Effect of impulsivity on cardiovascular and subjective reactivity to smoking cues

Individuals with high levels of impulsivity are more likely to smoke and may have greater difficulty quitting than other smokers. Although the specific mechanisms mediating this relationship are not explicitly known, one candidate is disproportionate cigarette craving in response to environmental smoking cues. We assessed the effect of impulsivity on three measures of cue reactivity. Regular smokers (n=75) were exposed to a smoking cue and a neutral cue in 2 counterbalanced experimental sessions. Cigarette craving, heart rate (HR), and mean arterial pressure (MAP) were used to index cue reactivity. More impulsive smokers exhibited a disproportionate response to the smoking cue in terms of MAP (p=.009) but not HR or craving. Impulsive smokers may experience disproportionate cigarette craving in response to environmental smoking cues that are not reflected in self-report measures due to a relative lack of conscious awareness of the urge to smoke.     

Olanzapine reduces urge to smoke and nicotine withdrawal symptoms in community smokers

Olanzapine (OLAN), an atypical antipsychotic medication with mixed 5-HT2/DA antagonist properties, was predicted to dose-dependently decrease urge to smoke, withdrawal, and cigarette reinforcement in smokers without psychosis. A double-blind placebo-controlled within-subjects cross-over trial investigated the acute effects of OLAN (0, 2.5, and 5.0 mg; counterbalanced order) in 24 community smokers who underwent 10-hr smoking deprivation. Urge to smoke, tobacco withdrawal, and cigarette reinforcement were assessed with cue reactivity and behavioral choice procedures. OLAN (2.5 mg) reduced withdrawal symptoms before and during cue exposure and decreased urge associated with anticipated positive affect from smoking before and during cue exposure; 5.0 mg OLAN decreased withdrawal only when cues were included. OLAN did not affect preference for cigarette puffs versus money, smoke intake, or urge to smoke associated with negative affect relief. The results indicate a potentially beneficial effect of 2.5 mg OLAN on tobacco withdrawal and urge to smoke. Combined 5HT/DA antagonists should be considered for future development of pharmacotherapies for smoking cessation.     

High-dose transdermal nicotine and naltrexone: effects on nicotine withdrawal, urges, smoking, and effects of smoking

Although treatment with transdermal nicotine replacement (TNR) has improved smoking abstinence rates, higher doses of TNR could improve effects on urge to smoke, nicotine withdrawal, and reinforcement from smoking, and naltrexone might further reduce reinforcement and urges. A laboratory investigation with 134 smokers using a 3 x 2 parallel-group design evaluated the effects of TNR (42-mg, 21-mg, or 0-mg patch) as crossed with a single dose of naltrexone (50 mg) versus placebo on urge to smoke, withdrawal, and responses to an opportunity to smoke (intake, subjective effects) after 10 hr of deprivation. Urge and withdrawal were assessed both prior to and after cigarette cue exposure. Only 42 mg TNR, not 21 mg, prevented urge to smoke, heart rate change, and cue-elicited increase in withdrawal. Both 21 and 42 mg TNR blocked cue-elicited drop in heart rate and arterial pressure. Naltrexone reduced cue-elicited withdrawal symptoms but not urges to smoke or deprivation-induced withdrawal prior to cue exposure. Neither medication significantly affected carbon monoxide intake or subjective effects of smoking except that 42 mg TNR resulted in lower subjective physiological activation. No interaction effects were found, and no results differed by gender. Results suggest that starting smokers with 42 mg TNR may increase comfort during initial abstinence, but limited support is seen for naltrexone during smoking abstinence.     

