Responses to smoking-related stimuli and early relapse to smoking

Prior to engaging in treatment for smoking cessation, subjects were tested for their responsiveness to cigarette smoking cues. Subjects performed a role-play with a confederate who lit their preferred brand of cigarette. Heart rate (HR) and galvanic skin conductance were assessed continuously, while urge to smoke and anxiety were rated subjectively after the role-play. Three months after treatment ended, subjects were divided into groups of continuous quitters, verified by expired carbon monoxide measurement, and relapsers. The results showed a significant difference between the groups in the pattern of pretreatment HR response to the lighting of the cigarette; relapsers displayed a sharp HR deceleration in response to the stimulus, while quitters' HR did not decelerate. The theoretical and clinical significance of these results is discussed.     

Changes in the relative reinforcing effects of cigarette smoking as a function of initial abstinence

Rationale  Experimental research is needed in investigating how early smoking abstinence affects relapse risk. Objective  The present study assessed the feasibility of promoting smoking abstinence using once- rather than thrice-daily abstinence monitoring and the relationship between different durations of initial abstinence and changes in smoking preference. Methods  Participants were 34 adult smokers randomized into one of two conditions: 14-day (14C) and 1-day (1C) contingent payment for smoking abstinence. Smoking status and participant ratings were assessed daily; a delay discounting task involving hypothetical money and an inter-temporal choice task involving hypothetical money and cigarettes were administered at baseline and days 7 and 14; a direct test of preference for smoking versus money was assessed on day 14. Results  Once-daily monitoring gained robust experimental control over smoking abstinence. No differences in delay discounting for hypothetical money were observed between the two conditions. Compared to the 1C condition, participants in the 14C condition (1) showed significant increases in the mean percent of delayed hypothetical money over cigarettes choices in the inter-temporal choice task, (2) were significantly less likely to ever choose the smoking option in the direct test of preference for smoking versus money, and (3) reported greater ease of abstaining from smoking and lower nicotine withdrawal and craving. Conclusions  These results offer a more efficient procedure for experimentally promoting smoking abstinence, while providing further evidence that an initial period of sustained abstinence produces a profile of changes consistent with an overall lowering of relapse risk.     

Predictors of initial abstinence in smokers enrolled in a smoking cessation program

The present study examined the relative contribution of nicotine dependence, self-efficacy, and stages of change variables in predicting the initial abstinence of 102 smokers enrolled in a smoking cessation program. Over half the participants were female, the majority were White, and about half were married or living with a partner Data were collected between 2000 and 2002. When smoking abstinence was defined as having a breath carbon monoxide (CO) level <4 ppm within 24 hours of enrollment in the study, low nicotine dependence and a higher level of contemplation both predicted abstinence. When other potentially confounding variables were included in the analysis, neither nicotine dependence nor contemplation was predictive of abstinence. When abstinence was defined as the number of study baseline days in which the participant had a breath CO level <4 ppm, multiple-regression analysis revealed that self-efficacy predicted abstinence. Self-efficacy remained predictive when other potentially confounding variables were included in the analysis. These results suggest that all three types of constructs are useful in predicting initial smoking abstinence.     

Effects of tryptophan depletion on acute smoking abstinence symptoms and the acute smoking response

Given the putative role of serotonin in the modulation of smoking withdrawal and the central actions of nicotine, this study examined the affective and neuroelectric correlates of smoking abstinence and cigarette smoking following depletion of the serotonin precursor, tryptophan. In a randomized, double-blind two session (tryptophan depletion [TD] vs. nondepletion), placebo-controlled design, spectrally analyzed electroencephalogram (EEG), self-ratings of withdrawal symptoms and mood states were assessed in 18 male cigarette smokers before smoking abstinence, 5 h postsmoking abstinence and again following sham smoking and the smoking of one cigarette. Compared to a nutritionally balanced amino acid (AA) mixture containing tryptophan (i.e., placebo mixture), oral ingestion of a similar mixture devoid of tryptophan resulted in a 70% reduction of plasma tryptophan but failed to alter the appearance or reversal (by acute cigarette smoking) of withdrawal symptoms, negative mood states and increased slow wave EEG in male smokers deprived of cigarettes. These results, although not supporting a role for the serotonergic system in acute smoking and early smoking abstinence symptoms, are discussed in relation to the neuropharmacology of smoking behavior and suggestions for future work.     

