Correction to Janes et al. (2009).

Reports an error in "Brain fMRI reactivity to smoking-related images before and during extended smoking abstinence" by Amy C. Janes, Blaise deB. Frederick, Sarah Richardt, Caitlin Burbridge, Emilio Merlo-Pich, Perry F. Renshaw, A. Eden Evins, Maurizio Fava and Marc J. Kaufman (Experimental and Clinical Psychopharmacology, 2009[Dec], Vol 17[6], 365-373). In the article the authors find it necessary to redefine the thresholding procedure used for data analyses, due to problems in the Brain Voyager software. This does not affect the main findings of the paper. (The following abstract of the original article appeared in record 2009-23091-001.) Reactivity to smoking-related cues may play a role in the maintenance of smoking behavior and may change depending on smoking status. Whether smoking cue-related functional MRI (fMRI) reactivity differs between active smoking and extended smoking abstinence states currently is unknown. We used fMRI to measure brain reactivity in response to smoking-related versus neutral images in 13 tobacco-dependent subjects before a smoking cessation attempt and again during extended smoking abstinence (52 ± 11 days) aided by nicotine replacement therapy. Prequit smoking cue induced fMRI activity patterns paralleled those reported in prior smoking cue reactivity fMRI studies. Greater fMRI activity was detected during extended smoking abstinence than during the prequit assessment subcortically in the caudate nucleus and cortically in prefrontal (BA 6, 9, 44, 46), primary somatosensory (BA 1, 2, 3), temporal (BA 22, 41, 42), parietal (BA 7, 40) anterior cingulate (BA 24, 32), and posterior cingulate (BA 31) cortex. These data suggest that during extended smoking abstinence, fMRI reactivity to smoking versus neutral stimuli persists in brain areas involved in attention, somatosensory processing, motor planning, and conditioned cue responding. In some brain regions, fMRI smoking cue reactivity is increased during extended smoking abstinence in comparison to the prequit state, which may contribute to persisting relapse vulnerability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measurement of the effects of abstinence from tobacco: A qualitative review.

This article reviews terms, methodologies, and scales used to describe the effects of abstinence from tobacco in humans. The review suggests operational definitions for withdrawal, offset, novel, and indefinite abstinence effects. The review recommends the use of prospective studies that use smokers trying to quit, multiple data points preabstinence and very soon after abstinence, comparison groups, at least 16 hrs of abstinence, objective measures, measures of clinical significance, and data analytic techniques that allow use of all participants' data. The 8 most commonly used tobacco withdrawal measures differ in coverage, brevity, and use of single vs. multiple items to describe each symptom. Of the measures, 6 consistently increase with abstinence, but no single measure appears superior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An investigation of predictors of nicotine abstinence in a smoking cessation treatment study of smokers with a past history of alcohol dependence.

This study investigated predictors for smoking abstinence at 12-week follow-up among 85 smokers with a past history of alcohol dependence enrolled in a smoking cessation trial. Length of alcohol abstinence at time of enrollment and longest previous period of smoking abstinence were significantly associated with smoking status at follow-up. Multiple logistic regression with these variables entered as predictors suggested that longest previous period of smoking abstinence partially mediated the relationship between length of alcohol abstinence at enrollment and smoking status at follow-up. Additional research is warranted to identify predictors of nicotine abstinence and smoking relapse in this population and to understand the factors that mediate the relationship between length of alcohol abstinence at enrollment and smoking outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between in-treatment abstinence and post-treatment abstinence in a smoking cessation treatment.

