucial challenge to address in future work. Trial Registration ClinicalTrials.gov NCT03068611; https://clinicaltrials.gov/ct2/show/NCT03068611
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Affiliation(s)
- Christopher W Kahler
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, United States
| | - Amy M Cohn
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | | | - Benjamin A Toll
- Medical University of South Carolina, Charleston, SC, United States
| | - Nichea S Spillane
- Department of Psychology, University of Rhode Island, South Kingston, RI, United States
| | - Amanda L Graham
- Innovations Center, Truth Initiative, Washington, DC, United States.,Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, United States
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11
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Nagano T, Katsurada M, Yasuda Y, Kobayashi K, Nishimura Y. Current pharmacologic treatments for smoking cessation and new agents undergoing clinical trials. Ther Adv Respir Dis 2020; 13:1753466619875925. [PMID: 31533544 PMCID: PMC6755639 DOI: 10.1177/1753466619875925] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Smoking causes various diseases and is a major public health threat worldwide.
Therefore, promoting smoking cessation is the most important intervention
contributing to maintaining the health of smokers and nonsmokers and saving
enormous financial expense. We reviewed existing and emerging smoking-cessation
pharmacotherapies from the Cochrane Database of Systemic Reviews, PubMed, Ovid,
and ClinicalTrials.gov databases. A literature review revealed that bupropion
may be appropriate for patients interested in reducing smoking who dislike, or
who have failed, nicotine-replacement therapy (NRT). Additionally, varenicline
and NRT are efficacious first-line smoking cessation treatments and should be
given to all individuals unless contraindicated. The reviews of this paper are available via the supplementary material
section.
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Affiliation(s)
- Tatsuya Nagano
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunokicho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Masahiro Katsurada
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Hyogo, Japan
| | - Yuichiro Yasuda
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Hyogo, Japan
| | - Kazuyuki Kobayashi
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Hyogo, Japan
| | - Yoshihiro Nishimura
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Hyogo, Japan
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12
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Roche DJO, Trela CJ, Argos M, Jasmine F, Kibriya MG, Ahsan H, King AC. Lack of Association between Opioid-Receptor Genotypes and Smoking Cessation Outcomes in a Randomized, Controlled Naltrexone Trial. Alcohol Alcohol 2020; 54:559-565. [PMID: 31206155 DOI: 10.1093/alcalc/agz046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 05/08/2019] [Accepted: 05/18/2019] [Indexed: 02/01/2023] Open
Abstract
AIMS The present study examined how variation in mu- (OPRM1), kappa- (OPRK), and delta- (OPRD) opioid receptor genes may influence the efficacy of naltrexone in the context of a smoking cessation trial. METHODS The study's primary objective was to examine the association of the Asn40Asp OPRM1 single nucleotide polymorphism (SNP) with naltrexone's effects on smoking quit rate, weight gain, and heavy drinking behavior during a double-blind, randomized clinical trial in 280 adult DSM-IV nicotine-dependent participants. The secondary goal of the study was to examine the relationship of 20 additional SNPs of OPRM1, OPRK, and OPRD with the aforementioned outcomes. RESULTS Results indicated a null association between any opioid-receptor gene SNP and naltrexone's effects on smoking quit rate, weight gain, and heavy drinking behavior in this sample of nicotine dependent participants. CONCLUSIONS In sum, these results do not suggest that genetic variation in opioid-receptors is related to treatment responses to naltrexone in a smoking cessation trial.
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Affiliation(s)
- Daniel J O Roche
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Constantine J Trela
- Department of Psychological Sciences, University of Missouri, 210 McAlester Hall, Columbia, MO 65211, USA
| | - Maria Argos
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL 60612, USA
| | - Farzana Jasmine
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL 60612, USA.,Department of Public Health Studies, University of Chicago, Chicago, IL 60637, USA
| | - Muhammad G Kibriya
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL 60612, USA
| | - Habibul Ahsan
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL 60612, USA
| | - Andrea C King
- Department of Psychiatry and Behavioral Sciences, University of Chicago, Chicago, IL 60637, USA
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13
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Palpacuer C, Hammas K, Duprez R, Laviolle B, Ioannidis JPA, Naudet F. Vibration of effects from diverse inclusion/exclusion criteria and analytical choices: 9216 different ways to perform an indirect comparison meta-analysis. BMC Med 2019; 17:174. [PMID: 31526369 PMCID: PMC6747755 DOI: 10.1186/s12916-019-1409-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/14/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Different methodological choices such as inclusion/exclusion criteria and analytical models can yield different results and inferences when meta-analyses are performed. We explored the range of such differences, using several methodological choices for indirect comparison meta-analyses to compare nalmefene and naltrexone in the reduction of alcohol consumption as a case study. METHODS All double-blind randomized controlled trials (RCTs) comparing nalmefene to naltrexone or one of these compounds to a placebo in the treatment of alcohol dependence or alcohol use disorders were considered. Two reviewers searched for published and unpublished studies in MEDLINE (August 2017), the Cochrane Library, Embase, and ClinicalTrials.gov and contacted pharmaceutical companies, the European Medicines Agency, and the Food and Drug Administration. The indirect comparison meta-analyses were performed according to different inclusion/exclusion criteria (based on medical condition, abstinence of patients before inclusion, gender, somatic and psychiatric comorbidity, psychological support, treatment administered and dose, treatment duration, outcome reported, publication status, and risk of bias) and different analytical models (fixed and random effects). The primary outcome was the vibration of effects (VoE), i.e. the range of different results of the indirect comparison between nalmefene and naltrexone. The presence of a "Janus effect" was investigated, i.e. whether the 1st and 99th percentiles in the distribution of effect sizes were in opposite directions. RESULTS Nine nalmefene and 51 naltrexone RCTs were included. No study provided a direct comparison between the drugs. We performed 9216 meta-analyses for the indirect comparison with a median of 16 RCTs (interquartile range = 12-21) included in each meta-analysis. The standardized effect size was negative at the 1st percentile (- 0.29, favouring nalmefene) and positive at the 99th percentile (0.29, favouring naltrexone). A total of 7.1% (425/5961) of the meta-analyses with a negative effect size and 18.9% (616/3255) of those with a positive effect size were statistically significant (p < 0.05). CONCLUSIONS The choice of inclusion/exclusion criteria and analytical models for meta-analysis can result in entirely opposite results. VoE evaluations could be performed when overlapping meta-analyses on the same topic yield contradictory result. TRIAL REGISTRATION This study was registered on October 19, 2016, in the Open Science Framework (OSF, protocol available at https://osf.io/7bq4y/ ).