Responses to positive and negative smoking-related images: effects of current smoking status and degree of smoking addiction

The literature indicates that stimulant users of various dependency levels endorse and react differently to stimuli that portray the stimulant either positively or negatively, however these studies have not been extended to smoking. Here pictures are used to depict either positive or negative connotations of smoking. The current study concentrated on smokers with different levels of dependency. Seventy-three digital images were rated on both a smoking and emotional content scale. The pictures were rank ordered, yielding the 10 most positive and negative smoking-related pictures. Emotional content scores for these pictures were also recorded. Data from 148 subjects [light- (n=28), heavy- (n=17), ex- (n=32) and never-smokers (n=71)] were analysed. Using a mixed factorial ANOVA light- and heavy-smokers were found to score positive pictures significantly more positive than the never-smokers, they did not vary on negative or emotional ratings. Thus positive pictures did not distinguish heavy and light levels of substance use as suggested by the literature and this was not influenced by emotional content.     

The effects of cigarette smoking and abstinence on auditory verbal learning

Smoking has been associated with both enhanced and impaired cognitive performance; across a variety of domains, but there is limited evidence demonstrating the effects on verbal learning. The current study assessed the effect of smoking and abstinence on verbal learning, immediate memory and retention using the Auditory Verbal Learning Test (AVLT). Three groups: 20 smokers, 20 abstaining smokers and 20 non-smoking adults were assessed on the AVLT on two occasions. At session one, abstaining smokers refrained from smoking for 12 h (pre-cigarette), whilst smokers had continued to smoke to satiety. Session two commenced after a 15-min break when both smoking groups were instructed to smoke a cigarette, followed by administration of the second version of the AVLT (post-cigarette). Abstaining smokers showed significant deficits in learning compared to smokers during the pre-cigarette session. Following re-initiation of smoking in the abstaining smokers, these learning decrements were no longer evident. There were trends towards significant group findings in immediate memory and retention during the pre-cigarette session, which again were no longer evident in the post-cigarette session. These findings provide further evidence that smoking abstinence affects verbal learning and furthermore smoking simply restores cognitive performance to pre-abstinence levels.     

The effects of exercise on cigarette cravings and brain activation in response to smoking-related images

Rationale

Smokers show heightened activation toward smoking-related stimuli and experience increased cravings which can precipitate smoking cessation relapse. Exercise can be effective for modulating cigarette cravings and attenuating reactivity to smoking cues, but the mechanism by which these effects occur remains uncertain.

Objective

The objective of the study was to assess the effect of exercise on regional brain activation in response to smoking-related images during temporary nicotine abstinence.

Methods

In a randomised crossover design, overnight abstinent smokers (n?=?20) underwent an exercise (10-min moderate-intensity stationary cycling) and passive control (seating for the same duration) treatment, following 15?h of nicotine abstinence. After each treatment, participants underwent functional magnetic resonance imaging (fMRI) brain scanning while viewing a random series of blocked smoking or neutral images. Self-reported cravings were assessed at baseline, mid-, and post-treatments.

Results

There was a significant interaction effect (treatment?×?time) for desire to smoke, F (2,32)?=?12.5, p?Conclusion The study shows differing activation towards smoking images following exercise compared to a control treatment and may point to a neuro-cognitive process following exercise that mediates effects on cigarette cravings.     

