Urge and affect: A facial coding analysis of smokers.

This study used an established facial coding system to assess participants' immediate affective responses during a smoking cue exposure protocol. Current smokers, randomly assigned to either a 12-hr smoking-deprived or a smoking-nondeprived condition, were exposed to both smoking and control cues. During exposure, the authors manipulated participants' perceived opportunity to smoke. Participants' reactions to the cues were videotaped and coded using P. Ekman and W. V. Friesen's (1978) Facial Action Coding System. Information regarding smoking opportunity, although altering participants' expressed affect, had no effect on the strength of their reported urge to smoke. The facial coding data are consistent with previous findings using self-report measures of affect and support the use of facial coding as a sensitive and unobtrusive measure of the affective responses to drug cue exposure. (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)     

Perceived smokeless tobacco addiction among adolescents.

Although the prevalence and associated factors of smokeless tobacco (SLT) use are well documented, there are no data on the prevalence and associated factors of SLT dependence-addiction. From a survey of 11,057 adolescents in the nonurban Southeastern United States, 3,726 reported having tried SLT, and 17% of those who had tried SLT perceived that they were addicted to it. Years of SLT use, frequency of use per day, and hours of exposure per day were strongly related to perceived addiction. Those using SLT for 1 year or longer had perceived addiction rates of 37% and were over 12 times more likely to report being addicted than were those using for less than 1 year. After controlling for level of SLT use, other factors including parental SLT use, perceived control over health, and racial-ethnic group also contributed minimally but significantly to reported SLT addiction. (PsycINFO Database Record (c) 2010 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)     

Surfing the urge: Brief mindfulness-based intervention for college student smokers.

The current study investigates effects of a brief mindfulness-based instruction set, based on Marlatt’s “urge surfing” technique (Marlatt & Gordon, 1985), on smoking-related urges and behavior. Undergraduate smokers (N = 123) who were interested in changing their smoking, but not currently involved in a cessation program, participated in a cue exposure paradigm designed to elicit urges to smoke. They were randomly assigned either to a group receiving brief mindfulness-based instructions or to a no-instruction control group. Results suggest that groups did not differ significantly on measures of urges. However, those in the mindfulness group smoked significantly fewer cigarettes over a 7-day follow-up period as compared to those in the control group. These findings suggest that the mindfulness techniques may not initially reduce urges to smoke but may change the response to urges. The study provides preliminary data for future studies examining both mechanisms and effectiveness of mindfulness-based interventions for cigarette smoking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A cognitive model of drug urges and drug-use behavior: Role of automatic and nonautomatic processes.

Contemporary urge models assume that urges are necessary but not sufficient for the production of drug use in ongoing addicts, are responsible for the initiation of relapse in abstinent addicts, and can be indexed across 3 classes of behavior: verbal report, overt behavior, and somatovisceral response. A review of available data does not provide strong support for these assumptions. An alternative cognitive model of drug use and drug urges is proposed that hypothesizes that drug use in the addict is controlled by automatized action schemata. Urges are conceptualized as responses supported by nonautomatic cognitive processes activated in parallel with drug-use action schemata either in support of the schema or in support of attempts to block the execution of the schema. The implications of this model for the assessment of urge responding and drug-use behavior are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of Transdermal Nicotine During Imaginal Exposure to Anxiety and Smoking Cues in College Smokers.

In a 2 (patch) × 2 (smoking) × 2 (anxiety) mixed design, 52 undergraduate smokers randomly received a nicotine (21 mg) or placebo patch. After a 4-hr nicotine absorption/deprivation period, participants imagined several scenarios varying in cue content: (a) anxiety plus smoking, (b) anxiety, (c) smoking, and (d) neutral. Although smoking urge increased in both the nicotine and placebo conditions after the absorption/deprivation period, those who received the placebo reported significantly greater urge. During the cue reactivity trials, a significant Patch × Smoking × Anxiety interaction effect was observed for urge. However, participants who received nicotine still experienced moderate urges, indicating that nicotine did not attenuate cue-elicited urge. Transdermal nicotine did not diminish anxiety during the absorption/deprivation period or in response to the cues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Naltrexone's effects on reactivity to alcohol cues among alcoholic men.

