Selective attention to smoking cues in former smokers

Repeated drug use modifies the emotional and cognitive processing of drug-associated cues. These changes are supposed to persist even after prolonged abstinence. Several studies demonstrated that smoking cues selectively attract the attention of smokers, but empirical evidence for such an attentional bias among successful quitters is inconclusive. Here, we investigated whether attentional biases persist after smoking cessation. Thirty-eight former smokers, 34 current smokers, and 29 non-smokers participated in a single experimental session. We used three measures of attentional bias for smoking stimuli: A visual probe task with short (500 ms) and long (2000 ms) picture stimulus durations, and a modified Stroop task with smoking-related and neutral words. Former smokers and current smokers, as compared to non-smokers, showed an attentional bias in visual orienting to smoking pictures in the 500 ms condition of the visual probe task. The Stroop interference index of smoking words was negatively related to nicotine dependence in current smokers. Former smokers and mildly dependent smokers, as compared to non-smokers, showed increased interference by smoking words in the Stroop task. Neither current nor former smokers showed an attentional bias in maintained attention (2000 ms visual probe task). In conclusion, even after prolonged abstinence smoking cues retain incentive salience in former smokers, who differed from non-smokers on two attentional bias indices. Attentional biases in former smokers operate mainly in early involuntary rather than in controlled processing, and may represent a vulnerability factor for relapse. Therefore, smoking cessation programs should strengthen self-control abilities to prevent relapses.     

Attentional and evaluative biases for smoking cues in nicotine dependence: component processes of biases in visual orienting

The present study investigated attentional and evaluative biases for smoking-related cues in cigarette smokers and non-smokers. Using a visual probe task, we manipulated the presentation conditions of the stimuli to examine: (1). whether smokers have a bias to allocate attention towards smoking-related pictures that appear below the threshold of conscious awareness; and (2). whether attentional biases for smoking-related pictures that appear above the threshold of awareness operate both in initial orienting and in the maintenance of attention. We also obtained explicit and implicit measures of the valence of the smoking-related pictures from pleasantness ratings and from behavioural responses on a stimulus-response compatibility (SRC) task. Results showed that smokers, but not non-smokers, had an attentional bias for smoking-related pictures which had been presented at two exposure durations (200 and 2000 ms). The bias was not found in a brief (17 ms) masked exposure condition, so there was no evidence that it operated preconsciously. Smokers also showed greater preferences for smoking-related than control cues, compared with non-smokers, on both the explicit and implicit indices of stimulus valence. Results are discussed with reference to incentive and cognitive models of addiction.     

Do the affective properties of smoking-related cues influence attentional and approach biases in cigarette smokers?

Research indicates that drug-related cues elicit attention and approach biases in drug users. However, attentional biases are not unique to addiction (e.g., they are also found for emotional information). This study examined whether attentional and approach biases in cigarette smokers are mediated by the motivational salience of cues (relevance to drug-taking), rather than by their affective properties (subjective liking of the cues). Cues included pleasant and unpleasant smoking-related pictures. Attentional biases, approach tendencies and subjective evaluation of the cues were assessed on visual probe, stimulus-response compatibility and rating tasks, respectively. Compared with non-smokers, smokers showed a greater attentional bias for both pleasant and unpleasant smoking-related cues presented for 2000 ms, but not for 200 ms. Smokers showed a greater approach bias for unpleasant cues, although the groups did not differ significantly in approach bias for pleasant smoking-related cues. Smokers rated both pleasant and unpleasant smoking pictures more positively than did non-smokers. Results suggest that a bias to maintain attention on smoking-related cues in young adult smokers is primarily a function of drug-relevance, rather than affective properties, of the cues. In contrast, approach tendencies and pleasantness judgements were influenced by drug use, drug-relevance and the affective properties of the cues.     