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Affiliation(s)
- Clément Palpacuer
- Centre d'Investigation Clinique INSERM 1414, Hôpital de Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes cedex 9, France. .,Department of Biostatistics, Institut de Cancérologie de l'Ouest Centre René-Gauducheau, Saint-Herblain, France.
| | - Karima Hammas
- Department of Epidemiology and Biostatistics and Clinical Research, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat Claude Bernard, Paris, France.,Inserm, CIC-EC 1425, Hôpital Bichat Claude Bernard, Paris, France
| | - Renan Duprez
- Fondation Saint Jean de Dieu, Centre Hospitalier Dinan/St Brieuc, Dinan, France
| | - Bruno Laviolle
- Centre d'Investigation Clinique INSERM 1414, Hôpital de Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes cedex 9, France.,Department of Biological and Clinical Pharmacology and Pharmacovigilance, Rennes University Hospital, Rennes, France.,Laboratory of Experimental and Clinical Pharmacology, Rennes 1 University, Rennes, France
| | - John P A Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA.,Departments of Medicine, of Health Research and Policy, Biomedical Data Science, and Statistics, Stanford University, Stanford, CA, USA
| | - Florian Naudet
- Centre d'Investigation Clinique INSERM 1414, Hôpital de Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes cedex 9, France.,Department of Biological and Clinical Pharmacology and Pharmacovigilance, Rennes University Hospital, Rennes, France.,Laboratory of Experimental and Clinical Pharmacology, Rennes 1 University, Rennes, France.,Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
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14
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Stewart SH, Walitzer KS, Blanco J, Swiatek D, Paine Hughes L, Quiñones-Lombraña A, Shyhalla K. Medication-enhanced behavior therapy for alcohol use disorder: Naltrexone, Alcoholics Anonymous Facilitation, and OPRM1 genetic variation. J Subst Abuse Treat 2019; 104:7-14. [PMID: 31370987 DOI: 10.1016/j.jsat.2019.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 05/03/2019] [Accepted: 05/03/2019] [Indexed: 01/24/2023]
Abstract
Medication-assisted behavior treatment for alcohol use disorder (AUD) holds promise to enhance the efficacy of medication and of behavior therapy when administered individually. The present study examines the treatment benefit of combined outpatient naltrexone (NTX) treatment with Alcoholics Anonymous Facilitation (AAF) behavior therapy, in the context of OPRM1 genotype. The minor OPRM1 Asp40 G-allele has been associated with greater positive reinforcing effects of alcohol consumption and greater alcohol craving, suggesting that individuals carrying the OPRM1 G allele may have an improved naltrexone response. Twenty patients, including 7 G-allele carriers, received 90 days of naltrexone with medication support and dispensing sessions, and ten AAF behavior therapy sessions. During treatment and the eight-week posttreatment follow-up, an overall increase in percent days abstinent was observed for the sample as a whole, but G-allele carriers reported relatively heavier drinking relative to other subjects. These findings suggest that this enhanced medication-assisted behavior treatment is a promising therapeutic combination, and mirror other recent findings that G-allele carriers may require more intensive treatment.
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Affiliation(s)
- Scott H Stewart
- Section on Addiction Medicine, Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
| | - Kimberly S Walitzer
- Clinical and Research Institute on Addictions, University at Buffalo, Buffalo, NY, USA
| | - Javier Blanco
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Denise Swiatek
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| | | | - Adolfo Quiñones-Lombraña
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Kathleen Shyhalla
- Clinical and Research Institute on Addictions, University at Buffalo, Buffalo, NY, USA
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15
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Lim AC, Ghahremani DG, Grodin EN, Green R, Bujarski S, Hartwell EE, Courtney KE, Hutchison K, Miotto K, Ray LA. Neuroimaging findings from an experimental pharmacology trial of naltrexone in heavy drinkers of East Asian descent. Drug Alcohol Depend 2019; 200:181-190. [PMID: 31160146 PMCID: PMC6760244 DOI: 10.1016/j.drugalcdep.2019.02.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/01/2019] [Accepted: 02/22/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Despite known genetic variation across races, studies examining pharmacogenetics of a single nucleotide polymorphism (SNP) of the mu-opioid receptor gene (OPRM1) on clinical response to naltrexone have been conducted in predominantly Caucasian samples. Evidence is mixed for pharmacogenetic OPRM1 and naltrexone effects on neural responses to alcohol cues. The current study tests the pharmacogenetic effects of naltrexone and OPRM1 on neural responses to alcohol taste cues in heavy drinkers of East Asian descent. METHODS Participants (N = 41) completed two double-blinded and counterbalanced functional magnetic resonance imaging (fMRI) sessions: one after taking naltrexone (50 mg/day) for four days and one after taking placebo for four days. Following titration, participants completed an fMRI alcohol taste-cues task. Analyses tested effects of naltrexone, OPRM1, and their interaction in whole-brain and region of interest (ROI) analyses of functional activation and functional connectivity in response to alcohol versus water taste cues. RESULTS We found no effects of naltrexone orOPRM1 on neural activation in whole-brain and ROI analyses, which included left and right ventral striatum (VS), anterior cingulate cortex (ACC), and orbitofrontal cortex (OFC). Naltrexone increased functional connectivity between left VS and clusters in medial prefrontal cortex, posterior cingulate gyrus, as well as right VS and occipital cortex, compared to placebo. CONCLUSIONS Naltrexone treatment enhanced functional connectivity in a key reinforcement-related pathway during alcohol versus water taste cues, corroborating neuroimaging work with other substances. Null medication and pharmacogenetics effects on functional activation add to a mixed naltrexone literature and may underscore the modest size of these effects in East Asians.