The mechanisms of naltrexone's effects on urges to drink during abstinence are unclear. Naltrexone may suppress either urges to drink specifically or appetitive responses in general. The effects of naltrexone on cue reactivity to alcoholic and sweet nonalcoholic beverages were investigated. Alcohol-dependent men (N ?=?53) in treatment received naltrexone (50 mg) or placebo. Four hours later, they received baseline assessment, exposure to fruit juice, and exposure to their usual alcoholic beverage in 3-min trials. Naltrexone reduced urge to drink and self-reported attention to the alcohol cues, not at the initial exposure but after repeated exposures to alcohol cues. Naltrexone reduced negative affect across baseline and alcohol trials. No effects of naltrexone on responses to the nonalcoholic appetitive beverage cues were found, suggesting that general appetite suppression does not mediate the effects of naltrexone on urges. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Testing the influence of external and internal cues on smoking motivation using a community sample.

Exposing smokers to either external cues (e.g., pictures of cigarettes) or internal cues (e.g., negative affect induction) can induce urge to smoke and other behavioral and physiological responses. However, little is known about whether the two types of cues interact when presented in close proximity, as is likely the case in the real word. Additionally, potential moderators of cue reactivity have rarely been examined. Finally, few cue-reactivity studies have used representative samples of smokers. In a randomized 2 × 2 crossed factorial between-subjects design, the current study tested the effects of a negative affect cue intended to produce anxiety (speech preparation task) and an external smoking cue on urge and behavioral reactivity in a community sample of adult smokers (N = 175), and whether trait impulsivity moderated the effects. Both types of cues produced main effects on urges to smoke, despite the speech task failing to increase anxiety significantly. The speech task increased smoking urge related to anticipation of negative affect relief, whereas the external smoking cues increased urges related to anticipation of pleasure; however, the cues did not interact. Impulsivity measures predicted urge and other smoking-related variables, but did not moderate cue-reactivity. Results suggest independent rather than synergistic effects of these contributors to smoking motivation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reactivity to instructed smoking availability and environmental cues: Evidence with urge and reaction time.

Reactivity to drug-related cues has been proposed as a possible mechanism to explain maintenance of drug use and relapse. This study examined whether cognitions associated with drug use (the belief that nicotine is available for use) also elicit reactivity. Smokers (N?=?132) were randomly assigned in a 2 (Smoking Availability)?×?2 (Smoking Stimuli) factorial design. Reactivity was measured by self-reported urge and probe reaction time. A main effect for availability was found in that participants who had been told that they could smoke shortly reported greater urges than those who had been told that smoking would not be permitted for 3 hr. Moreover, smoking-related stimuli produced increases in urge ratings only when participants had been told that smoking would be available shortly. Probe reaction time, in contrast, increased in the presence of smoking stimuli only when participants were told that cigarettes were unavailable. The theoretical and treatment implications of drug availability as a moderator of cue reactivity, as well as the utility of reaction time as an index of drug use motivation, are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcohol and tobacco cessation in alcohol-dependent smokers: Analysis of real-time reports.

Alcohol-tobacco interactions and relapse precipitants were examined among alcohol-dependent smokers in a trial of concurrent alcohol and tobacco treatment. After discharge from treatment, participants completed 14 days of electronic diary (ED) assessments of mood, self-efficacy, urges to drink or smoke, and drinking and smoking behavior. ED data revealed an increase in frequency of alcohol urges after smoking episodes. Drinking relapse episodes were predicted by prior ED ratings of low self-efficacy to resist drinking and high urge to smoke. Smoking relapse episodes were predicted by high urge to smoke and high negative, high arousal mood. Results support a cross-substance cue reactivity model of multiple substance use and a limited-strength model, but not a cross-substance coping model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Induction of smoking urge through imaginal and in vivo procedures: Physiological and self-report manifestations.

This experiment assessed reactivity to imaginal and in vivo smoking and control cues. One hundred current smokers were assessed during 2 sessions separated by a 6-hr interval, and half of the participants were abstinent from smoking over this interval. Verbal and physiological reactivity measures were selected based on their relevance for several models of urge. Results indicated that imaginal and in vivo smoking cues were equally effective at eliciting high levels of self-reported urges. Smoking deprivation led to a general enhancement in urge report, rather than a specific increase to smoking cues. Physiological responding differed somewhat as a function of urge induction method, although autonomic responses to smoking cues were uniformly consistent with the direct effects of nicotine. There was no relationship between verbal and physiological urge indices. Implications of the findings for several contemporary models of drug urges are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cue exposure with coping skills treatment for male alcoholics: A preliminary investigation.

