Studies on clinical characteristics of nicotine dependence using a two compartment model of drug dependence]

The purpose of the present study was to develop a new clinical evaluation form to compare the clinical characteristics of nicotine dependence with those associated with other drugs of abuse, using a two-compartment model consisting of "drug dependence" and "dependence syndrome". The evaluation form consisted of five scoring items: subjective effects, drug liking, withdrawal syndrome, acute psychic and acute physical disorders, and social disturbance. "Drug dependence" was defined by positive scores on the "drug liking" item. "Dependence syndrome" was defined by positive scores on drug-induced pathological symptoms (withdrawal syndrome, and acute psychic and physical disorders) and social disturbance. The subjects were dependent on nicotine (cigarette smoking) (n = 114), alcohol (n = 101), methamphetamine (n = 90), inhalants (n = 63), and benzodiazepines (n = 39). All subjects met the DSM-IV-TR criteria for drug dependence. Nicotine produced a mild or the least degree of drug liking and withdrawal syndrome, without any significant social disturbance, or acute disorders. The other four drugs produced more intensive degrees of withdrawal syndrome and acute psychic and physical symptoms, with more significant social disturbance than nicotine. The present study indicated that nicotine dependence differed from other forms of drug dependence in that nicotine was not associated with "dependence syndrome".     

Clinical features of nicotine dependence]

Nicotine dependence is characterized by weak dependence potential and less ability to produce psychotoxicity and social disturbance. A two-compartment model consisting of "dependence" and "dependence syndrome" was used to clarify clinical features of nicotine dependence. "Dependence" was defined by drug liking. "Dependence syndrome" was defined by a compulsion to take a drug, and drug-induced pathological symptoms (withdrawal syndrome and acute disorders) and social disturbance. Nicotine produced a mild or the least degree of drug liking and withdrawal syndrome, without any significant social disturbance, or acute disorders. Thus, nicotine dependence differed from other forms of drug dependence in that nicotine was not associated with "dependence syndrome". This review also introduced other current topics of nicotine dependence. First, adolescence is regarded as a risk factor for the development of nicotine dependence, whereas the involvement of gender difference (female) in this respect is controversial. Secondly, many smokers feel difficulties in quitting smoking in spite of the weak dependence potential of nicotine, which is known as the "nicotine paradox". Several working hypotheses have been presented to explain this phenomenon. For example, nicotine has relatively strong conditioning effects and/or dependence liability compared with other drugs of abuse. However, further studies should be carried out to clarify clinical characteristics of the "nicotine paradox".     

丁丙诺啡药物依赖性评价

目的:调查评价阿片滥用人群中丁丙诺啡(buprenorphine,Bup)的药物依赖性及滥用潜力。方法:采用询问调查方法,对戒毒机构收治的阿片依赖者进行Bup使用情况、药物依赖性及滥用潜力的调查。被调查对象为使用Bup 3天以上,无精神障碍的阿片依赖者;调查内容包括药物滥用史,Bup一般使用情况和药物依赖性评价等。Bup的身体依赖性采用30项阿片戒断症状量表(OWS)评价。根据被调查对象先前出现过的Bup戒断症状经历(及严重程度)将各项症状/体征分为0-3分进行评价。对Bup的主观欣快效应采用视觉类比量表(VAS)评价。结果:共对1235例符合条件者进行了调查。被调查者初次使用Bup目的(多选择回答)以“戒毒目的使用”(占77.4％)和“治疗稽延性戒断症状”(占26.6％)为主。30项阿片戒断症状量表(OWS)平均分值介于0.2至1.3之间,除失眠、骨关节疼痛和烦躁不安平均分值分别为1.3、1.2和1.0外,其余症状均为1分以下,表明身体依赖性低。Bup“连续使用”,“间断使用”和“有时连续,有时间断使用”三种不同使用时间方式的OWS均分分别为0.9±0.9,0.4±0.5和0.7±0.4;ANOVA方差检验F值=70.846,P<0.05,差异具有极显著性。VAS测查结果表明,VAS均值为(27±24)mm,属“轻度”至“次中等”欣快程度;对Bup含服、注射两种不同使用途径的群体进     