The addiction Stroop task: examining the fast and slow effects of smoking and marijuana-related cues

Research has shown that attentional bias toward smoking-related stimuli is related to the maintenance of smoking behaviour and the chance of a relapse during a quit attempt. Effects of smoking attentional bias can occur both during smoking stimulus presentation (fast effect) and on stimuli that immediately follow smoking stimuli (slow effect). The current research builds on these findings by closely examining the temporal aspects of these fast and slow effects across groups of different smoking status. In Experiment 1 (n = 64), smokers, smokers attempting to quit (SATQ) and non-smokers completed an addiction Stroop task using smoking related, negative emotion and neutral stimuli. In Experiment 2 (n = 32), marijuana smokers and non-marijuana smokers completed an addiction Stroop task using marijuana and neutral stimuli. Results showed fast effects across all smoking groups (except non-smokers) and slow effects in SATQ and marijuana smokers. Furthermore, marijuana smokers showed slow effects over extended periods of time. Results also show a relationship between anxiety, nicotine dependence and attentional bias in SATQ. The implications of these findings are discussed.     

Eye movements to smoking-related cues: effects of nicotine deprivation

RATIONALE: According to recent theories of addiction, nicotine deprivation may influence biases in the orienting and maintenance of attention on smoking-related cues. OBJECTIVES: We examined the effect of nicotine deprivation on different aspects of attentional biases for smoking-related cues. METHODS: Smokers' eye movements to smoking-related and control pictures were assessed during a visual probe task under deprived and non-deprived conditions. RESULTS: When deprived, smokers maintained their gaze for longer on smoking-related than control cues, relative to when non-deprived. Deprivation also increased craving and pleasantness ratings of smoking cues. Across both deprived and non-deprived conditions, smokers were more likely to shift their gaze towards smoking cues and were faster to respond to probes replacing smoking cues, relative to non-smoking cues, but these attentional bias measures were not significantly affected by the deprivation manipulation. CONCLUSIONS: Results suggest a selective effect of deprivation on the maintenance of attention on smoking-related cues.     

The effect of pictorial warnings on cigarette packages on attentional bias of smokers

Given that previous studies demonstrated that smoking-related cues (like cigarette packages) grab the attention of smokers and thereby contribute to craving and tobacco seeking we investigated how pictorial health warnings presented on cigarette packages affect attention allocation towards cigarette packages. The WHO advises the use of pictorial health warnings on cigarette packages. However, at present no experimental studies are available investigating if pictorial warnings modulate incentive properties of cigarette packages. Fifty-nine tobacco smokers and 55 non-smokers performed a visual dot probe task to assess attention allocation towards cigarette packages with and without health warnings. Smokers were divided a priori in a group of light smokers (< 20 cigarettes/day; n = 39) and heavy smokers (≥ 20 cigarettes/day; n = 20). Psychometric measures on anxiety and nicotine craving were administered. Light smokers showed an attentional bias towards packages without pictorial warnings while no effects were observed in the other groups. In heavy smokers attention allocation towards pictorial health warnings was associated with an increase of craving and anxiety. The results have a potential public health perspective as pictorial health warnings might be an effective strategy to reduce attentional bias towards cigarette packages of light smokers, while counterproductive effects in heavy smokers warrant further investigation.     

An early attentional bias to BEGIN-stimuli of the smoking ritual is accompanied with mesocorticolimbic deactivations in smokers

Rationale

Biased processing of drug-associated stimuli is believed to be a crucial feature of addiction. Particularly, an attentional bias seems to contribute to the disorder's maintenance. Recent studies suggest differential effects for stimuli associated with the beginning (BEGIN-smoking-stimuli) or the terminal stage of the smoking ritual (END-smoking-stimuli), with the former but not the later evoking high cue-reactivity.

Objective

The current study investigated the neuronal network underlying an attentional bias to BEGIN-smoking-stimuli and END-smoking-stimuli in smokers and tested the hypothesis that the attentional bias is greater for BEGIN-smoking-stimuli.

Methods

Sixteen non-deprived smokers and 16 non-smoking controls participated in an fMRI study. Drug pictures (BEGIN-smoking-stimuli, END-smoking-stimuli) and control pictures were overlaid with geometrical figures and presented for 300?ms. Subjects had to identify picture content (identification-task) or figure orientation (distraction-task). The distraction-task was intended to demonstrate attentional bias.