Although early investigations were promising, no controlled follow-up studies have investigated the effectiveness of cue exposure treatment for alcoholics. In this study, inpatient alcoholics received either cue exposure integrated with urge coping skills training (CET; n?=?22) or a contrast condition (CC) involving daily contact with assessment only (n?=?18) in addition to standard treatment. Comprehensive assessment measures were used to investigate change in process and outcome variables. In the 2nd 3 mo after treatment, the CET group included more patients who were completely abstinent, had a higher percentage of abstinent days, and tended to report fewer drinks per day than did patients in the contrast condition. The significantly greater use of coping skills during follow-up by the CET group and the significant relationship of these coping skills to decreased drinking suggest that treatment effects were due, at least in part, to the coping skills training, consistent with recent formulations. Theoretical and treatment implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Absentminded lapses during smoking cessation.

Although it is widely believed that drug cravings are responsible for drug use and relapse, S. T. Tiffany (1990) has proposed a cognitive model in which drug use is triggered not by craving but by the cuing of automatized action plans. The purpose of this study was to examine the lapse episodes from an ecological momentary assessment (EMA) study of smokers attempting to quit for evidence of automatic, or absentminded, lapses with slight or no urges to smoke, in keeping with S. T. Tiffany's (1990) model. Qualitative analysis of 270 EMA reports made by 41 smokers during the first 14 days of quitting identified 15 (6%) absentminded lapses. Quantitative urge levels were significantly lower during absentminded lapses compared with nonabsentminded lapses; however, urges were not very low. Results indicate that absentminded lapses may occur but are probably relatively rare. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drugs and homicide by women

In this paper we use data derived from interviews with 215 female homicide offenders incarcerated or on parole in New York to examine their drug use prior to and at the time of the homicide, their victims' drug use, and their perceptions as to the drug-relatedness of the homicides. We found that about 7 out of 10 respondents had been regular users of some drug at some point in their lives prior to their incarceration, while over half had been addicted to a substance. Over one-third of the respondents who were present at the scene were "high" on a drug at the time, while about half of the victims of these homicides used drugs before the homicide. Almost two-thirds of the homicides committed by respondents who were present at the scene were perceived to be drug-related. Alcohol, crack, and powdered cocaine were the drugs most likely to be related to these homicides. The implications of our findings are discussed.     

Classical conditioning of environmental cues to cigarette smoking.

Smoking-related cues tend to produce urges and cardiac responses in smokers. This reactivity has been assumed to reflect prior classical conditioning. However, little direct evidence exists supporting the notion that environmental cues can be classically conditioned to cigarette smoking. In this study, 8 smokers received 22 daily trials during which 2 cue complexes (comprising visual, olfactory, and auditory stimuli) were paired with smoking (CS+ trials) and not smoking (CS– trials). Reactivity to the environmental cues, as measured by self-report of urge and pulse rate, increased across CS+ trials, diverging from responses in the CS– trials. Reactivity was stronger among light smokers and those who verbalized awareness of smoking contingencies. Findings indicate that environmental cues can be classically conditioned to smoking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of extinction context and retrieval cues on alcohol cue reactivity among nonalcoholic drinkers.

Pavlovian conditioning models have influenced the development of cue exposure treatments for drug abuse. However, poor maintenance of extinction performance (renewal) after treatment is a common problem. A treatment-analogue experiment tested the role of context in renewal, as well as a potential strategy for reducing renewal. Seventy-eight social drinkers completed extinction trials to reduce saliva and urge reactivity to alcohol cues and were randomly assigned to a renewal test in either the same context as extinction, a different context, or the different context containing a cue from the extinction context (E-cue). As predicted, the different context produced greater renewal than the same context and renewal was attenuated when the E-cue was present. These results offer preliminary evidence for the context dependence of extinction to alcohol cues and for the use of an extinction cue to improve the generalizability of exposure therapies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relation between self-reported affect and drug urges and cravings in continuing and withdrawing smokers.

Investigated, in 2 experiments, the effects of withdrawal and stress on the affective correlates of urges to smoke. In both, habitual cigarette smokers were divided into continuing and withdrawing smoker groups. In the 1st study, 44 adults reported current mood, urge, and expectations over a 24-hr period. In the 2nd, a controlled laboratory study, urge, affect, and physiological data were obtained from continuing and withdrawing groups (N?=?64) exposed to high- or low-stress conditions. Urges among withdrawing smokers were positively associated with negative affect and negatively associated with positive affect; continuing smokers reported urges that were directly associated with positive affect and unrelated to negative affect. Stress and withdrawal produced urge and self-reports that were related to negative affect. Moreover, Ss who smoked after exposure to withdrawal and stress reported greater pleasure and arousal than did other Ss. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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