Levels of opioid physical dependence in heroin addicts

The levels of opioid physical dependence in a group of long-term heroin addicts were ascertained by measuring the severity of the opioid withdrawal syndrome before and after pharmacological challenge with either 0.4 mg naloxone or placebo. Prior to challenge, patients manifested some subjective symptoms but few objective signs of opioid withdrawal. Patients who received placebo (n = 18) showed a significant increase in the mean score on one of three rating scales used to assess opioid withdrawal. Patients who received naloxone (n = 58) showed significant increases in mean scores on all three rating scales, but this was due primarily to increases observed in a minority of patients. Sixty-one percent of patients failed to manifest clinically significant changes in subjective symptoms, and 74% of patients failed to manifest clinically significant changes in objective signs of opioid withdrawal following naloxone administration. The results suggest that a substantial subgroup of heroin addicts are able to use opioids regularly while maintaining relatively low levels of physical dependence.     

食欲素在酒精依赖及复发中的研究进展

酒精依赖是长期过度饮酒导致中枢神经系统紊乱的一种慢性、复发性脑疾病,该疾病已给全球造成了巨大的社会和经济负担.但目前为止,酒精依赖形成的机制仍不明确,且缺乏相对有效的治疗手段,戒酒后的高复发率严重影响着酒依赖患者的身心健康.近年来研究发现,由下丘脑产生的食欲素除了参与调节机体的食物摄入、睡眠-觉醒和能量平衡外,在物质成...     

Methamphetamine and alcohol abuse and dependence symptoms: associations with affect lability and impulsivity in a rural treatment population

The present study examined associations between impulsivity and affect lability and methamphetamine and alcohol abuse and dependence symptoms in a rural inpatient treatment population (N=235). Thirty-two percent of participants reported methamphetamine use in the past 90 days prior to admission. Amphetamine use disorders were found to be more common among younger participants whereas alcohol use disorders were more common among older and Native American participants. After controlling for age, gender, use frequency, and injection use, impulsivity but not affect lability was associated with methamphetamine abuse but not dependence symptoms. Lability but not impulsivity was associated with alcohol dependence but not abuse symptoms after controlling for age, gender, and use frequency. Consistent with past epidemiological studies, results indicate that methamphetamine use is a prominent problem facing rural substance use treatment facilities. Affect lability and impulsivity are associated with methamphetamine and alcohol-related problems in this population.     

Symptoms of alcohol dependence and smoking initiation and persistence: A longitudinal study among US adults

Background

A large number of adults report symptoms of, but do not meet diagnostic criteria for, an alcohol use disorder. Yet, little is known about the relationship between symptoms of alcohol use disorders and the initiation and persistence of smoking. This study prospectively examines the relationship between having 1–2 symptoms of alcohol dependence (without abuse) and smoking initiation and persistence as well as nicotine dependence over a 3-year period among adults in the United States.

Methods

Data were drawn from Wave 1 (2001–2002) and Wave 2 (2004–2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Relationships between Wave 1 symptoms of alcohol dependence, alcohol abuse, and alcohol dependence and initiation and persistence of cigarette smoking and nicotine dependence at Wave 2 were examined using logistic regression analyses. Analyses were adjusted for demographics, mood and anxiety disorders.

Results

Symptoms of alcohol dependence were associated with smoking initiation at Wave 2. There was no association between symptoms of alcohol dependence and smoking persistence. Symptoms of alcohol dependence predicted incident and persistent nicotine dependence. Findings persisted after adjusting for demographic characteristics and mood/anxiety disorders.

Conclusions

Even 1–2 symptoms of alcohol dependence are associated with increased vulnerability to smoking initiation and onset and persistence of nicotine dependence at a similar strength as alcohol use disorders. Efforts at smoking cessation must address problematic alcohol use, even at the subclinical level, in order to improve efficacy.     