Acute effects of self-paced walking on urges to smoke during temporary smoking abstinence

Rationale Recent research highlights the need to extend our understanding of how exercise may aid smoking cessation, through exploration of different modes, intensity and duration of exercise. Objectives The purpose of the study was to examine the effects of a 1-mile self-paced walk on different measures of urges to smoke following temporary smoking abstinence. Methods In a within-subject counterbalanced design, following 15 h of smoking abstinence, participants (N=15) exercised or sat passively on separate days. A single-item measure of strength of desire to smoke (West and Russell in Psychopharmacology 87:407–415, 1985) was administered during, immediately post, and at 10 and 20 min post-treatment. The two-factor Questionnaire for Smoking Urges (QSU; Tiffany and Drobes in Br J Addict 86:467–1476, 1991), involving intention and desire to engage in smoking behaviour which is anticipated as pleasant, enjoyable and satisfying (desire–behave), and anticipation of relief from negative affect through smoking (desire–affect relief), was administered before and 20 min post-treatment. Results A two-way repeated-measures MANOVA revealed a significant overall interaction effect for time by condition for strength of desire to smoke, and the two QSU scales. Two-way repeated-measures univariate ANOVAs revealed significant interaction effects for time by condition for each of the three urges to smoke measures. Planned contrasts revealed that exercise reduced cigarette cravings for up to 20 min after exercise, in comparison with the control condition. ANCOVAs revealed mixed support for independent effects of exercise on all measures of urges to smoke. Conclusion A self-paced walk, at a low intensity, lasting 15–20 min can have a rapid and measurable positive effect on both single and multi-item measures of urges to smoke, lasting at least 20 min, during temporary smoking abstinence.     

The Questionnaire of Smoking Urges is sensitive to abstinence and exposure to smoking-related cues

The Questionnaire of Smoking Urges (QSU) was designed to measure cravings elicited by abstinence from cigarette smoking. In the present study, the sensitivity of the QSU both to brief periods of abstinence and to exposure to smoking-related cues was investigated. A progressive ratio (PR) operant procedure was also employed, in which behaviour was maintained either by primary reinforcement (puffs on a cigarette) or by secondary reinforcement (tokens exchanged later for puffs on a cigarette) in separate experiments. Dependent smokers, who were not abstinent or who were abstinent for either 2 or 4 h, were tested in both a cue-rich and a no-cue environment. The results indicated that the QSU was sensitive both to brief periods of abstinence and to exposure to smoking-related cues, but the effect of smoking-related cues on QSU scores was maximal in non-abstinent smokers. In contrast, neither abstinence nor exposure to smoking-related cues significantly influenced the number of reinforcers earned, or the number of responses made, in either PR task. However, there was a significant interaction between gender and degree of abstinence on PR performance under primary reinforcement, and correlations between PR and QSU measures that were dependent on a complex interaction between the presence/absence of smoking-related cues and the type of reinforcer used. These results suggest that the QSU is sensitive to subtle influences on subjective urges to smoke in dependent smokers and, although PR measures are relatively insensitive to these influences, there is some evidence that PR performance is related to subjective measures of the urge to smoke.     

Cigarette smoking and psychophysiological stress responsiveness: effects of recent smoking and temporary abstinence

Studies comparing the cardiovascular function and stress responsiveness of regular smokers and non-smokers have produced mixed results, possibly because of variable intervals between stress tests and recency of smoking. This experiment compared the cardiovascular, cortisol and affective responses to a problem solving task of non-smoking young men (n=16) and regular smokers randomised to overnight abstinence (n=14) and smoking 30 min prior to testing (n=19). Smoking status was validated biochemically. Overnight abstinence was associated with reduced diastolic blood pressure at rest and with enhanced diastolic pressure and emotional responses to the task compared with other conditions. Recent smokers showed elevated heart rates, suppressed cardiac baroreceptor reflex sensitivity and reduced cortisol responsiveness, but did not differ from nonsmokers in blood pressure responses. The behavioral performance of the abstinent group was impaired, and their craving was greater than that of recent smokers. Both groups of smokers reported more dysphoric mood than non-smokers, and showed only limited recovery of emotional equilibrium following tests. The results are discussed in relation to mechanisms linking smoking, stress responsiveness and cardiovascular disease risk. The methodological implications for including regular smokers in psychophysiological studies are also considered.     