Previous research has indicated that abstinence early in a smoking cessation program is predictive of successful posttreatment abstinence. However, it has not been established whether or not this effect is independent of other in-treatment abstinence patterns. In this paper the relationship between three potentially important aspects of in-treatment smoking abstinence and posttreatment smoking abstinence are examined: early abstinence, extended abstinence, and end-of-treatment abstinence. We examined the relationship between smoking behavior measured each weekday over 70 visits (approximately 14 weeks) of a contingency management smoking cessation program and at a follow-up visit 6 months after study entry (3 months after the scheduled end of treatment). Ninety-five of 102 participants were successfully followed-up. Seven of these 95 participants were confirmed abstinent. Early abstinence, defined as abstinence during the first 10 treatment visits, was significantly and independently related to follow-up abstinence (OR = 56.67 [7.29–440.63]). Extended abstinence and end-of-treatment abstinence were related to follow-up abstinence, but not independent of early abstinence based on multiple regression models. Inclusion of a variety of demographic and environmental characteristics did not significantly alter this relationship. Thus, consistent with the previous literature, the establishment of early abstinence appears to be crucial to establishing longer-term abstinence, independent of other in-treatment abstinence patterns. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of smoking and smoking abstinence on verbal and visuospatial working memory capacity.

Several studies have examined the effects of smoking and abstaining from smoking on working memory (WM) but have yielded inconclusive findings. Thus, the authors used a repeated measures design to assess the effects of smoking and abstaining from smoking on both visuospatial and verbal WM capacity (WMC) using highly reliable, well-validated, and theoretically driven WM span tasks. Verbal n-back was also administered to examine its relationship to these complex WM span tasks and to compare this study's results with previous findings. Smokers (n = 23) and nonsmokers (n = 21) participated in 2 sessions separated by 1 week. During 1 session, smokers completed the WM tasks after abstaining from smoking for at least 12 hr, whereas in the other session smokers did not abstain from smoking and were tested immediately after smoking (all WM tasks were completed 45 min or less since last cigarette). Results indicated that smokers' verbal WM span was lower than nonsmokers' and was lower during the nonabstinent session compared with the abstinent session. Smokers' verbal n-back performance was also lower than nonsmokers', although there was no difference in verbal n-back performance between the smoking sessions. In contrast, there was no difference in visuospatial WM span between the smoking sessions or between smokers and nonsmokers. Taken together, these findings demonstrate that (a) smokers' verbal WM is lower than nonsmokers, (b) smokers' verbal WMC is lower during nonabstinence compared with abstinence, and (c) smoking exhibits differential effects on the different WM domains. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smokers’ expectancies for abstinence: Preliminary results from focus groups.

Smokers’ expectancies regarding the effects of cigarette use are powerful predictors of smoking motivation and behavior. However, studies have not investigated the consequences that smokers expect when they attempt to quit smoking: abstinence-related expectancies. The primary goal of this qualitative study was to gain initial insight into smokers’ expectancies for abstinence. Eight focus groups were conducted with 30 smokers diverse with respect to age, gender, and ethnoracial background. Content analyses indicated that smokers anticipate a variety of outcomes from abstinence. The most frequently reported expectancies included pharmacologic withdrawal symptoms, behavioral withdrawal symptoms, decreased monetary expense, and immediate improvement of certain aspects of physical functioning and health. Additional expectancies concerned weight gain, improved attractiveness, enhanced social functioning/self-esteem, long-term health outcomes, and loss of relationships. Finally, a number of relatively unheralded expectancies were revealed. These involved nicotine replacement therapy effectiveness, alcohol and other drug use, cue reactivity, cessation-related social support, aversion to smoking, and “political process” implications. This study provides a preliminary step in understanding smokers’ expectancies for abstinence from cigarettes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pretreatment task persistence predicts smoking cessation outcome.