麻果所致精神障碍的临床特征

目的:了解麻果所致精神障碍者的精神症状特点。方法:填写自制的麻果所致精神障碍者一般情况问卷,并对29例麻果所致精神障碍者和29名正常人的《症状自评量表》(SCL-90)测试结果进行对照分析。结果:麻果所致精神障碍者的特点:(1)其躯体化、人际关系、抑郁、焦虑、精神病性等因子分及总分均明显高于正常人(P<0.05,P<0.01);(2)其强迫、敌对、恐怖、偏执等因子分虽高但无差异(P>0.05)。结论:麻果所致精神障碍者的精神症状具有以情感症状和精神病性症状为主、伴有躯体依赖的特点。建议对其采用抗抑郁为主、抗精神病为辅的治疗方案。     

Construct validity for alcohol dependence as indicated by the SUDDS-IV

OBJECTIVE: This study considers the diagnostic construct validity of the DSM-IV (Diagnostic and Statistical Manual-lV) for "alcohol dependence". Previous reports have indicated that "dependence" constitutes a more distinct and pronounced syndrome than "alcohol abuse". METHOD: Data were collected in 2000-2001 on 1340 male and female inmates evaluated for "substance use disorders" using the SUDDS-IV, a detailed structured diagnostic interview, to collect data on all of the DSM-IV diagnostic criteria for "abuse" and "dependence". RESULTS: Dependent individuals tended to produce distinct and extensive symptom profiles that distinguished them from individuals without a diagnosis or those meeting abuse criteria. CONCLUSIONS: Alcohol dependence as defined by the DSM-IV appears to be quite distinct from abuse and can be identified unequivocally for the majority of dependent cases.     

The impact of sociodemographics, comorbidity and symptom recency on health-related quality of life in alcoholics.

OBJECTIVE: To obtain estimates of the relationship between alcoholism and health-related quality of life (HRQL) in twin pairs discordant for alcohol dependence. METHOD: In 1995, 1,258 male-male twin pair members of the Vietnam Era Twin Registry (total Registry N = 7.375 pairs) were administered a modified Medical Outcomes Study 36 Item Short Form (SF-36) and the Diagnostic Interview Schedule (DIS) to obtain measures of HRQL and a DSM-III-R criteria lifetime diagnosis of alcohol dependence. Mean within pair differences on eight separate SF-36 subscales were calculated for 436 remitted (no alcohol symptoms in the past 5 years) alcohol-dependent discordant twin pairs and for 194 recent (at least one alcohol symptom in the past 5 years) alcohol-dependent discordant pairs before and after adjustment for covariates. Covariates included lifetime physical illness, lifetime psychiatric disorders, lifetime drug dependence, lifetime nicotine dependence, current marital status, current income and severity. RESULTS: In the unadjusted analysis remitted alcoholic twins compared to their nonalcoholic co-twins reported significantly lower mean scores for six of eight SF-36 subscales. Recent alcoholic twins, compared to their nonalcoholic co-twins, reported significantly lower mean scores for all of the SF-36 subscales. However, after simultaneous adjustment for all covariates, no SF-36 subscale mean, except "vitality" among recent alcoholic twins, was significantly different between alcoholic twins and their nonalcoholic co-twins. CONCLUSIONS: Differences in HRQL between alcoholic and nonalcoholic co-twins is due to covariation from physical and psychiatric problems, drug and nicotine dependence, marital status, income and severity.     

Smoking, nicotine dependence and psychiatric comorbidity--a population-based study including smoking cessation after three years

BACKGROUND: Evidence suggests that nicotine-dependent smokers are at increased risk for psychiatric comorbidity but general population data that included the number of nicotine dependence and withdrawal symptoms according to DSM-IV, the Fagerstrom Test for Nicotine Dependence (FTND), somatoform disorders and the number of psychiatric diagnoses are rare. The goal of the present study was to analyse relationships of smoking and nicotine dependence with psychiatric disease and whether psychiatric disease predicts the sustaining of smoking after three years. METHODS: Cohort study with a random adult population sample in a northern German region (N = 4075) including a baseline measurement of ever daily smokers aged 18-64 (n = 2458), a first follow-up of the current smokers at baseline (n = 1552) after 30 months and a second follow-up after 36 months. Measures included DSM-IV diagnoses by the Composite International Diagnostic Interview, FTND, smoking cessation by interview. RESULTS: Current daily smokers showed higher odds of a substance use disorder other than nicotine dependence compared with never smokers (odds ratio, OR, 4.6; confidence interval, CI, 2.9-7.2), affective (OR 1.8; CI 1.4-2.5), anxiety (OR 1.6; CI 1.2-2.0) or somatoform disorder (OR 1.4; CI 1.0-1.8). DSM-IV nicotine dependence and the FTND were positively related with the number of psychiatric diagnoses. Psychiatric comorbidity did not predict the maintenance of smoking or quitting. CONCLUSIONS: Findings of increased rates of mental disorders among smokers and nicotine-dependent smokers in the adult general population are supported by this study. The number of nicotine dependence and withdrawal symptoms are related to mental disorders. In addition, somatoform disorders show relationships with smoking similar to relationships with depressive or anxiety disorders. The intention to stop smoking should be proactively supported among these comorbid patients.     