Self-reported abstinence effects in the first month after smoking cessation.

The present study evaluated self-reported subjective complaints (29 single items and 11 scales) at precessation, on quit day, and on Days 1, 2, 3, 7, 14, 21, and 28 after cessation in 46 healthy quitters who remained abstinent for the first month after cessation (biochemically confirmed). Also tested on the same schedule were 29 nonsmokers matched for age and gender. Specific criteria were set for transient and offset effects based on the direction, magnitude, and time course of changes in symptoms after cessation. Results indicated that single-item anger, anxiety, depression, difficulty concentrating, irritability, restlessness, dizziness, and nausea, and the Shiffman-Jarvik Stimulation/Sedation Subscale, the Perceived Stress scale, and the POMS anger, confusion, and tension subscales met the criteria for transient effects, and that single-item desire to smoke, cough, and headache, and the Shiffman-Jarvik Psychological Subscale met the criteria for offset effects. These findings help to clarify which subjective complaints after smoking cessation are transient effects and which are offset effects, a distinction with important implications for understanding nicotine dependence and for designing pharmacological and nonpharmacological interventions for smoking cessation.     

Effects of divalproex on smoking cue reactivity and cessation outcomes among smokers achieving initial abstinence

Divalproex, a GABA agonist, may be a useful agent in the treatment of tobacco dependence. Cue reactivity assessment paradigms are ideally suited to explore basic mechanisms underlying the pharmacological effects of medications that purport to have efficacy for smoking cessation. Our primary goal in the current study was to examine the effects of divalproex on in-treatment reactivity to smoking-relevant and affective cues, and to determine if these reactions were predictive of posttreatment smoking behavior. There were 120 nicotine dependent smokers enrolled in an 8-week double-blind clinical trial and randomly assigned to either divalproex or placebo conditions. Of these, 72 smokers (60% female) who achieved a minimal level of abstinence underwent an in-treatment cue reactivity assessment. Contrary to expectations, divalproex was associated with greater craving and arousal during smoking cue presentation. Divalproex also inhibited cardiovascular response to pleasant cues. Although no significant differences in cessation-related outcomes between divalproex- and placebo-treated participants were observed, cue-elicited craving to smoke predicted end-of-treatment and posttreatment smoking rates. These findings suggest that in-treatment cue reactivity assessment may proactively and dynamically inform ongoing treatment as well as provide a tool for screening potential medications for smoking cessation.     

The effects of contingent payment and frequent workplace monitoring on smoking abstinence

This study examined the relative contribution of contingent payment and worksite CO monitoring to the long-term maintenance of smoking abstinence. Forty-seven hospital employees who had abstained from smoking for five days (confirmed by CO analysis) were randomly assigned to one of three follow-up groups: (a) contingent payment/frequent monitoring (n = 17); (b) noncontingent payment/frequent monitoring (n = 16); or (c) non-contingent payment/infrequent monitoring (n = 14). Contingent payment combined with frequent CO monitoring delayed but did not ultimately prevent subjects relapse to smoking by the end of the six month follow-up. Contingent subjects maintained CO values less than or equal to 11 ppm significantly longer than did either the Non-contingent or the Control subjects (p = .03). CO monitoring alone had no effect on abstinence outcomes; both Noncontingent and Control subjects showed high rates of early relapse.     

The effects of cigarette smoking on the response to stress in a driving simulator

1. Some behavioural and physiological responses of cigarette smokers and non-smokers exposed to varying degrees of stress in a driving simulator were compared.2. When the smokers were smoking a cigarette, some of their reaction times to light signals differed significantly from those of non-smokers, some being longer and some shorter. These differences disappeared when the smokers were not smoking.3. Of the physiological measurements, only heart rate differed significantly between smokers and non-smokers, being higher at all levels of stress in the smokers. There were no significant differences in blood pressure, calf blood flow and respiration rate between smokers and non-smokers.4. The results of the Cattell Sixteen Personality Factor Questionnaire showed that the smokers were significantly more extroverted and self-reliant than the non-smokers.5. The results are discussed in relation to the pharmacology of cigarette smoking. It is concluded that the differences in reaction times and heart rates between smokers and non-smokers were a consequence of cigarette smoking.     