Reactivity to alcohol cues: isolating the role of perceived availability

Perceived availability of a substance has been proposed to play a role in cue reactivity by both traditional classical conditioning models and S. T. Tiffany's (1990) cognitive processing model (CPM) of substance use. This study investigated the role of availability information on alcohol cue reactivity. Subjects were 134 heavy drinkers in a 2 x 2 between-subjects design, crossing cues (alcohol vs. neutral) and availability information (availability vs. unavailability). The results indicated significant main effects for cue type, with alcohol cues eliciting greater reactivity on multiple measures, and an interaction effect on the Alcohol Urge Questionnaire (M. J. Bohn, D. D. Krahn, & B. B. Staehler, 1995), such that exposure to alcohol cues in conjunction with unavailability information elicited a greater urge. This was largely a result of changes in self-reported craving and was interpreted as consistent with the CPM. Alternative methodologies and limitations are discussed.     

Smoking cue reactivity across massed extinction trials: negative affect and gender effects

Designing and implementing cue exposure procedures to treat nicotine dependence remains a challenge. This study tested the hypothesis that gender and negative affect (NA) influence changes in smoking urge over time using data from a pilot project testing the feasibility of massed extinction procedures. Forty-three smokers and ex-smokers completed the behavioral laboratory procedures. All participants were over 17 years old, smoked at least 10 cigarettes daily over the last year (or the year prior to quitting) and had expired CO below 10 ppm at the beginning of the ~4-hour session. After informed consent, participants completed 45 min of baseline assessments, and then completed a series of 12 identical, 5-minute exposure trials with inter-trial breaks. Smoking cues included visual, tactile, and olfactory cues with a lit cigarette, in addition to smoking-related motor behaviors without smoking. After each trial, participants reported urge and negative affect (NA). Logistic growth curve models supported the hypothesis that across trials, participants would demonstrate an initial linear increase followed by a decrease in smoking urge (quadratic effect). Data supported hypothesized gender, NA, and gender×NA effects. Significant linear increases in urge were observed among high and low NA males, but not among females in either NA subgroup. A differential quadratic effect showed a significant decrease in urge for the low NA subgroup, but a non-significant decrease in urge in the high NA group. This is the first study to demonstrate gender differences and the effects of NA on the extinction process using a smoking cue exposure paradigm. Results could guide future cue reactivity research and exposure interventions for nicotine dependence.     

Gender differences in acute tobacco withdrawal: effects on subjective, cognitive, and physiological measures

Gender differences in tobacco withdrawal are of considerable clinical importance, but research findings on this topic have been mixed. Methodological variation in samples sizes, experimental design, and measures across studies may explain the inconsistent results. The current study examined whether male (n = 101) and female (n = 102) smokers (> or =15 cigarettes/day) differed in abstinence-induced changes on a battery of self-report measures (withdrawal, affect, craving), cognitive performance tasks (attention, psychomotor performance), and physiological responses (heart rate, blood pressure, brain electroencephalogram). Participants attended 2 counterbalanced laboratory sessions, 1 following 12 hr of abstinence and the other following ad libitum smoking. Results showed that women reported greater abstinence-induced increases in negative affect, withdrawal-related distress, and urge to smoke to relieve withdrawal distress. In contrast, both genders reported similar abstinence-induced changes in positive affect and urge to smoke for pleasure. Men and women exhibited generally similar abstinence-induced changes in physiological and cognitive performance measures. In addition, gender did not moderate the association between withdrawal symptoms and baseline measures of smoking behavior and dependence. Abstinence-induced changes in withdrawal distress mediated the effect of gender on latency until the 1st cigarette of the day at trend levels ( p < .10). These findings suggest that there are qualitative gender differences in the acute tobacco withdrawal syndrome that may underlie gender-specific smoking patterns.     