Results

Behavioral data revealed an attentional bias to BEGIN-smoking-stimuli but not to END-smoking-stimuli in both groups. However, only smokers showed mesocorticolimbic deactivations in the distraction-task with BEGIN-smoking-stimuli. Importantly, these deactivations were significantly stronger for BEGIN- than for END-smoking-stimuli and correlated with the attentional bias score.

Conclusions

Several explanations may account for missing group differences in behavioral data. Brain data suggest smokers using regulatory strategies in response to BEGIN-smoking-stimuli to prevent the elicitation of motivational responses interfering with distraction-task performance. These strategies could be reflected in the observed deactivations and might lead to a performance level in smokers that is similar to that of non-smokers.     

Modulation of craving by cues having differential overlap with pharmacological effect: evidence for cue approach in smokers and social drinkers

Rationale: An increased risk of drug intake produced by drug cues may reflect the fact that the cues are withdrawal-like or aversive, reflecting a conditioned adaptation to the drug’s acute effects. More recent work suggests that they may also be appetitive, signalling the goal characteristics of drug taking. Objective: These opposing mechanisms were tested in dependent smokers and in social drinkers by examining the motivational nature of drug cues that overlap differentially with the acute effects of the drug. Methods: Pictures of different phases of smoking or alcohol drinking were presented to deprived and non-deprived smokers, to never smokers and non-deprived smokers or to social drinkers. Desire for cigarettes or alcohol and momentary pleasure and arousal were measured after viewing an experimental picture or a pleasant, neutral or unpleasant control scene. Results: High desire for smoking was evoked by pictures of preparation for and actual smoking but not by scenes of the end of smoking, although the latter were best correlated with acute drug effect. This pattern was not affected by overnight smoke deprivation, it was seen in different smokers but not in never-smokers and it was replicated in social drinkers using pictures of alcohol consumption. Moreover, scenes evoking high desire to consume did not evoke states of momentary unpleasantness and they were seen as relaxing and not arousing. Control pictures had a minimal effect on desire to consume. Conclusions: In line with incentive models of drug cues, cues based on pictures of drug intake may be conditioned stimuli encoding cue approach and preparation for consumption. Received: 10 March 1999 / Final version: 3 August 1999     

Effects of smoking on acoustic startle and prepulse inhibition in humans

RATIONALE: Prepulse inhibition of the acoustic startle response (PPI) is a paradigm in which a startle response to an auditory stimulus is reduced when that stimulus is preceded by a lower intensity, non-startling stimulus (prepulse). PPI is used as an operational measure of sensorimotor gating in both humans and other mammals. Acute administration of nicotine enhances PPI in rats, an effect that has been recently demonstrated in humans. OBJECTIVES: We compared PPI in 12 male smokers and 14 male non-smokers tested in four repeat startle sessions across 2 test days in order to examine further the effects of smoking and smoking withdrawal on acoustic startle and PPI. METHODS: In a crossover design, the smokers smoked ad lib or abstained from smoking overnight prior to 9 a.m. testing. These 2 test days were in randomized order. On both days, smokers were immediately retested after smoking three cigarettes. Non-smokers were tested twice on each of 2 separate days. RESULTS: Across sessions, the smokers had reduced startle to pulse alone stimuli in the first block of each session when compared to the non-smokers. The non-smokers had no change in gating across their four test sessions. For the smokers, the abstinence condition produced a non-significant reduction in PPI compared to that of the ad lib smoking day. During the smoking abstinence session, smokers had comparable gating to non-smokers. Smoking immediately after washout produced a significant improvement in PPI such that gating in the smokers exceeded that of the non-smokers. CONCLUSION: Smoking after overnight washout from cigarettes enhanced sensorimotor gating compared to pre-smoking values and compared to gating in non-smokers.     