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Affiliation(s)
- Aaron C. Lim
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Dara G. Ghahremani
- Department of Psychiatry and Biobehavioral Sciences, 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
| | - Spencer Bujarski
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Emily E. Hartwell
- 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
| | - Kent Hutchison
- Department of Psychology, University of Colorado, Boulder, CO, USA
| | - Karen Miotto
- Department of Psychiatry and Biobehavioral Sciences, 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, University of California, Los Angeles, Los Angeles, CA, USA
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16
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Green R, Bujarski S, Lim AC, Venegas A, Ray L. Naltrexone and alcohol effects on craving for cigarettes in heavy drinking smokers. Exp Clin Psychopharmacol 2019; 27:257-264. [PMID: 30628813 PMCID: PMC7227763 DOI: 10.1037/pha0000252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Naltrexone has been extensively studied for the treatment of alcohol use disorder. However, less is known about the effects of naltrexone on smoking outcomes in the context of alcohol use among East Asian individuals who have been suggested to differ in response to alcohol and to naltrexone. The present study is a secondary analysis that used a double-blind placebo-controlled design (n = 31) to examine the (a) effects of alcohol on basal craving for cigarettes, (b) effects of naltrexone on cigarette craving and alcohol craving during alcohol administration, and (c) relationship between craving for alcohol and cigarettes. Heavy drinking smokers of East Asian descent completed two counterbalanced intravenous alcohol administration sessions, one after taking naltrexone (50 mg) for five days and one after taking a placebo for five days. Self-reported subjective craving for cigarettes and for alcohol was recorded during each experimental session. Craving for cigarettes and alcohol increased significantly throughout the intravenous alcohol administration. A significant breath alcohol concentration (BrAC) × Medication interaction revealed that naltrexone blunted cigarette craving during alcohol administration, compared to placebo. Naltrexone significantly reduced craving for alcohol during alcohol administration in this group of heavy drinking smokers. Alcohol craving significantly predicted cigarette craving, however this effect did not vary across rising alcohol administration or by medication. These findings demonstrate that naltrexone reduces the urge to smoke and to drink during alcohol administration. Clinical studies are needed to further ascertain whether naltrexone may be of benefit to this distinct subgroup of heavy drinking smokers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- ReJoyce Green
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Spencer Bujarski
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Aaron C. Lim
- 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
| | - Lara Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
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17
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An improved model of ethanol and nicotine co-use in female P rats: Effects of naltrexone, varenicline, and the selective nicotinic α6β2* antagonist r-bPiDI. Drug Alcohol Depend 2018; 193:154-161. [PMID: 30384323 PMCID: PMC6239925 DOI: 10.1016/j.drugalcdep.2018.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/06/2018] [Accepted: 09/08/2018] [Indexed: 12/17/2022]
Abstract
Background Although pharmacotherapies are available for alcohol (EtOH) or tobacco use disorders individually, it may be possible to develop a single pharmacotherapy to treat heavy drinking tobacco smokers by capitalizing on the commonalities in their mechanisms of action. Methods Female alcohol-preferring (P) rats were trained for EtOH drinking and nicotine self-administration in two phases: (1) EtOH alone (0 vs. 15% EtOH, 2-bottle choice) and (2) concomitant access, during which EtOH access continued with access to nicotine (0.03 mg/kg/infusion, i.v.) using a 2-lever choice procedure (active vs. inactive lever) in which the fixed ratio (FR) requirement was gradually increased to FR30. When stable co-use was obtained, rats were pretreated with varying doses of naltrexone, varenicline, or r-bPiDI, an α6β2* subtype-selective nicotinic acetylcholine receptor antagonist shown previously to reduce nicotine self-administration. Results While EtOH intake was initially suppressed in phase 2 (co-use), pharmacologically relevant intake for both substances was achieved by raising the "price" of nicotine to FR30. In phase 2, naltrexone decreased EtOH and water consumption but not nicotine intake; in contrast, naltrexone in phase 1 (EtOH only) did not significantly alter EtOH intake. Varenicline and r-bPiDI in phase 2 both decreased nicotine self-administration and inactive lever pressing, but neither altered EtOH or water consumption. Conclusions These results indicate that increasing the "price" of nicotine increases EtOH intake during co-use. Additionally, the efficacy of naltrexone, varenicline, and r-bPiDI was specific to either EtOH or nicotine, with no efficacy for co-use. Nevertheless, future studies on combining these treatments may reveal synergistic efficacy.
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18
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Lim AC, Roche DJO, Ray LA. Distress Tolerance and Craving for Cigarettes Among Heavy Drinking Smokers. J Stud Alcohol Drugs 2018; 79:918-928. [PMID: 30573023 PMCID: PMC6308171 DOI: 10.15288/jsad.2018.79.918] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 07/23/2018] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE Heavy drinking smokers experience significant difficulties with smoking cessation. Craving is closely tied to relapses during cessation attempts, and alcohol consumption increases cigarette craving among heavy drinking smokers. To date, however, few moderators of the relationship between craving and relapse have been identified. Individuals' capacity for distress tolerance predicts smoking cessation outcomes and may be connected to craving. Relatedly, pharmacotherapies like varenicline and naltrexone reduce cigarette and alcohol cravings, respectively. No studies have examined the interrelationships among distress tolerance, craving, and pharmacotherapy effects. This study therefore examines distress tolerance as a moderator of the relationship between overnight abstinence-induced cigarette craving and subsequent alcohol- and cigarette-induced changes in craving among heavy drinking smokers. This study also examines the impact of varenicline and naltrexone on these relationships. METHOD A total of 120 non-treatment-seeking heavy drinking smokers were randomized and titrated to one of the following conditions: (a) placebo, (b) varenicline, (c) naltrexone, or (d) varenicline + naltrexone. Participants then completed a laboratory paradigm after overnight abstinence that included consumption of alcohol (target .06 g/dl breath alcohol concentration) and one cigarette. Craving was assessed as abstinence-induced (Time 1), alcohol-induced (Time 2), and cigarette-induced (Time 3). RESULTS Within varenicline + naltrexone, low distress tolerance individuals exhibited higher increases from abstinence- to alcohol-induced cigarette craving relative to high distress tolerance individuals. Across medications, low distress tolerance individuals reported flatter decreases from abstinence- to cigarette-induced cigarette craving relative to high distress tolerance individuals. CONCLUSIONS Distress tolerance may differentially predict alcohol-induced cigarette craving when titrated to pharmacotherapy, as well as moderate decreases in craving after cigarette consumption. Future exploration of the identified interactive effects could elucidate specific conditions in which cravings are more proximally related to abstinence-induced smoking.