Short-term clinical exposure evaluation of a third-generation electrically heated cigarette smoking system (EHCSS) in adult smokers

This randomized, controlled, forced-switching, open-label, parallel-group, single-center study in 100 male and female adult smokers evaluated 12 biomarkers of tobacco smoke exposure. We measured exposure to the following smoke constituents: nicotine, pyrene, tobacco-specific nitrosamines, three aromatic amines, carbon monoxide, benzene, acrolein, crotonaldehyde, and 1,3-butadiene. After baseline exposure determination, adult smokers of a conventional cigarette (CC) were switched to an electrically heated cigarette smoking system (EHCSS, Series K), continued smoking the CC, or stopped smoking (No-smoking) for 8 days in a controlled, confined, clinical setting. In the EHCSS group, the mean decrease from Baseline to Day 8 in the biomarkers of exposure ranged from 16% to 77% at Day 8 compared to Baseline. After adjusting for the residual effect (carryover effects due to long elimination half-life and non-tobacco confounding sources of exposure), the mean percent decrease from Baseline for all 12 biomarkers ranged from 47% to 90%. In conclusion, switching for 8 days from a conventional cigarette to the EHCSS substantially reduced exposure of adult smokers to several constituents of both the particulate and gas phases of cigarette smoke.     

Smoking environment cues reduce ability to resist smoking as measured by a delay to smoking task

Introduction: Environments associated with smoking may promote lapse and relapse in smokers attempting to quit. Here we examined the effects of exposure to visual smoking environment cues on smoking urge and the ability to resist smoking, as measured with a delay-to-smoking task in which monetary contingencies are provided for resisting smoking. Methods: Adult daily smokers (n = 22) completed two experimental sessions, each following 6 h smoking abstinence. Sessions differed only in the type of cue participants were exposed to (smoking environments vs. nonsmoking environments). Participants completed subjective ratings of smoking urge, withdrawal and other reactions (i.e. craving, affect). Behavioral outcomes on the delay-to-smoking task included latency to first cigarette, number of cigarettes smoked and average number of puffs per cigarette. Results: Across cue exposure sessions, 64% of participants initiated smoking (no effect of condition was observed). However, exposure to smoking environments as compared to the nonsmoking environments resulted in greater craving, faster initiation of smoking, and more smoked cigarettes. Greater craving was associated with a shorter time to initiate smoking, but this effect did not differ across sessions. In contrast, withdrawal was more strongly associated with number of cigarettes smoked during smoking environment sessions. Conclusion: Together, these results suggest smoking environments increase smoking urge and promote smoking behavior. Further research is necessary to examine the specific and interactive effects of smoking-related environments on real-world smoking lapse and relapse.     

Assessment of smoking urge and its concomitants under an environmental smoking cue manipulation

The construct validity of smoking urge was examined through investigation of the effects of an environmental smoking cue manipulation on subjective smoking urge ratings and on the physiological, behavioral and cognitive responses hypothesized to relate to smoking urges. Forty-eight moderate cigarette smokers served as participants. All participants underwent an exposure to smoking cues condition and a nonexposure condition. Order of conditions was counterbalanced across participants. Results indicated that measures of physiological response, cognitions, and behavior vary with urge to smoke. Higher physiological indices and closer association between specific cognitive measures and smoking urges occurred under the cue exposure manipulation. Results were interpreted as preliminary data supporting the construct validity of smoking urge.     

Behavioral Activation System (BAS) sensitivity and reactivity to alcohol cues among hazardous drinkers

Previous research has suggested that Behavioral Activation System (BAS) sensitivity may be associated with stronger appetitive responses to alcohol cues. This study was conducted to explore whether those with higher BAS sensitivity showed greater urge and affective responses to alcohol cues and whether different types of appetitive cues moderated the magnitude of these associations. One hundred eighty-eight hazardous drinkers (90 women) were exposed to the sight and smell of their favorite alcoholic beverage during a cue exposure procedure. Participants were asked to either lean towards the beverage (Cue Only) when signaled by tones, or lift the beverage towards them (Cue+Action). BAS sensitivity was significantly associated with baseline ratings of urge and affect, and was found to be a significant predictor of urge and affect reactivity; however significant interaction effects with cue type were not observed. Results provide further evidence for the influence of individual differences in reward responsiveness on alcohol use and abuse.     

