Negative affect is associated with alcohol,but not cigarette use in heavy drinking smokers

Co-use of alcohol and cigarettes is highly prevalent, and heavy drinking smokers represent a large and difficult-to-treat subgroup of smokers. Negative affect, including anxiety and depressive symptomatology, has been associated with both cigarette and alcohol use independently, but less is known about the role of negative affect in heavy drinking smokers. Furthermore, while some studies have shown negative affect to precede substance use, a precise biobehavioral mechanism has not been established. The aims of the present study were twofold. First, to test whether negative affect is associated with alcohol and cigarette use in a large community sample of heavy drinking smokers (n = 461). And second, to examine craving as a plausible statistical mediator of the association between negative affect and alcohol and/or cigarette use. Hypothesis testing was conducted using a structural equation modeling approach with cross-sectional data. Analysis revealed a significant main effect of negative affect on alcohol use (β = 0.210, p < 0.05), but not cigarette use (β = 0.131, p > 0.10) in this sample. Mediational analysis revealed that alcohol craving was a full statistical mediator of this association (p < 0.05), such that there was no direct association between negative affect and alcohol use after accounting for alcohol craving. These results are consistent with a negative reinforcement and relief craving models of alcohol use insofar as the experience of negative affect was associated with increased alcohol use, and the relationship was statistically mediated by alcohol craving, presumably to alleviate negative affect. Further longitudinal or experimental studies are warranted to enhance the causal inferences of this mediated effect.     

Reward dependence moderates smoking-cue- and stress-induced cigarette cravings

Background

Cigarette cravings following exposure to smoking cues in a smoker's environment are thought to play an important role in cessation failure. The possibility that dispositional factors may impact cue-induced cravings, though intriguing, has received little attention. According to Cloninger's Tridimensional Personality Theory, factors such as reward dependence (RD), harm avoidance (HA), and novelty seeking (NS) may figure prominently in risk for addiction, as well as relapse, in individuals attempting to abstain from drug and alcohol use. Particularly interesting in this regard is the possibility that smokers with higher levels of RD, who are especially sensitive to reward signals, will have heightened craving reactions to smoking cues.

Methods

To that end, non-treatment-seeking nicotine dependent smokers (n = 96, mean age = 41.1, 47% African American, 17% Caucasian, 22% Hispanic, 19.3 cigs/day, FTND = 7.5) underwent a classic experimental cue-induction, during which they were exposed to imagery of: (1) smoking, (2) neutral, and (3) stress cues, and reported their cigarette cravings (0–100) before and after each exposure. Participants also completed the Tridimensional Personality Questionnaire.

Results

Not surprisingly, smoking and stress cues (but not neutral cues) elicited significant elevations in craving (p's < 0.0001). Consistent with study hypothesis, smokers who scored higher on RD had stronger craving reactions to both smoking cues (p < .02) and stress cues (p < .03).

Conclusions

Findings raise the possibility that dispositional characteristics, in particular, reward dependence, influence smoking by potentiating reactions to environmental smoking cues. Furthermore, the similar effects of RD on stress-induced craving suggest that both cue-and stress-induced cravings may be influenced by a common underlying disposition.