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Affiliation(s)
- Aaron C Lim
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Daniel J O Roche
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
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19
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Lim AC, Roche DJO, Ray LA. Distress Tolerance and Craving for Cigarettes Among Heavy Drinking Smokers. J Stud Alcohol Drugs 2018; 79:918-928. [PMID: 30573023 PMCID: PMC6308171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVE Heavy drinking smokers experience significant difficulties with smoking cessation. Craving is closely tied to relapses during cessation attempts, and alcohol consumption increases cigarette craving among heavy drinking smokers. To date, however, few moderators of the relationship between craving and relapse have been identified. Individuals' capacity for distress tolerance predicts smoking cessation outcomes and may be connected to craving. Relatedly, pharmacotherapies like varenicline and naltrexone reduce cigarette and alcohol cravings, respectively. No studies have examined the interrelationships among distress tolerance, craving, and pharmacotherapy effects. This study therefore examines distress tolerance as a moderator of the relationship between overnight abstinence-induced cigarette craving and subsequent alcohol- and cigarette-induced changes in craving among heavy drinking smokers. This study also examines the impact of varenicline and naltrexone on these relationships. METHOD A total of 120 non-treatment-seeking heavy drinking smokers were randomized and titrated to one of the following conditions: (a) placebo, (b) varenicline, (c) naltrexone, or (d) varenicline + naltrexone. Participants then completed a laboratory paradigm after overnight abstinence that included consumption of alcohol (target .06 g/dl breath alcohol concentration) and one cigarette. Craving was assessed as abstinence-induced (Time 1), alcohol-induced (Time 2), and cigarette-induced (Time 3). RESULTS Within varenicline + naltrexone, low distress tolerance individuals exhibited higher increases from abstinence- to alcohol-induced cigarette craving relative to high distress tolerance individuals. Across medications, low distress tolerance individuals reported flatter decreases from abstinence- to cigarette-induced cigarette craving relative to high distress tolerance individuals. CONCLUSIONS Distress tolerance may differentially predict alcohol-induced cigarette craving when titrated to pharmacotherapy, as well as moderate decreases in craving after cigarette consumption. Future exploration of the identified interactive effects could elucidate specific conditions in which cravings are more proximally related to abstinence-induced smoking.
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Affiliation(s)
- Aaron C Lim
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Daniel J O Roche
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, California.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
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20
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Anton RF, Latham PK, Voronin KE, Randall PK, Book SW, Hoffman M, Schacht JP. Nicotine-Use/Smoking Is Associated with the Efficacy of Naltrexone in the Treatment of Alcohol Dependence. Alcohol Clin Exp Res 2018; 42:751-760. [PMID: 29431852 PMCID: PMC5880727 DOI: 10.1111/acer.13601] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/09/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND The opioid antagonist naltrexone is not efficacious for every alcohol treatment seeker. However, various individual factors, such as genetic differences and nicotine-use/smoking status, have been suggested as predictors of naltrexone response. In a randomized clinical trial, we previously reported that nicotine-use/smoking status might be a stronger predictor of naltrexone efficacy than OPRM1 A118G single nucleotide polymorphism (SNP) genotype. In this report, we further characterize the nicotine-users in that trial, examine other drinking outcomes, examine the influence of smoking change on naltrexone effects on drinking, and validate the result in smokers with disialo carbohydrate-deficient transferrin (%dCDT) change as an independent biomarker of response. METHODS Individuals (n = 146) meeting DSM-IV criteria for alcohol dependence who were genotyped for the OPRM1 A118G SNP and who did, or did not, use nicotine/cigarettes were randomized, in a balanced fashion, to naltrexone (50 mg/d) or placebo and provided medical management (MM) over a 16-week clinical trial. Alcohol use and smoking during the trial were assessed and analyzed. RESULTS Nicotine-use/smoking status significantly interacted with medication in reducing percent heavy drinking days (PHDD) during the trial (p = 0.003), such that nicotine-users/smokers showed significantly lower PHDD on naltrexone versus placebo (p = 0.0001, Cohen's d = 0.89), while nonusers showed no significant difference between naltrexone and placebo (p = 0.95, Cohen's d = 0.02). Similar effects were shown for drinks per day and percent days drinking. The superiority of naltrexone over placebo on PHDD reduction in nicotine-users/smokers was confirmed with %dCDT (Cohen's d range 0.3 to 0.9 over the study). Naltrexone did not significantly change cigarette use in smokers, and change in use did not influence naltrexone's effect on PHDD. CONCLUSIONS These data confirm past findings that naltrexone is more efficacious in those who use nicotine/cigarettes. Compared to previous work on the OPRM1 A118G SNP, it appears that nicotine-use might be a more salient predictor of naltrexone treatment response. While naltrexone did not change cigarette use during the study, and smoking change was not related to alcohol reduction, it should be noted that participants were not seeking smoking cessation and MM did not address this issue.