Alcohol exposure therapy: generalisation and changes in responsivity

Fifty male alcohol-dependent individuals presenting for treatment were randomly assigned to either a cue exposure (CE) or control group. The experimental group were presented with 10 exposure trials to the sight and smell of alcohol, whilst the control group were presented with a neutral beverage. Following this, subjects received exposure to alcohol in a different room to examine whether extinguished responses generalised to a different environment. Results showed that only those subjects presented with the alcohol cue showed a significant reduction in cue-elicited swallowing, subjective withdrawal symptoms, arousal and urge to drink alcohol and that these extinguished responses remained diminished in magnitude in a different environment. These results provide additional support for the effectiveness of CE in reducing responsivity to alcohol cues.     

Exposure to negative affect cues and urge to smoke

While much of the cue exposure literature for cigarette smoking has focused on external cues, little has been done in the area of exposing participants to internal cues, such as negative affect (NA), despite the important role of such cues in maintaining smoking behavior. Smokers were exposed to an NA mood induction to induce an urge to smoke and then exposed to NA cues over several trials in an attempt to decrease this urge. Participants (N = 32) were undergraduate smokers assigned to either the exposure or control group for the mood induction procedure, which occurred over 8 trials. All participants viewed NA images and listened to NA music at Trial 1. The exposure group continued to view NA images and listened to NA music, and the control group viewed neutral images and listened to neutral music for 6 subsequent trials lasting about 5 min each. Both groups were exposed to NA images and NA music at Trial 8. NA and urge to smoke ratings were assessed at the end of each trial; heart rate was measured continuously. Results indicated that the mood induction procedure induced NA and urge to smoke, but the extinction procedure did not decrease urge over trials. Heart rate data were not associated with self-report data. In conclusion, the mood induction procedure in the present study appears to be an efficient way to induce urge to smoke. However, further research is necessary to determine why urge to smoke seems to be resistant to extinction.     

Nicotine withdrawal: a behavioral assessment using schedule controlled responding,locomotor activity,and sensorimotor reactivity

Three different behavioral measures were used to assess the effects of abrupt cessation of chronic nicotine treatment. Nicotine (0, 3, or 6 mg/kg per day) was continuously administered for 12 days in rats by surgically implanting Alzet osmotic mini-pumps subcutaneously. Experiment 1 employed a light/dark discrimination task. There were no significant effects on number of responses or percent correct responding either during nicotine administration, or following cessation of nicotine. Experiment 2 examined ambulatory (locomotor) and nonambulatory activity. Chronic nicotine administration produced significant dose-dependent increases in both ambulatory and nonambulatory activity during the first 3 days of exposure. However, no significant alterations were seen in activity levels following nicotine cessation. Experiment 3 examined sensorimotor reactivity using the auditory startle response. During nicotine withdrawal, significant increases were seen in startle amplitude in both nicotine groups for 4 days. Nicotine (0.4 mg/kg, IP) administered before startle testing during the withdrawal phase attenuated the increased reactivity seen during nicotine cessation. These studies indicate that 1) rats display increased sensorimotor reactivity after cessation of chronic nicotine exposure, and 2) the expression of nicotine dependence and withdrawal is dependent on the behavioral task employed.     

Effect of positive and negative affective stimuli and beverage cues on measures of craving in non treatment-seeking alcoholics

RATIONALE: Laboratory paradigms are useful for investigating mechanisms of human alcohol cue reactivity in a highly controlled environment. A number of studies have examined the effects of beverage exposure or negative affective stimuli on cue reactivity independently, but only a few have reported on interaction effects between beverage cue and affective stimuli, and none have evaluated the effects of positive stimuli on beverage cue reactivity. OBJECTIVES: To assess independent and interactive effects of both positive and negative affective stimuli and beverage cue on psychophysiological and subjective measures of reactivity in alcohol dependence. MATERIALS AND METHODS: A total of 47 non-treatment-seeking paid volunteers with current alcohol dependence participated in a within-subjects trial where each was exposed to a standardized set of pleasant, neutral, or unpleasant visual stimuli followed by alcohol or water cues. Psychophysiological cue-reactivity measures were obtained during beverage presentation, and subjective reactivity measures were taken directly following beverage presentation. RESULTS: Mixed-effect models revealed a significant main effect of beverage and positive (but not negative) affective stimuli on subjective strength of craving and significant main effects of both positive and negative affective stimuli on ratings of emotionality. Despite the power to detect relatively small interaction effects, no significant interactions were observed between affect and beverage conditions on any reactivity measure. CONCLUSIONS: A key finding of this study is that positive affective stimuli commonly associated with drinking situations can induce craving in the absence of alcohol cues. Main effects of beverage cue replicated results from previous studies. Beverage and affective cues showed no interaction effects.     