Predictors of smoking lapse in a human laboratory paradigm

Rationale

During a smoking quit attempt, a single smoking lapse is highly predictive of future relapse. While several risk factors for a smoking lapse have been identified during clinical trials, a laboratory model of lapse was until recently unavailable and, therefore, it is unclear whether these characteristics also convey risk for lapse in a laboratory environment.

Objectives

The primary study goal was to examine whether real-world risk factors of lapse are also predictive of smoking behavior in a laboratory model of smoking lapse.

Methods

After overnight abstinence, 77 smokers completed the McKee smoking lapse task, in which they were presented with the choice of smoking or delaying in exchange for monetary reinforcement. Primary outcome measures were the latency to initiate smoking behavior and the number of cigarettes smoked during the lapse. Several baseline measures of smoking behavior, mood, and individual traits were examined as predictive factors.

Results

Craving to relieve the discomfort of withdrawal, withdrawal severity, and tension level were negatively predictive of latency to smoke. In contrast, average number of cigarettes smoked per day, withdrawal severity, level of nicotine dependence, craving for the positive effects of smoking, and craving to relieve the discomfort of withdrawal were positively predictive of number of cigarettes smoked.

Conclusions

The results suggest that real-world risk factors for smoking lapse are also predictive of smoking behavior in a laboratory model of lapse. Future studies using the McKee lapse task should account for between subject differences in the unique factors that independently predict each outcome measure.     

Effects of resistance exercise on the HPA axis response to psychological stress during short-term smoking abstinence in men

Purpose

The purpose of this study was to examine the effects of resistance exercise on the hypothalamic–pituitary–adrenal axis (HPA) response to mental challenge, withdrawal symptoms, urge to smoke, and cognitive stress during 24-hour smoking abstinence.

Methods

8 sedentary smokers (mean ± SD age: 20.1 ± 1.7 y; height: 171.6 ± 10.8 cm; body mass: 70.4 ± 12.0 kg; smoking history: 2.9 ± 0.8 y) completed a 24-hour ad libitum smoking trial (SMO) followed by two 24-hour smoking abstinence trials. During abstinence trials, participants performed six whole body resistance exercises (EX) or a control condition (CON) in the morning, followed by mental challenge tasks in the afternoon. Plasma adrenocorticotropin hormone (ACTH), and salivary and serum cortisol were measured during each visit at rest (REST), and then before (PRE-EX), immediately after (IP-EX), and 30 min after exercise (30-EX); and before (PRE-MC), immediately after (IP-MC), and 30 min after mental challenge (30-MC).

Results

Resistance exercise significantly (p ≤ 0.05) elevated plasma ACTH and serum cortisol at IP-EX during EX compared with SMO and CON trials. Resting ACTH, salivary and serum cortisol concentrations at Pre-MC did not differ between EX and CON trials. The HPA axis response to mental challenge was similar after EX and CON trials. Finally, resistance exercise did not reduce withdrawal symptoms, urge to smoke, or stress.

Conclusion

Resistance exercise did not substantially alter resting HPA hormones or the HPA response to mental challenge tasks during 24 h of smoking abstinence.     

Influence of the duration of abstinence on the relative reinforcing effects of cigarette smoking