R. Eisenberger's (1992) learned industriousness theory states that individuals display differing degrees of persistence depending on their history of reinforcement for effortful behavior. These differences may influence the development, maintenance, and cessation of addictive behaviors. In cross-sectional studies, E. P. Quinn, T. H. Brandon, and A. L. Copeland (1996) found that cigarette smokers were less persistent than nonsmokers, and R. A. Brown, C. W. Lejuez, C. W. Kahler, and D. R. Strong (2002) found that smokers who had previously abstained for 3 months were more persistent than those who had never quit. The present study extended these findings by using a prospective design. A pretreatment measure of task persistence (mirror tracing) completed by 144 smokers predicted sustained abstinence throughout 12 months of follow-up. Moreover, persistence predicted outcome independent of other significant predictors: gender, nicotine dependence, negative affect, and self-efficacy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The influence of transdermal nicotine on tobacco/nicotine abstinence and the effects of a concurrently administered cigarette in women and men.

Transdermal nicotine (TN) is an efficacious smoking cessation pharmacotherapy thought to work, in part, by attenuating the effects of tobacco/nicotine abstinence and the effects of concurrently smoked cigarettes. Clinical trials suggest that TN may be less efficacious for women. This study explored the possibility of TN-related gender differences in ≥8 hour abstinent smokers (54 women, 70 men) who completed four within-subject, double-blind, placebo-controlled sessions corresponding to 0, 7, 14, and 21 mg TN. In each approximately 6.5-hr long session participants smoked an own-brand cigarette 4 hours after TN administration and physiological and subjective outcomes were examined throughout each session. Results revealed that TN suppressed some signs and symptoms of tobacco abstinence and attenuated some effects of smoking, and these effects were not dependent on gender. Women were more sensitive to the direct effects of nicotine (e.g., ratings of Nauseous) and, independent of TN dose, self-administered less nicotine when smoking and rated smoking as less rewarding. Thus, although this study does not shed light on clinical observations that TN is less effective for women, results suggest that TN might need to be combined with other interventions to supplement its effects on tobacco/nicotine abstinence and concurrent smoking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of night smoking, sleep disturbance, and their co-occurrence on smoking outcomes.

Recent evidence suggests that smoking during the night is an indicator of nicotine dependence and predicts smoking cessation failure. Night smokers are likely to experience disturbance to their sleep cycle when they wake to smoke, but we are not aware of the prevalence of night smokers' self-reported sleep disturbance. Because sleep disturbance also predicts smoking cessation failure, we examined how the pre-cessation risk factors of night smoking and sleep disturbance, and their co-occurrence, predict smoking cessation failure in a 6-week double-blind randomized controlled trial examining whether naltrexone augments the efficacy of the nicotine patch (O'Malley et al., 2006). Smokers (N = 385) completed the Pittsburgh Sleep Quality Index (Buysse, Reynolds, Monk, Berman, & Kupfer, 1989) and a single item of waking at night to smoke pre-cessation. Smoking status was determined at weeks 1, 6, 24, and 48 weeks after quitting. The two main findings were: (a) night smokers reported significantly greater sleep disturbance than nonnight smokers; and (b) smokers with co-occurring night smoking and sleep disturbance experienced significantly greater risk for smoking than smokers with neither risk factor. Results suggest that individuals who both wake during the night to smoke and report clinically-significant sleep disturbance represent a high-risk group of smokers. Future smoking cessation treatment might incorporate strategies related to managing these smokers' sleep habits and physiological dependence on nicotine in order to bolster their cessation outcomes. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Automatic affective responses to smoking cues.

The authors examined automatic emotional reactions to smoking cues among 35 smokers and 25 nonsmokers (32 women and 28 men), using a novel implicit measure, the Affect Misattribution Procedure. Associative-learning theories of addiction suggest that smokers develop positive responses to cues linked to the rewarding effects of nicotine. Prior research, however, has yielded mixed evidence for whether smokers have favorable or unfavorable automatic responses to smoking cues. These findings may depend on the methods used to measure implicit responses. Using the Affect Misattribution Procedure, the authors found that nonsmokers responded to smoking cues with clear negative affect, whereas smokers' responses depended on individual differences in current smoking withdrawal. Smokers having withdrawal symptoms and those most motivated to smoke showed favorable emotional responses to smoking cues, but those with no withdrawal or low motivation to smoke showed negative responses. These results help integrate previous studies finding that smokers have negative automatic responses to cigarettes with those studies finding that smokers' responses were relatively positive. The results are important for theories that emphasize the role of cue conditioning in maintaining addiction because these theories assume, consistent with the current findings, that smoking cues can take on positive reward value. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Extended treatment with bupropion SR for cigarette smoking cessation.