Comparing attentional bias to smoking cues in current smokers,former smokers,and non-smokers using a dot-probe task

Much evidence documents that individuals with emotional and drug-use disorders demonstrate biased attention toward stimuli associated with their disorder. This bias appears to diminish following successful treatment. Two studies examined whether current cigarette smokers show biased attention toward smoking-related images compared with non-smokers (Studies 1 and 2) and whether this bias is less pronounced in former smokers (Study 2). Attentional bias toward cigarette-related photographs was examined using the dot-probe task. Pairs of images (one smoking-related) appeared side by side for 500 ms on a computer screen prior to the presentation of a probe (an asterisk) replacing one of the photographs. Subjects struck a key as quickly as possible to indicate the probe location. Attentional bias was defined as faster reaction times when the probe replaced the smoking-related image. In both studies, current smokers displayed significantly greater attentional bias toward cigarette stimuli than did non-smokers. Former smokers in Study 2 displayed an intermediate level of bias, but did not differ significantly in bias score from either of the other groups. These results support further use of the dot-probe task as a measure of attentional bias in non-abstinent smokers and in individuals undergoing smoking cessation treatment.     

Selective processing of smoking-related cues in current smokers, ex-smokers and never-smokers on the modified Stroop task

The aim of this study was to investigate selective processing biases towards smoking-related stimuli in relation to acute abstinence and smoking history. Differences in the processing of smoking-related and control cues in current smokers, ex-smokers and never-smokers on the modified Stroop task were investigated, with smokers randomized to either abstain or smoke normally for a period of 24 h. The results indicated no significant effect of deprivation (abstinent versus non-abstinent smokers), or of smoking history (ex- versus never-smokers) on colour-naming times for smoking-related versus control words. However, there was a significant effect of smoking status (current versus non-smokers) on colour-naming times for smoking words compared to control words (i.e. slower colour-naming of smoking-related words in smokers). This effect approached significance when stimuli were presented in a masked exposure condition. Among smokers, colour-naming interference was associated with the personality trait of Sensitivity to Reward. These results indicate a processing bias for smoking-related cues in current smokers. However, this bias does not appear to be a permanent feature of nicotine addiction, given the lack of difference between ex-smokers and never-smokers.     

Selective processing of smoking-related cues in smokers: manipulation of deprivation level and comparison of three measures of processing bias

Recent theories of addiction suggest that an attentional bias for drug-related cues plays an important role in maintaining drug-taking behaviours. A key feature of the present study is that it used three different measures of processing bias for linguistic and pictorial smoking-related cues: masked and unmasked conditions of the modified Stroop task, and a pictorial version of the visual probe task. Participants were smokers (n = 27), who were tested twice, with deprivation level manipulated as a within-subjects variable. They were asked to abstain from smoking for 12 h before one session, and to smoke normally before the other. Results were consistent with an attentional bias for smoking-related pictures on the visual probe task, and for smoking-related words in the unmasked condition of the modified Stroop task. The latter bias was most strongly predicted by self-reported urge to smoke, rather than by the deprivation manipulation. There was no evidence of a preconscious bias for smoking cues. The three measures of cognitive bias (from masked and unmasked Stroop and visual probe tasks) were not significantly correlated with each other, which suggests they may tap different underlying mechanisms. We discuss the results with respect to conceptualizations of selective attention, addiction and motivational states in general.     

Using mobile eye-tracking to assess attention to smoking cues in a naturalized environment

Introduction

Attentional bias to drug cues is thought to contribute to maintenance of drug-use behavior among chronic drug users. Studies assessing this bias traditionally have assessed drug cues that are explicitly presented in a laboratory setting. This study tested the use of a mobile eye-tracking procedure to assess visual attention to smoking cues by smokers and non-smokers in a more naturalized environment.

Methods

A mobile eye-tracker was used to assess the number and duration of fixations made to smoking cues located in an office space environment by smokers and non-smokers while completing a sham experimental task. Smokers completed two sessions, once after 12 h of abstinence and once after smoking.

Results

Results indicated that smokers made significantly more fixations to the smoking cues than non-smokers, regardless of smoking condition though the mean amount of time spent fixating on the cues did not differ significantly. Smokers did not differ in the number of fixations or mean fixation duration across the two smoking conditions, suggesting in this sample that a 12-h period of abstinence did not make the smoking cues more salient in this context.