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Affiliation(s)
- Raymond F Anton
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Patricia K Latham
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Konstantin E Voronin
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Patrick K Randall
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Sarah W Book
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Michaela Hoffman
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Joseph P Schacht
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
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21
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Gómez-Coronado N, Walker AJ, Berk M, Dodd S. Current and Emerging Pharmacotherapies for Cessation of Tobacco Smoking. Pharmacotherapy 2018; 38:235-258. [PMID: 29250815 DOI: 10.1002/phar.2073] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Tobacco use disorder is a chronic illness. With its high comorbidity rate, it is a major cause of years of life lost or years lived with disability; however, it is also considered the most preventable cause of death in developed countries. Since the development of nicotine replacement therapy (NRT) in 1978, treatment options have continued to evolve and expand. Despite this, currently available treatments remain insufficient, with less than 25% of smokers remaining abstinent 1 year after treatment. In this article, we review existing and emerging smoking cessation pharmacotherapies, with a special emphasis on the most promising agents that are currently being investigated. A search of the Cochrane Database of Systematic Reviews and the PubMed, Ovid, and ClinicalTrials.gov databases (August 2 to September 1, 2017) was undertaken for articles on smoking cessation pharmacotherapies, applying no language restrictions. More than 40 pharmacotherapies were reviewed including conventional pharmacotherapies-NRT, bupropion, and varenicline (all approved by the U.S. Food and Drug Administration as first-line treatment of smoking cessation)-and novel therapies: cytisine, N-acetylcysteine, cycloserine, memantine, baclofen, topiramate, galantamine, and bromocriptine. Studies of combination NRT and varenicline showed the greatest smoking cessation rates. Clonidine and nortriptyline are second-line treatments used when first-line treatments fail or are contraindicated, or by patient preference. Some novel therapies, especially acetylcholinesterase inhibitors, cytisine, and N-acetylcysteine, display promising results. Because the results of randomized clinical trials were reported using varied end points and outcome measures, direct comparisons between different pharmacotherapies cannot easily be evaluated. Additional high-quality randomized double-blind placebo-controlled trials with long-term follow-up, using validated sustained abstinence measures, are needed to find more effective smoking cessation aids.
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Affiliation(s)
- Nieves Gómez-Coronado
- Unidad de Gestión Clinica Salud Mental, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Adam J Walker
- IMPACT Strategic Research Centre, Deakin University, Geelong, Victoria, Australia
| | - Michael Berk
- IMPACT Strategic Research Centre, Deakin University, Geelong, Victoria, Australia.,Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia.,Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Seetal Dodd
- IMPACT Strategic Research Centre, Deakin University, Geelong, Victoria, Australia.,Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia.,Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
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22
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Lim AC, Courtney KE, Moallem NR, Allen VC, Leventhal AM, Ray LA. A Brief Smoking Cessation Intervention for Heavy Drinking Smokers: Treatment Feasibility and Acceptability. Front Psychiatry 2018; 9:362. [PMID: 30147661 PMCID: PMC6095957 DOI: 10.3389/fpsyt.2018.00362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 07/20/2018] [Indexed: 12/01/2022] Open
Abstract
Approximately 20-25% of regular smokers report heavy drinking. Abstinent smokers are five times as likely to experience a smoking lapse during drinking episodes. Current efforts seek to improve treatments for this subgroup of heavy-drinking smokers. This study tested the feasibility and acceptability of addressing alcohol use in a brief, single session smoking cessation intervention (SMK+A) compared to smoking cessation counseling only (SMK); these interventions were grounded in a motivational interview framework and included personalized feedback, decisional balance, quit day setting, and tailored skills building (e.g., breathing techniques, coping with urges, dealing with social pressures) to maintain abstinence. Descriptive outcomes included reported helpfulness of intervention skills, readiness to change scores, and feasibility of participant recruitment and retention. We also assessed 7-day point prevalence of smoking cessation, and smoking and drinking reduction at 1-month follow-up. Participants (N = 22) were community-based treatment-seeking daily smokers (≥5 cigarettes/day) who were also heavy drinkers (≥14 drinks/week for men, ≥ 7 drinks/week for women; or ≥5 drinks on one episode in past week for men, ≥4 for women). Twenty five percent of interested individuals were eligible after initial phone screen, and all randomized participants were retained through follow up. All skills demonstrated high acceptability (i.e., rated between moderately and very helpful), and a significant proportion of participants in each condition reported taking action to reduce cigarette smoking and/or alcohol use at 1-month post-quit. Three participants in each condition (27.3%) attained bioverified (CO ≤ 4 parts per million and cotinine ≤ 3 ng/mL) smoking quit at follow-up. Given the modified intervention's acceptability and flexibility, larger studies may help to elucidate this intervention's effects on readiness to change, smoking cessation, and alcohol reduction.
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Affiliation(s)
- Aaron C Lim
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Kelly E Courtney
- Department of Psychology, University of California, San Diego, San Diego, CA, United States
| | - Nathasha R Moallem
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Vincent C Allen
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Adam M Leventhal
- Department of Preventive Medicine and Psychology, University of Southern California, Los Angeles, CA, United States
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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23
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Predictors of Naltrexone Response in a Randomized Trial: Reward-Related Brain Activation, OPRM1 Genotype, and Smoking Status. Neuropsychopharmacology 2017; 42:2640-2653. [PMID: 28409564 PMCID: PMC5686497 DOI: 10.1038/npp.2017.74] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 03/01/2017] [Accepted: 04/04/2017] [Indexed: 01/14/2023]
Abstract
Naltrexone reduces drinking among individuals with alcohol use disorders (AUDs), but it is not effective for everyone. Variability in its effects on reward-related brain activation, genetic variation, and/or cigarette smoking may account for this mixed response profile. This randomized clinical trial tested the effects of naltrexone on drinking and alcohol cue-elicited brain activation, evaluated whether OPRM1 A118G genotype or smoking moderated these effects, and explored whether the effects of medication on cue-elicited activation predicted subsequent drinking. One hundred and fifty-two treatment-seeking individuals with alcohol dependence, half preselected to carry at least one A118G G (Asp) allele, were randomized to naltrexone (50 mg) or placebo for 16 weeks and administered an fMRI alcohol cue reactivity task at baseline and after 2 weeks of treatment. Naltrexone, relative to placebo, significantly reduced alcohol cue-elicited activation of the right ventral striatum (VS) between baseline and week 2 and reduced heavy drinking over 16 weeks. OPRM1 genotype did not significantly moderate these effects, but G-allele carriers who received naltrexone had an accelerated return to heavy drinking after medication was stopped. Smoking moderated the effects of medication on drinking, such that naltrexone was superior to placebo only among smokers. The degree of reduction in right VS activation between scans interacted with medication in predicting subsequent drinking, such that individuals with greater reduction in activation who received naltrexone, but not placebo, experienced the least heavy drinking during the following 14 weeks. These data replicate previous findings that naltrexone reduces heavy drinking and reward-related brain activation among treatment-seeking individuals with AUDs, and indicate that smoking and the magnitude of reduction in cue-elicited brain activation may predict treatment response.