Effects of smoking abstinence on adult smokers with and without attention deficit hyperactivity disorder: results of a preliminary study

Rationale Individuals with attention deficit hyperactivity disorder (ADHD) smoke at higher rates than the general population; however, little is known about the mechanisms underlying this comorbidity. Objective This study evaluated the effects of overnight abstinence on withdrawal symptoms and cognitive performance in adult smokers with and without ADHD. Materials and methods Individuals smoking ≥15 cigarettes per day were recruited from the community and underwent an evaluation to establish a diagnosis of ADHD (n = 12) or not (n = 14). Withdrawal symptoms, mood, craving, cognitive performance, and smoking cue reactivity were measured during two laboratory sessions—in a ‘Satiated’ condition participants smoked up to and during the session while in an ‘Abstinent’ condition, participants were required to be smoking abstinent overnight and remain abstinent during the session. Results The effects of abstinence on ADHD and non-ADHD smokers did not differ for withdrawal symptom severity, mood, craving or cue reactivity. Significant Group × Condition interactions were observed for measures of attention and response inhibition on the Conners’ CPT. For reaction time (RT) variability and errors of commission, the ADHD group exhibited greater decrements in performance after overnight abstinence compared to the non-ADHD group. The effects of abstinence on other cognitive measures (e.g., rapid visual information processing task, cued Go/No-Go task) did not differ between the two groups. Conclusion This preliminary study is the first to systematically evaluate the effects of acute smoking abstinence in adult smokers diagnosed with ADHD. Individuals with the disorder may smoke at higher rates due to greater worsening of attention and response inhibition after abstinence.     

Evaluating reactivity to ecological momentary assessment during smoking cessation

Ecological momentary assessment (EMA) consists of assessing phenomena in real time in the natural environment. EMA allows for more fine-grained analyses of addictive behavior and minimizes threats to internal validity, such as recall biases and errors. However, because of the intensive monitoring involved in EMA, measurement reactivity is a concern. To test whether EMA with palmtop personal computers induces reactivity, the authors compared smoking-related outcomes between smokers using EMA and those not using EMA during a quit attempt. The use of no-EMA control groups has been rare in reactivity investigations to date. The EMA protocol included event-contingent assessments (smoking episodes, urge episodes) and random assessments. Outcomes included biologically confirmed abstinence and self-report measures of withdrawal, self-efficacy, motivation, affect, and temptations. Participants were smokers motivated to quit (N = 96). They were randomized to 1 of 3 groups: EMA for the week preceding a planned quit date, EMA for the week following the quit date, and no EMA. Abstinence rates did not differ between the groups at Day 7 or at Day 28 postcessation. For the 20 subscales assessed at each of 3 assessment times, there were significant differences between participants with and without EMA experience for 3 subscales at the 1st of 3 assessment times, and significant differences for 3 different subscales at the 3rd assessment time. These differences suggest some reactivity to EMA, although the inconsistent pattern across time indicates that further research is needed to definitively conclude that EMA induces reactivity.     

Alcohol cue reactivity and private self-consciousness among male alcoholics.