The authors present results of a randomized clinical trial of the efficacy of extended treatment with bupropion SR in producing longer term cigarette smoking cessation. Adult smokers (N = 362) received open-label treatment (11 weeks) that combined relapse prevention training, bupropion SR, and nicotine patch followed by extended treatment (14 weeks) with bupropion SR or matching placebo. Abstinence percentages were relatively high (week 11: 52%; week 25: bupropion, 42%; placebo, 38%; week 52: bupropion, 33%; placebo, 34%), but bupropion SR did not surpass placebo. Gender and baseline craving level were identified as significant, independent moderators of treatment response. Men were more likely to abstain than women (week 11: 59% vs. 43%, p = .001; week 25: 48% vs. 31%, p = .001; week 52: 39% vs. 27%, p = .01). Because most smokers suffer relapse with any current cessation treatment, the comparatively high abstinence percentages achieved in this trial are of interest. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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 × 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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Life before and after quitting smoking: An electronic diary study.

This article describes a multidimensional, multivariate, and multilevel approach to the assessment of nicotine withdrawal. In this prospective study, 70 adult smokers assigned to an active or placebo nicotine patch condition completed multiple daily assessments using an electronic diary. Average and individual growth curves were estimated for affective and nonaffective withdrawal symptoms. All symptoms but hunger increased significantly on the quit day and remained elevated for three weeks. Variability in symptom experiences across individuals increased from pre- to post-quit. Relations between symptom reports (e.g., negative affect or craving) and episodic events (e.g., stressful events or seeing someone smoke) changed from pre-quit to post-quit. Pre-quit increases in negative affect and quit-day increases in craving were inversely related to abstinence three months after the quit day, suggesting that anticipatory and immediate reactions to quitting influence success. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality influences on change in smoking behavior.

Objective: To investigate associations between personality traits in early adulthood (and changes in them) and change in smoking status. Design: Prospective, longitudinal study of a general-population birth cohort. Main Outcome Measures: We measured smoking at ages 18, 26, and 32, and personality at ages 18 and 26 using the Multidimensional Personality Questionnaire (Tellegen & Waller, in press). We assessed personality’s ability to predict future smoking, and assessed how changes in personality traits relate to change in smoking status. Results: Higher aggression and alienation at age 18 predicted smoking at 26; higher self-control and traditionalism at age 18 predicted nonsmoking at 26; and higher alienation at age 26 predicted persistence of smoking to age 32. Personality change between 18 and 26 was associated with change in smoking behavior; those who stopped smoking decreased more than others in negative emotionality and increased more in constraint. Conclusion: These findings suggest that interventions fostering personality change may be effective in reducing smoking and indicate appropriate targets for such antismoking interventions in young people. In particular, high alienation predicted smoking persistence, perhaps due to resistance to existing antismoking messages; we discuss approaches that may overcome this. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Baseline reaction time predicts 12-month smoking cessation outcome in formerly depressed smokers.

Burgeoning evidence points to a positive association between cigarette smoking and depression. Moreover, depressive symptomatology, whether historical, current, or subsyndromal, appears to negatively influence smoking cessation efforts. Whereas depression is typically assessed via clinical interview or self-report, rarely are the known neurocognitive deficits linked to depression (e.g., global slowing) assessed in the context of smoking cessation research. Hence, this study examined whether simple reaction time--color naming of affectively neutral words--is predictive of 12-month smoking cessation outcome among a sample of formerly depressed smokers (N = 28). Results revealed a significant, positive correlation between reaction time and depressive symptoms such that those who exhibited slower reaction times were at heightened risk to relapse. Baseline depressive symptoms, as assessed via self-report, neither correlated with nor predicted smoking cessation outcome. Results from logistic regression analyses further showed that reaction time added incremental variance to the prediction of smoking cessation outcome. Therefore, simple reaction time may capture aspects of depression not typically assessed in self-report questionnaires. These results are discussed in terms of their theoretical and clinical implications for smoking cessation research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of depressed mood on smoking cessation: Mediation by postcessation self-efficacy.