The quantitative assessment of physical dependence on opiates

A procedure for administering naloxone to narcotic-dependent individuals and a technique for quantitating the ensuing acute withdrawal syndrome have been developed to assess the degree of physical dependence. Successive injections of increasing doses of naloxone produce a controlled increase in severity of withdrawal signs and symptoms as measured by a subjective and an objective assessment battery. There is good agreement between the subjective and objective assessments and a global rating of withdrawal severity. The objective measures are, however, most sensitive and produce a withdrawal syndrome score related to the duration of the current cycle of drug abuse. Hand tremor, trapezius electromyogram and heart rate are the most sensitive signs of withdrawal and can be used in combination to form the basis of a simplified and shortened antagonist assessment test for physical dependence.     

Nicotine dependence and withdrawal in alcoholic and nonalcoholic ever-smokers

We compared nicotine dependence and withdrawal in male alcoholic and control ever-smokers, controlling for relevant demographic and clinical variables. Alcoholics were more likely to meet criteria for moderate or severe nicotine dependence and endorse more nicotine dependence symptoms. Symptoms reported more frequently by alcoholics included: (a) using nicotine in larger amounts or over a longer time than intended; (b) continued use despite problems caused or exacerbated by nicotine; (c) marked tolerance; and (d) experiencing characteristic nicotine withdrawal symptoms. Alcoholics also smoked more heavily. Other than “headaches,” and “decreased heart rate,” alcoholics consistently endorsed nicotine withdrawal symptoms at a higher rate. After controlling for demographic and clinical variables and level of nicotine dependence, only “feel depressed” differed significantly between groups. Our research supports previous findings suggesting that nicotine dependence is more severe in those with a history of alcohol dependence. As a result, alcoholics may experience greater discomfort from nicotine withdrawal upon smoking cessation.     

Opioid physical dependence development: effects of single versus repeated morphine pretreatments and of subjects' opioid exposure history

In acute dependence, signs and symptoms of opioid withdrawal are precipitated when an opioid antagonist (naloxone) is administered following acute (e.g. single dose) pretreatment with amu agonist. This study examined the influence of amount of previous opioid exposure, both immediate and remote, on intensity of precipitated withdrawal effects in an acute dependence model. Two groups of subjects, opioid abusers (n=20) and nonabusers (n=20), received either one 15 mg/70 kg IM morphine pretreatment or two such pretreatments spaced 24 h apart. Naloxone challenge (30 mg/70 kg) followed 4.33 h after the second pretreatment. There were clear effects of morphine pretreatment condition (single versus repeated 15 mg) on the intensity of precipitated withdrawal responses elicited by naloxone. More intense effects were seen after the repeated pretreatment, suggesting that physical dependence escalates with repeated opioid exposures spaced at appropriate intervals. Subjects with an opioid abuse history reported greater liking of agonist drug effects than did nonabusers, whereas nonabusers reported more sedating effects. However, an opioid abuse history did not influence the intensity of precipitated withdrawal symptoms and signs. The latter finding suggests that a previous opioid exposure history does not dramatically modulate initial stages of physical dependence development during subsequent opioid exposure episodes.This research was supported by USPHS Grant DA04011 and Research Training Grant T32 DA07209 from the National Institute on Drug Abuse     

甲基苯丙胺依赖者在戒断28周内心理状况调查分析简

目的獉獉：探究甲基苯丙胺依赖者在戒断毒品的28周内心理状况的变化,以便更细致地了解甲基苯丙胺依赖者的戒断症状。方法獉獉：选取符合入组标准的甲基苯丙胺依赖者组成甲基苯丙胺依赖组（n=96）,以末次吸食为基准点,分别在第2周、第8周、第16周和第28周应用症状自评量表（SCL-90）、汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HAMA）对其进行心理状况测试;同时,选取无药物滥用史的健康人群作为正常对照组（n=192）,进行上述3个经典量表的测试。结果獉獉：在强制隔离戒毒期间,3个量表均提示,甲基苯丙胺依赖组分值在第2周最高,此后第8、16、28周分值均有下降趋势,其中第28周分值最低。但在汉密尔顿焦虑量表中,焦虑总分在第16周有小幅升高,且与第8周比较有统计学意义（P〈0.05）。针对3个量表进行相关性分析,3者均呈正相关。结论獉獉：甲基苯丙胺依赖者戒断28周内存在严重的心理和情感问题,在戒断后第2周稽延性戒断症候群最为严重,其中焦虑、抑郁症候群最为显著。在第16周精神状况有小幅波动,此后各心理量表分值均呈现下降趋势。     