Conclusion

This study demonstrates the successful use of mobile eye-tracking to assess attentional biases to environmental drug cues. Results suggest that smoking cues in the environment are potentially more attention grabbing for smokers compared to non-smokers but these cues do not necessarily hold visual attention of smokers longer than that of non-smokers.     

Lack of startle modulation by smoking cues in smokers

Rationale The startle reflex methodology has been used to study the effects of nicotine in humans and the motivational effects of smoking cues in smokers. However, no other studies investigate startle modulation by smoking cues in smokers compared to non-smokers. In the other studies, smoking deprivation was manipulated in smokers or smokers were not compared directly to non-smokers.Objective The goal of this study was to examine the temporal course of information processing following the presentation of a smoking-related cue using the startle probe methodology in smokers compared to non-smokers.Methods Thirty-four smokers were selected on the basis of nicotinic dependence according to the DSM-IV, and compared to 34 non-smokers. During testing, subjects viewed neutral pictures and smoking related pictures displayed on a computer screen. Acoustic startle stimuli were delivered at various times after picture onset (60, 120 or 5000 ms) to examine inhibition by lead stimulus and the affective modulation of startle.Results The magnitude of startle reflex inhibition increased in smokers compared to non-smokers, at 60 and 120 ms. In all, there was no Picture×Group interaction effect.Conclusion We showed that smoking cues have no impact on the startle reflex of either group, even if, in line with previous results, prepulse inhibition was higher in smokers than non-smokers. These results suggest that smoking cues have no effect on the positive reinforcement of nicotine consumption, and that cognitive factors play a primary role in the development and maintenance of tobacco dependence.     

Neural Substrates of Attentional Bias for Smoking-Related Cues: An fMRI Study

Attentional bias for drug-related stimuli, as measured by emotional Stroop (ES) tasks, is predictive of treatment outcomes for tobacco smoking and other abused drugs. Characterizing relationships between smoking-related attentional bias and brain reactivity to smoking images may help in identifying neural substrates critical to relapse vulnerability. To this end, we investigated putative relationships between interference effects in an offline smoking ES task and functional MRI (fMRI) measures of brain reactivity to smoking vs neutral images in women smokers. Positive correlations were found between attentional bias and reactivity to smoking images in brain areas involved in emotion, memory, interoception, and visual processing, including the amygdala, hippocampus, parahippocampal gyrus, insula, and occipital cortex. These findings suggest that smokers with elevated attentional biases to smoking-related stimuli may more readily shift attention away from other external stimuli and toward smoking stimuli-induced internal states and emotional memories. Such attentional shifts may contribute to increased interference by smoking cues, possibly increasing relapse vulnerability. Treatments capable of inhibiting shifts to drug cue-induced memories and internal states may lead to personalized tobacco dependence treatment for smokers with high attentional bias to smoking-related stimuli.     

Attentional bias in smokers: exposure to dynamic smoking cues in contemporary movies

Research has shown that smokers have an attentional bias for pictorial smoking cues. The objective of the present study was to examine whether smokers also have an attentional bias for dynamic smoking cues in contemporary movies and therefore fixate more quickly, more often and for longer periods of time on dynamic smoking cues than non-smokers. By drawing upon established methods for assessing attentional biases for pictorial cues, we aimed to develop a new method for assessing attentional biases for dynamic smoking cues. We examined smokers' and non-smokers' eye movements while watching a movie clip by using eye-tracking technology. The sample consisted of 16 smoking and 17 non-smoking university students. Our results confirm the results of traditional pictorial attentional bias research. Smokers initially directed their gaze more quickly towards smoking-related cues (p?=?0.01), focusing on them more often (p?=?0.05) and for a longer duration (p?=?0.01) compared with non-smokers. Thus, smoking cues in movies directly affect the attention of smokers. These findings indicate that the effects of dynamic smoking cues, in addition to other environmental smoking cues, need to be taken into account in smoking cessation therapies in order to increase successful smoking cessation and to prevent relapses.     