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24
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Cohn AM, Zhao K, Cha S, Wang X, Amato MS, Pearson JL, Papandonatos GD, Graham AL. A Descriptive Study of the Prevalence and Typology of Alcohol-Related Posts in an Online Social Network for Smoking Cessation. J Stud Alcohol Drugs 2017; 78:665-673. [PMID: 28930053 DOI: 10.15288/jsad.2017.78.665] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Alcohol use and problem drinking are associated with smoking relapse and poor smoking-cessation success. User-generated content in online social networks for smoking cessation provides an opportunity to understand the challenges and treatment needs of smokers. This study used machine-learning text classification to identify the prevalence, sentiment, and social network correlates of alcohol-related content in the social network of a large online smoking-cessation program, BecomeAnEX.org. METHOD Data were analyzed from 814,258 posts (January 2012 to May 2015). Posts containing alcohol keywords were coded via supervised machine-learning text classification for information about the user's personal experience with drinking, whether the user self-identified as a problem drinker or indicated problem drinking, and negative sentiment about drinking in the context of a quit attempt (i.e., alcohol should be avoided during a quit attempt). RESULTS Less than 1% of posts were related to alcohol, contributed by 13% of users. Roughly a third of alcohol posts described a personal experience with drinking; very few (3%) indicated "problem drinking." The majority (70%) of alcohol posts did not express negative sentiment about drinking alcohol during a quit attempt. Users who did express negative sentiment about drinking were more centrally located within the network compared with those who did not. CONCLUSIONS Discussion of alcohol was rare, and most posts did not signal the need to quit or abstain from drinking during a quit attempt. Featuring expert information or highlighting discussions that are consistent with treatment guidelines may be important steps to ensure smokers are educated about drinking risks.
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Affiliation(s)
- Amy M Cohn
- Battelle Memorial Institute, Arlington, Virginia.,Department of Oncology, Georgetown University Medical Center, Washington, DC
| | - Kang Zhao
- Department of Management Sciences, Tippie College of Business, The University of Iowa, Iowa City, Iowa
| | - Sarah Cha
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC
| | - Xi Wang
- School of Information, Central University of Finance and Economics, Beijing, China
| | - Michael S Amato
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC
| | - Jennifer L Pearson
- School of Community Health Sciences, University of Nevada, Reno, Reno, Nevada.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - George D Papandonatos
- Center for Statistical Sciences, Brown University School of Public Health, Brown University, Providence, Rhode Island
| | - Amanda L Graham
- Department of Oncology, Georgetown University Medical Center, Washington, DC.,Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC
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25
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Smith LJ, McNamara PJ, King AC. Optimizing follow-up and study retention in the 21st century: Advances from the front line in alcohol and tobacco research. Drug Alcohol Depend 2017; 175:171-178. [PMID: 28437721 PMCID: PMC5654598 DOI: 10.1016/j.drugalcdep.2017.01.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 01/10/2017] [Accepted: 01/12/2017] [Indexed: 11/28/2022]
Abstract
AIMS Longitudinal studies are integral in addiction research but retention of participants over time can be challenging. While statistical algorithms for missing data have advanced, they remain less desirable than collecting actual data with high retention rates. An update to methodological primers with consideration of evolving technology and privacy concerns is needed for 21st century researchers. METHODS Comprehensive follow-up methodological strategies were conducted in four concurrent laboratory- and intervention-based studies across N=697 drinker and smokers enrolled in studies at the Clinical Addictions Research Laboratory at the University of Chicago. The methods of three key longitudinal research themes and their outcomes are outlined, including: a) mindset of the research team starting at study enrollment, b) modalities with a particular focus on advances in technological strategies in follow-up, and c) mitigating difficult to reach and challenging participants. RESULTS The techniques described herein produced follow-up rates of 95% and 99% in two laboratory-based studies with follow-ups of 1- and 6-years, respectively and 94% and 97% in two intervention studies with follow-ups of 6- and 12- months. Adapting incentive strategies more than tripled on-time follow-up, from 18% to 68% of the sample, switching to more advanced technologies decreased participant burden and time by 30% from traditional telephone interviews, and difficult-to-reach participants averaged 47 contact attempts. CONCLUSIONS The methods presented produced exceptional follow-up retention across four studies. The principles and methodologies discussed may be modified across a range of studies to target various sub-populations in the addiction field.
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Affiliation(s)
- Lia J Smith
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, United States
| | - Patrick J McNamara
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, United States
| | - Andrea C King
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, United States.
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26
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Kahler CW, Cioe PA, Tzilos GK, Spillane NS, Leggio L, Ramsey SE, Brown RA, O'Malley SS. A Double-Blind Randomized Placebo-Controlled Trial of Oral Naltrexone for Heavy-Drinking Smokers Seeking Smoking Cessation Treatment. Alcohol Clin Exp Res 2017; 41:1201-1211. [PMID: 28401564 DOI: 10.1111/acer.13396] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 04/06/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Post hoc analyses of 2 randomized controlled trials suggest naltrexone may reduce alcohol use and improve smoking cessation outcomes among heavy drinkers receiving smoking cessation treatment. However, no studies have been conducted specifically to examine naltrexone for this purpose or to test whether naltrexone has benefit when added to smoking cessation counseling that explicitly addresses heavy drinking. METHODS We recruited heavy-drinking smokers from the community and randomized them to receive 10 weeks of either (i) 50 mg naltrexone (n = 75) or (ii) placebo (n = 75) daily. Participants received 6 weeks of transdermal nicotine patch and 6 sessions of counseling that addressed both heavy drinking and smoking. Participants were followed for 26 weeks after their target quit smoking date. RESULTS Across medication conditions, there were substantial reductions at follow-up in percent heavy drinking days (primary outcome) and average drinks per week (secondary outcome). However, participants receiving naltrexone did not differ significantly from those receiving placebo on percent heavy drinking days (effect size d = -0.04, 95% CI [-0.30, 0.22], p = 0.76) or average drinks per week (d = -0.09, 95% CI [-0.35, 0.18], p = 0.54) during follow-up. Naltrexone compared to placebo was not associated with a significant increase in smoking abstinence rates during follow-up, odds ratio = 0.93, 95% CI [0.46, 1.86], p = 0.83. The effect of naltrexone on these outcomes was not significantly moderated by current alcohol dependence or gender. CONCLUSIONS Results indicate that heavy-drinking smokers, including those with current alcohol dependence, can make substantial reductions in drinking in the context of smoking cessation treatment. However, this study provided no evidence that naltrexone is efficacious for enhancing reductions in drinking or improving smoking cessation in this population. Limitations of this study included lower-than-desired sample size and modest adherence to study medication.