The Fagerstrom Test for Nicotine Dependence and the Diagnostic Interview Schedule: do they diagnose the same smokers?

Two common assessment tools for nicotine dependence are the Fagerstrom Test for Nicotine Dependence (FTND) and the Nicotine Dependence section of the Diagnostic Interview Schedule [(DIS)-III-R or -IV based on the Diagnostic and Statistical Manual (DSM)-III-R and -IV, respectively]. The FTND emphasizes morning smoking and overall "heaviness" of smoking. The DSM emphasizes adverse consequences, desire to cut down, and mood changes during withdrawal. We tested (1) how the DSM-III-R diagnosis of Nicotine Dependence is related to FTND score; and (2) how the (a) DSM-III-R or (b) elevated FTND score is related to longer smoking histories, greater psychiatric symptomatology, and tobacco liking scores. Retrospective chart reviews were conducted on 370 smokers, the majority (55.9%) of whom had a current DSM-III-R diagnosis of Substance Dependence other than nicotine. All subjects had completed the FTND, the DIS-III-R, the Symptom Checklist-90-Revised (SCL-90-R), and a survey on drug liking. Agreement statistics were calculated between the DSM-II-R diagnosis of Nicotine Dependence and various cutoff scores values that were assigned as thresholds for nicotine dependence on the FTND. At no cutoff score did the two instruments reliably agree; the highest kappa (at a cutoff of FTND > or = 7) was 0.205. At cutoffs above 5, the FTND diagnosed fewer cases than the DSM-III-R. Multiple regression analysis showed that DSM diagnosis was associated with greater psychiatric symptomatology on the SCL-90-R, while FTND scores were associated with greater tobacco liking. The FTND and the DSM-III-R appear to measure different aspects of the tobacco dependence process. Specifically, the FTND may provide a stronger measure of physical dependence, while the DSM may tap other domains such as awareness of dependence, behaviors resulting from that awareness, and psychiatric symptomatology. Disagreements between the FTND and the DSM are likely to become greater with the changes in the DSM-IV.     

Functional involvement of cerebral diazepam binding inhibitor (DBI) in the establishment of drug dependence

Mechanisms for formation of drug dependence and emergence of withdrawal syndrome are not yet fully understood despite of a huge accumulation of experimental and clinical data. Several clinical features of withdrawal syndrome are considered to be common (i.e., anxiety) among patients with drug dependence induced by different drugs of abuse. In this review, we have discussed the possibility of the functional involvement of diazepam binding inhibitor (DBI), an endogenous neuropeptide for benzodiazepine receptors with endogenously anxiogenic potential, in the development of drug dependence and emergence of its withdrawal symptom. The levels of DBI protein and its mRNA significantly increased in the brain derived from mice dependent on alcohol (ethanol), nicotine and morphine, and abrupt cessation of these drugs facilitated further increase in DBI expression. In the cases of nicotine- and morphine-dependent mice, concomitant administration of antagonists for nicotinic acetylcholine and opioid receptors, respectively, abolished the increase in DBI expression. Therefore, these alterations in DBI expression have a close relationship with formation of drug dependence and/or emergence of withdrawal syndrome and are considered to be a common biochemical process in drug dependence induced by different drugs of abuse.     