Recent alcohol cue exposure studies have noted that not all alcoholics demonstrate increased reactivity when presented with alcohol-related cues. This study examined the relationship of private self-consciousness (PSC) to subjective, self-report measures of reactivity and measures of negative mood states that involve a focus on internal processes. These subjective measures of reactivity were contrasted with salivary reactivity, an objective measure of reactivity which does not require individual self-report or awareness. A cue reactivity assessment was administered to 47 men meeting DSM-III-R criteria for a diagnosis of alcohol dependence. Our hypothesis, that PSC would predict urge reactivity status and greater levels of negative mood states, was supported. Urge reactors were more likely to be high in PSC, while the proportions of salivary reactors and nonreactors were not significantly different between the high and low PSC groups. Although regression analyses indicated that PSC did not significantly predict urge to drink alcohol, it did predict angry/frustrated mood and sad/depressed mood at the first alcohol trial. These results suggest that individuals high in PSC may benefit more from cue exposure-based treatment, as they are more likely to be urge reactors and to evidence negative mood reactivity. Low PSC individuals may be at higher risk for relapse given they are less able to recognize internal reactions signaling the presence of a high-risk alcohol use situation, and therefore less likely to mobilize coping responses.     

Effect of chronic pyridostigmine bromide treatment on cardiovascular and behavioral parameters in mice

Experiments were performed to determine the effect of chronic low-dose pyridostigmine bromide (PB) treatment on blood acetylcholinesterase (AChE), cardiovascular (CV) function, and behavior in C57BL/6J male mice. Chronic carotid arterial catheters were used for long-term CV measurements and for collection of blood samples. Separate groups of mice were used for behavioral open field tests. PB was administered subcutaneously using osmotic minipumps at 1 and 3 mg/kg/day for 7 days. Blood pressure and heart rate (HR) were measured continuously for 24 h before treatment and on Days 3 and 7 after minipump insertion. Blood samples were collected on the same days. Mean arterial pressure (MAP) of the control group was 108+/-2 and 104+/-2 mm Hg during the dark and light periods, respectively. HR was 510+/-18 and 493+/-19 beats/min during the dark and light periods, respectively. PB treatment had no effect on MAP or HR in either dark or light period. Basal AChE activity was 0.42+/-0.1 micromol/min/ml, with no changes observed with PB at 1 mg/kg/day. The higher PB dose (3 mg/kg/day) decreased blood AChE activity by 85% on Day 7. Despite the reduction in blood AChE activity, there were no alterations in open field behaviors (locomotor activity, rearing, distance traveled, rest time, number of entries, and pokes). In conclusion, chronic low-dose PB exposure decreased blood AChE activity but had no effect on CV function or behavior in mice.     

No effect of negative mood on the alcohol cue reactivity of in-patient alcoholics

Forty in-patient alcoholics were exposed to an alcohol cue (holding and smelling an alcoholic drink) while in a negative mood, and while in a neutral mood. For the negative mood condition either a distressing or depressing Mood Induction Procedure (MIP) was used. In the control condition, a neutral MIP was used. In the negative mood condition, the subjects were found to be more distressed, more irritated, less calm, and less satisfied than in the neutral mood condition. In all conditions, following exposure to the alcohol cue, the desire to drink, systolic blood pressure, and heart rate variability increased, while self-efficacy beliefs to resist the urge to drink, and heart rate decreased. In sum, alcohol cue reactivity was observed, but not in response to a negative as opposed to a neutral mood or a distressed versus a depressed mood.     

A review of the effects of perceived drug use opportunity of self-reported urge

Although persons addicted to drugs reliably report experiencing cravings or urges during drug cue exposure, less is known about factors that may moderate this effect. This article reviews cue exposure studies with people who smoke, are dependent on alcohol, or are addicted to cocaine or opiates. Perceived drug use opportunity is found to affect urge ratings. Specifically, people who are addicted to substances and who perceive an opportunity to consume their drug of choice report higher urges than do those who do not anticipate being able to use the drug. This factor was proposed to explain why those in treatment for substance dependence report urges that are about half the strength of those in nontreatment settings. The impact of perceived drug use opportunity on urge is considered from a variety of perspectives, including conditioning theories, a cognitive appraisal framework, and motivated reasoning theory. Conceptual and methodological implications of perceived drug use opportunity are addressed.