Alcohol increases cognitive biases for smoking cues in smokers

Rationale Alcohol increases the motivation to smoke, possibly because it increases the incentive motivational properties of smoking cues.Objectives We examined whether alcohol would increase attentional, approach, and evaluative biases for smoking-related cues in a sample of daily cigarette smokers.Methods The study used a visual probe task with eye movement recording to investigate biases in visual orienting to smoking-related cues. A stimulus–response compatibility task was used to assess approach tendencies for smoking-related cues, and an explicit rating task was used to assess the perceived valence of smoking-related cues. Participants completed the tasks in two sessions, once after consumption of 0.4 g/kg alcohol and once after consumption of a non-alcoholic drink.Results Alcohol increased the maintenance of attention on smoking cues (evident from gaze duration and a reaction time index of attentional bias), the perceived pleasantness of smoking cues, and cigarette craving, relative to the non-alcoholic drink. However, alcohol had no effect on the initial shifting of gaze to smoking cues or on the tendency to approach smoking cues.Conclusions These results suggest that, in smokers, ingestion of a moderate dose of alcohol increases the propensity for smoking-related cues to hold attention and makes those cues seem more attractive, which is consistent with alcohol increasing the incentive salience of smoking cues.     

Acute cigarette smoking reduces latencies on a Smoking Stroop test

Rationale

Sensitivity to addiction-related cues, a type of attentional bias, may interfere with executive functions that are important in sustaining abstinence from drug abuse. Assessments of attentional bias in research participants who smoke cigarettes have used Smoking Stroop tasks, which are variations of emotional Stroop tasks in which the stimuli are smoking-related and neutral words.

Objectives

We aimed to determine the effect of resumption of smoking by deprived cigarette smokers on attentional bias.

Methods

Testing occurred twice on each of two test days. One test day began after overnight abstinence (13–16 h) and the other after < 1 h of abstinence. The participants (n = 51) smoked a cigarette between the two test sessions on each test day.

Results

Smokers exhibited attentional bias for smoking-related words and had longer response times after overnight abstinence than after brief abstinence. Cigarette smoking between sessions reduced response times on both test days with no interaction by stimulus type.

Conclusions

Smoking-related cues have distracting effects in smokers, and smoking reduces response latency, with no specific effect on attentional bias. The increase in response speed may contribute to a smoker's impression that abstinence hinders performance and that smoking reverses impairment.     

Attentional biases for alcohol cues in heavy and light social drinkers: the roles of initial orienting and maintained attention

Rationale There has been considerable theoretical interest in attentional biases for drug-related cues. However, there is little research on the component processes of such attentional biases.Objectives We examined initial orienting to, and the maintenance of attention on, alcohol-related cues in heavy and light social drinkers.Methods The present study used a visual probe task to investigate biases in visual orienting to alcohol-related cues. We varied the presentation duration of alcohol-related pictures (200, 500 or 2000 ms) to investigate whether attentional biases operated in initial orienting or the maintenance of attention.Results In comparison with light social drinkers, heavy social drinkers had an attentional bias for alcohol pictures which were presented at the longer exposure durations (500 and 2000 ms), but not at the shorter duration of 200 ms. Subjective alcohol craving was correlated with the attentional bias index for alcohol pictures presented for 2000 ms.Conclusions These results suggest that biases in visual orienting to alcohol-related cues in heavy social drinkers operate mainly in the processes involved in the maintenance of attention.     

Peering through the smoke: the effect of parental smoking behavior and addiction on daily smokers' attentional bias to smoking cues

Although previous research has demonstrated that individuals with parents who smoke are more likely to become smokers and are less successful in smoking cessation efforts compared with those without a smoking parent, the reasons for this link have not been established. In the current study, implicit attentional bias to smoking-related cues was investigated in college-age smokers, based on models of addiction that suggest that attention to drug-related cues plays an important role in drug addiction. Sixty-one participants completed a dot-probe task to measure attentional bias to smoking-related and matched non-smoking-related control pictures. Results indicated that while those who reported smoking occasionally did not demonstrate an attentional bias, daily smokers who had a smoking parent showed more of an attentional bias to the smoking cues than those without a smoking parent, but only to cues that did not contain human content. In addition to parental influence, nicotine dependence explained a significant portion of the variance in the attentional bias for daily smokers. Implications for models of nicotine addiction and the development of smoking cessation programs are discussed.