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Affiliation(s)
- Christopher W Kahler
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island
| | - Patricia A Cioe
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island
| | - Golfo K Tzilos
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Nichea S Spillane
- Department of Psychology, University of Rhode Island, South Kingston, Rhode Island
| | - Lorenzo Leggio
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island.,Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism and National Institute on Drug Abuse, Bethesda, Maryland
| | - Susan E Ramsey
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island.,Department of Medicine, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island
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27
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Kasai S, Nishizawa D, Hasegawa J, Sato N, Tanioka F, Sugimura H, Ikeda K. Nociceptin/orphanin FQ receptor gene variation is associated with smoking status in Japanese. Pharmacogenomics 2016; 17:1441-51. [DOI: 10.2217/pgs.15.184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: The endogenous opioid system has been reportedly implicated in tobacco/nicotine dependence. Materials & methods: We examined the genetic effects of eight SNPs in opioid receptor-related genes on smoking status and smoking-related traits in Japanese. Results: The genotypic and allelic variations of the rs2229205 SNP in the OPRL1 gene were significantly associated with smoking status, but no significant differences were found in the genetic variations of any of the SNPs with regard to smoking-related traits. The rs2229205 SNP did not show high linkage disequilibrium with the other SNPs in the linkage disequilibrium block that contained the SNP. Conclusion: The rs2229205 SNP in the OPRL1 gene may be a genetic factor that contributes to individual differences in the vulnerability to smoking in Japanese individuals.
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Affiliation(s)
- Shinya Kasai
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan
| | - Daisuke Nishizawa
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan
| | - Junko Hasegawa
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan
| | - Naomi Sato
- First Department of Tumor Pathology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka 431-3192, Japan
| | - Fumihiko Tanioka
- Division of Pathology, Iwata City Hospital, 512-3 Ookubo, Iwata, Shizuoka 438-8550, Japan
| | - Haruhiko Sugimura
- First Department of Tumor Pathology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka 431-3192, Japan
| | - Kazutaka Ikeda
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan
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28
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Bernardi RE, Zohsel K, Hirth N, Treutlein J, Heilig M, Laucht M, Spanagel R, Sommer WH. A gene-by-sex interaction for nicotine reward: evidence from humanized mice and epidemiology. Transl Psychiatry 2016; 6:e861. [PMID: 27459726 PMCID: PMC5545715 DOI: 10.1038/tp.2016.132] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 04/19/2016] [Accepted: 04/24/2016] [Indexed: 02/03/2023] Open
Abstract
It has been proposed that vulnerability to nicotine addiction is moderated by variation at the μ-opioid receptor locus (OPRM1), but results from human studies vary and prospective studies based on genotype are lacking. We have developed a humanized mouse model of the most common functional OPRM1 polymorphism rs1799971_A>G (A118G). Here we use this model system together with a cohort of German youth to examine the role of the OPRM1 A118G variation on nicotine reward. Nicotine reinforcement was examined in the humanized mouse model using i.v. self-administration. Male (n=17) and female (n=26) mice homozygous either for the major human A allele (AA) or the minor G allele (GG) underwent eight daily 2 h sessions of nicotine self-administration. Furthermore, male (n=104) and female (n=118) subjects homozygous for the A allele or carrying the G allele from the Mannheim Study of Children at Risk were evaluated for pleasurable and unpleasant experiences during their initial smoking experience. A significant sex-by-genotype effect was observed for nicotine self-administration. Male 118GG mice demonstrated higher nicotine intake than male 118AA mice, suggesting increased nicotine reinforcement. In contrast, there was no genotype effect in female mice. Human male G allele carriers reported increased pleasurable effects from their first smoking experience, as compared to male homozygous A, female G and female homozygous A allele carriers. The 118G allele appears to confer greater sensitivity to nicotine reinforcement in males, but not females.