Rationale Sustaining smoking abstinence during the initial weeks of a cessation effort is highly correlated with long-term smoking abstinence. However, experimental research is needed to establish a direct causal relationship between achieving early abstinence and lowered relapse risk. Objective In the present study, we tested whether a period of sustained abstinence directly decreases the relative reinforcing effects of cigarette smoking. Methods Participants were 63 adult smokers who were randomized into one of three conditions: 14-day (14C), 7-day (7C), and 1-day (1C) contingent payment for smoking abstinence. Smoking status was assessed three times per day for 14 consecutive days using breath carbon monoxide monitoring and an abstinence criterion of ≤4 ppm. In the 14C condition, monetary payment was contingent on abstinence for all 14 days; in the 7C condition, payment was noncontingent for days 1–7 and contingent for days 8–14; in the 1C condition, payment was noncontingent for days 1–13 and contingent for day 14. On day 14, all participants completed a 3-h preference session under controlled laboratory conditions wherein they could make a maximum of 20 exclusive choices between options to smoke (two puffs/choice) or earn money ($0.25/choice). Preference was deemed an index of the relative reinforcing effects of smoking and money. Results A significantly lower proportion of participants in the 14C condition ever chose the smoking option (19%) compared to those in the 7C (57%) or 1C (62%) conditions. Conclusions These results provide experimental evidence that sustained abstinence can decrease the relative reinforcing effects of smoking, an effect that may be related to the commonly observed decrease in relapse risk among those who are able to sustain smoking abstinence during the initial weeks of a cessation effort.     

Time dependency of craving and response inhibition during nicotine abstinence

Background: Nicotine withdrawal produces increased craving for cigarettes and deficits in response inhibition, and these withdrawal symptoms are predictive of relapse. Although it is well established that these symptoms emerge early during abstinence, there is mixed evidence regarding whether they occur simultaneously. Given the importance of the early withdrawal period, this study examined craving and response inhibition at 24?h and 72?h abstinence. Methods: Twenty-one non-treatment seeking adult smokers were evaluated at baseline, 24?h, and 72?h abstinence for craving (Questionnaire on Smoking Urges – Brief) and response inhibition (Stop Signal Task, Stroop Task, Continuous Performance Task). Generalised linear regression models were used for primary outcomes, and Pearson correlations for examining the association between craving and response inhibition. Results: Factor 2 craving (anticipated relief of negative affect) increased from baseline to 24?h abstinent (p?=?0.004), which subsided by 72?h (p?=?0.08). Deficits in response inhibition measured by the Stop Signal Task were observed at 72?h (p?=?0.046), but not 24?h (p?=?0.318). No correlation was found between response inhibition and craving at any time point (p values>0.19), except between the Stroop Task and the factor 1 craving at baseline (p?=?0.025). Conclusions: Factor 2 craving peaked at 24?h, whereas deficits in response inhibition did not emerge until 72?h, indicating that need to target craving and cognitive function during early abstinence may not occur simultaneously. Further characterizing the time course of withdrawal symptoms may guide development of targeted treatments for smoking cessation.     

Effects of human calcitonin on the response to noxious stimuli and morphine-antinociception

Effects of human calcitonin (HCT) on the responses of mice and rats to noxious stimuli of various types and morphine-antinociception in the mice tail-pinch method were studied as compared with procine calcitonin (PCT). I.c.v. administration of HCT (0.007-0.071 mg/mouse) delayed response time to tail-pinch stimuli and suppressed acetic acid writhing dose-relatedly. PCT (0.5-3 U/mouse, i.c.v.) exerted a dose-related antinociceptive effect in the tail-pinch and acetic acid writhing methods. The antinociceptive effect was also produced by s.c. administration of HCT (0.071-7.1 mg/kg) and PCT (10-1000 U/kg) in the tail-pinch and writhing methods, while the antinociceptive effect was not detected by the tail-flick method following i.c.v. and s.c. administration of HCT and PCT. Increase in response threshold in the hind paw pressure test was produced by 0.071-7.1 mg/kg, s.c. of HCT and 10-1000 U/kg, s.c. of PCT in rats. Inhibition of writhing due to i.c.v. administration of HCT and PCT was not antagonized by naloxone. Pre-drug control response time to tail-pinch stimuli tended to be shortened after 7-14 days of s.c. treatment with CT, especially with PCT. Pretreatment with HCT and PCT exerted no obvious influence on their acute effects. Morphine-antinociception in the tail-pinch method tended to be potentiated by single s.c. dose of HCT and to be decreased by 14 days chronic s.c. treatment with HCT. The role of calcium in HCT action was discussed.