度洛西丁对甲基苯丙胺依赖者情绪障碍的疗效观察

目的:探讨度洛西丁对甲基苯丙胺依赖者情绪障碍的治疗效果。方法:对103例甲基苯丙胺依赖戒断者在成功脱瘾后的一周内,测查汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)。将103例患者随机分为对照组(n=51)和药物处理组(n=52),对照组仅给予简单的言语解释和支持,药物处理组给度洛西丁60 mg.d-1治疗。6周后复查HAMA和HAMD量表,评定治疗效果。结果:甲基苯丙胺依赖戒断者均有明显的焦虑、抑郁等情绪障碍。连续给予度洛西丁治疗6周后,HAMA、HAMD评分较对照组明显下降,有显著统计学差异(P<0.01)。结獉论獉:对甲基苯丙胺依赖戒断者脱瘾后早期使用度洛西丁干预,可缓解其情绪障碍,可能有利于防止复吸。     

北京地区三种新型毒品流行滥用特征

目的:了解北京地区发生流行性滥用的主要"新型毒品"的滥用现状、滥用特征和对个体身心及社会的危害。方法:自拟调查问卷对北京市公安局强制戒毒所2007年8月-2008年3月收治的主要吸食"冰毒"(MA)、"摇头丸"(MDMA)、氯胺酮(ketamine)的人员进行调查。结果:共调查"新型毒品"滥用人员268名,其中滥用毒品种类以MA为主139例(51.9%),以MDMA为主62例(23.1%),以氯胺酮为主67例(25.0%);被调查对象的年龄29.2±s6.3 a(最小年龄19 a,最大年龄50 a)。滥用者的职业涉及多种行业,以私营/个体劳动者(37.5%)和无业者(32.2%)为主。三种"新型毒品"滥用方式和滥用场所的特征是:"冰毒"滥用场所以家中(59.7%)为主,主要滥用方式为烫吸(98.6%);"摇头丸"滥用场所主要集中在歌舞厅(66.1%),滥用方式以口服为主(96.8%);氯胺酮滥用场所以歌舞厅为主(55.2%),滥用方式以鼻吸为主(91.0%)。滥用毒品的种类除以上述三种"新型毒品"为主外,该群体中的部分人还有"麻谷"、可卡因、大麻和海洛因滥用行为/经历。该群体95.5%在停止使用后出现不同程度、不同表现的戒断症状/体征,59.0%出现过主动或强迫性寻找和服用"新型毒品"的行为。268例"新型毒品"滥用者滥用"新型毒品"后均出现了涉及重要生命器官和精神系统不同程度的中毒症状/体征,使用"新型毒品"后体重平均减轻12.57 kg±s9.25 kg,有4.5%的滥用者发生急性中毒。有27.3%发生与使用"新型毒品"有关的冲动行为、易激惹及打架、吵架等行为,63.6%发生过使用"新型毒品"有关的性冲动,4.9%发生性暴力行为。结论:北京地区"新型毒品"滥用及其产生的健康和社会后果严重,滥用后可产生中度至次重度躯体依赖和精神依赖,精神依赖性强度强于躯体依赖性。由于其特殊的药理/毒理学作用,滥用后不仅损害了个体健康,也给社会治安带来了严重的隐患。目前北京地区正面临着继海洛因之后多种"新型毒品"流行滥用的威胁。     

Effect of three smoking cessation treatments on nicotine withdrawal in 141 abstinent alcoholic smokers

This prospective study examined the effect of three behavioral smoking interventions and reductions in cigarettes smoked per day on nicotine withdrawal symptoms in 141 abstinent alcoholic smokers (73 men, 68 women). The participants' mean +/- SD age was 41.4 +/- 9.2 years. They smoked an average of 27.7 +/- 12.1 cigarettes per day and reported 4.1 +/- 4.3 years of current abstinent from alcohol and other drugs of dependence. Participants were randomly assigned to a 12-week program of standard treatment (ST, n = 61), behavioral counseling plus exercise (BEX, n = 39), or behavioral counseling plus nicotine gum (BNIC, n = 41). All three conditions included instructions to reduce the number of cigarettes smoked per day prior to the target quit date (TQD). The TQD was week 4 for ST subjects and week 8 for those in the BEX and BNIC groups. The post-treatment assessment occurred one week after TQD. The Profile of Mood States (POMS) and the Beck Depression Inventory were administered at baseline and posttreatment to assess nicotine withdrawal. Significant increases were detected for the POMS total mood disturbance score, and the depression, tension, anger and confusion subscales, while vigor scores decreased (all p < 0.03). Withdrawal change scores were not found to be associated with treatment condition or percentage reduction in cigarettes, and there was no evidence of a significant interaction of treatment and cigarette reduction. Results are discussed in relation to implications for treatment and for future research.