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Affiliation(s)
- R E Bernardi
- Institute of Psychopharmacology, Central
Institute of Mental Health, Medical Faculty Mannheim/Heidelberg
University, Mannheim, Germany
| | - K Zohsel
- Department of Child and Adolescent
Psychiatry, Central Institute of Mental Health, Medical Faculty
Mannheim/Heidelberg University, Mannheim,
Germany
| | - N Hirth
- Institute of Psychopharmacology, Central
Institute of Mental Health, Medical Faculty Mannheim/Heidelberg
University, Mannheim, Germany
| | - J Treutlein
- Genetic Epidemiology, Central Institute
of Mental Health, Medical Faculty Mannheim/Heidelberg University,
Mannheim, Germany
| | - M Heilig
- Center for Social and Affective
Neuroscience, Linköping University, Linköping,
Sweden
| | - M Laucht
- Department of Child and Adolescent
Psychiatry, Central Institute of Mental Health, Medical Faculty
Mannheim/Heidelberg University, Mannheim,
Germany
| | - R Spanagel
- Institute of Psychopharmacology, Central
Institute of Mental Health, Medical Faculty Mannheim/Heidelberg
University, Mannheim, Germany
| | - W H Sommer
- Institute of Psychopharmacology, Central
Institute of Mental Health, Medical Faculty Mannheim/Heidelberg
University, Mannheim, Germany,Addiction Medicine, Central Institute of
Mental Health, Medical Faculty Mannheim/Heidelberg University,
Mannheim, Germany,Institute of Psychopharmacology, Central Institute of Mental
Health, Medical Faculty Mannheim/Heidelberg University, Square
J5, Mannheim
68159, Germany; E-mail:
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29
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Braithwaite RS, Fang Y, Tate J, Mentor SM, Bryant KJ, Fiellin DA, Justice AC. Do Alcohol Misuse, Smoking, and Depression Vary Concordantly or Sequentially? A Longitudinal Study of HIV-Infected and Matched Uninfected Veterans in Care. AIDS Behav 2016; 20:566-72. [PMID: 26187007 DOI: 10.1007/s10461-015-1117-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We analyzed temporal patterns of alcohol misuse, smoking, and depression among veterans in care to determine whether these conditions vary concordantly or sequentially. Using the Veterans Aging Cohort Study, harmful alcohol use (AUDIT-C ≥ 4), current smoking, and depression (PHQ-9 ≥ 8), were measured. In regression analyses, predictors included each outcome condition at baseline, the other two conditions in the same survey, the other two conditions in the immediately preceding survey, number of years since enrollment, and HIV status. We found that current smoking and depression were more common among HIV infected individuals. Harmful alcohol use was more common among uninfected individuals. Temporal analyses suggested a concurrent pattern: each condition was associated with the other two conditions (p < 0.03, OR 1.12-1.66) as well as with the prior presence of the same condition (p < 0.0001; OR 6.38-22.02). Smoking was associated with prior depression after controlling for current depression (OR 1.16; p = 0.003). In conclusion, alcohol misuse, smoking, and depression were temporally concordant and persistent, raising the question of whether they constitute a common syndrome in HIV infected patients and others with chronic diseases.
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Affiliation(s)
- R Scott Braithwaite
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Floor 6 Room 615, New York, NY, 10016, USA.
| | - Yixin Fang
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Floor 6 Room 615, New York, NY, 10016, USA
| | - Janet Tate
- Yale University School of Medicine, New Haven, CT, USA
| | - Sherry M Mentor
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Floor 6 Room 615, New York, NY, 10016, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | | | - Amy C Justice
- Yale University School of Medicine, New Haven, CT, USA
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30
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Roche DJO, Ray LA, Yardley MM, King AC. Current insights into the mechanisms and development of treatments for heavy drinking cigarette smokers. CURRENT ADDICTION REPORTS 2016; 3:125-137. [PMID: 27162709 PMCID: PMC4859339 DOI: 10.1007/s40429-016-0081-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
There is a strong association between cigarette smoking and alcohol use at the epidemiological, behavioral, and molecular levels, and this co-use creates substantial impediments to smoking cessation among smokers who are also heavy drinkers. Compared with individuals who only smoke, those who both drink and smoke heavily experience more severe health consequences and have greater difficulty in quitting smoking. During smoking abstinence, greater alcohol use is associated with decreased odds of smoking cessation, and smokers are substantially more likely to experience a smoking lapse during drinking episodes. As heavy drinking smokers are less responsive to the currently available pharmacological treatments, this subgroup of high-risk substance users possesses a unique clinical profile and treatment needs. Thus, treatment development for heavy drinking smokers represents a significant and understudied research area within the field of smoking cessation. This review will briefly describe findings from epidemiological, behavioral, and molecular studies illustrating alcohol and tobacco co-use and identify how the behavioral and neurobiological mechanisms underlying the interaction of alcohol and nicotine may inform the development of targeted treatments for this unique population of smokers.
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Affiliation(s)
- Daniel J O Roche
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA, 90095, USA
| | - Lara A Ray
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA, 90095, USA; University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, 90095, USA
| | - Megan M Yardley
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA, 90095, USA
| | - Andrea C King
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL 60637, USA
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31
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Roche DJO, Bujarski S, Hartwell E, Green R, Ray LA. Combined varenicline and naltrexone treatment reduces smoking topography intensity in heavy-drinking smokers. Pharmacol Biochem Behav 2015; 134:92-8. [PMID: 25933795 DOI: 10.1016/j.pbb.2015.04.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 03/24/2015] [Accepted: 04/22/2015] [Indexed: 11/15/2022]
Abstract
Heavy drinking smokers constitute a distinct sub-population of smokers for whom traditional smoking cessation therapies may not be effective. Recent evidence suggested that combined varenicline (VAR) and naltrexone (NTX) therapy may be more efficacious than either monotherapy alone in reducing smoking and drinking-related behavior in this population. The manner in which individuals smoke a cigarette (i.e., smoking topography) may be predictive of smoking cessation outcomes, yet the effects of smoking pharmacotherapies on puffing behavior have not been thoroughly examined. Therefore, the current double-blind medication study examined the effects of VAR alone (1mg BID), low dose NTX alone (25mg QD), the combination of VAR+NTX, and placebo on smoking topography measures in heavy drinking, non-treatment seeking daily smokers (n=120). After a 9-day titration period, participants completed a laboratory session in which they smoked their first cigarette of the day using a smoking topography device following 12h of nicotine abstinence and consumption of an alcoholic beverage (BrAC=0.06g/dl). The primary measures were puff count, volume, duration, and velocity and inter-puff interval (IPI). Independent of medication group, puff velocity and IPI increased, while puff volume and duration decreased, over the course of the cigarette. The active medication groups, vs. the placebo group, had significantly blunted puff duration and velocity slopes over the course of the cigarette, and this effect was particularly evident in the VAR+NTX group. Additionally, the VAR+NTX group demonstrated lower average IPI than the monotherapy groups and lower average puff volume than all other groups. These results suggest that smoking pharmacotherapies, particularly the combination of VAR+NTX, alter smoking topography in heavy drinking smokers, producing a pattern of less intense puffing behavior. As smoking topography has been predictive of the ability to quit smoking, future studies should examine how smoking pharmacotherapies' effects on puffing behavior relate to smoking cessation outcomes.
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Affiliation(s)
- Daniel J O Roche
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095, United States
| | - Spencer Bujarski
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095, United States
| | - Emily Hartwell
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095, United States
| | - ReJoyce Green
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095, United States
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095, United States; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA 90095, United States.
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