This study evaluated the relationship between precessation depressed mood and smoking abstinence and assessed the mediation of this effect by postcessation self-efficacy, urges to smoke, nicotine withdrawal, and coping behavior. The sample included 121 smokers previously treated in a randomized controlled trial involving behavior therapy and the nicotine patch. The results showed that precessation depressed mood was inversely related to 6-month abstinence. This effect remained significant after controlling for treatment, possible depression history, baseline smoking rates, and several other demographic factors. Postcessation self-efficacy, at the 2-, 4-, and 8-week postquit assessments, was the strongest mediator of the effects of precessation depressed mood on abstinence, accounting for 32%, 38%, and 48% of the effect of mood on abstinence, respectively. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using self-efficacy judgments to predict characteristics of lapses to smoking.

According to relapse prevention theory, abstinence self-efficacy judgments (ASE; confidence in ability to abstain from smoking) about particular affective and environmental contexts should predict behavior in those contexts. Low-ASE contexts should present challenges to abstinence. In this study, the authors used profile correlations to quantify the relationship between context-specific ASE ratings and the characteristics of lapse episodes. To assess the distinctiveness of this relationship, they also correlated the situations surrounding temptation and randomly selected (nontemptation) episodes with context-specific ASE. The ASE-first lapse profile correlation was significantly greater than zero and significantly greater than ASE-temptation and ASE-nontemptation correlations. This pattern of results remained when multiple lapse episodes were considered. Thus, low-ASE contexts tend to be associated with lapses to smoking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pain, nicotine, and smoking: Research findings and mechanistic considerations.

Tobacco addiction and chronic pain represent 2 highly prevalent and comorbid conditions that engender substantial burdens upon individuals and systems. Interrelations between pain and smoking have been of clinical and empirical interest for decades, and research in this area has increased dramatically over the past 5 years. We conceptualize the interaction of pain and smoking as a prototypical example of the biopsychosocial model. Accordingly, we extrapolated from behavioral, cognitive, affective, biomedical, and social perspectives to propose causal mechanisms that may contribute to the observed comorbidity between these 2 conditions. The extant literature was 1st dichotomized into investigations of either effects of smoking on pain or effects of pain on smoking. We then integrated these findings to present a reciprocal model of pain and smoking that is hypothesized to interact in the manner of a positive feedback loop, resulting in greater pain and increased smoking. Finally, we proposed directions for future research and discussed clinical implications for smokers with comorbid pain disorders. We observed modest evidence that smoking may be a risk factor in the multifactorial etiology of some chronically painful conditions and that pain may come to serve as a potent motivator of smoking. We also found that whereas animal studies yielded consistent support for direct pain-inhibitory effects of nicotine and tobacco, results from human studies were much less consistent. Future research in the emerging area of pain and smoking has the potential to inform theoretical and clinical applications with respect to tobacco smoking, chronic pain, and their comorbid presentation. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Effect of smoking opportunity on responses to monetary gain and loss in the caudate nucleus.

The authors examined the effects of smoking opportunity on neural responses to monetary outcomes in nicotine-deprived cigarette smokers. Participants who were told that they would be able to smoke during the study exhibited smaller responses to monetary gains and losses in the caudate nucleus than did those who anticipated having to wait several hours before having the opportunity to smoke. These findings highlight the importance of investigating the effects of perceived drug use opportunity on motivational processing in addicted populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)