Dependence and Withdrawal-Induced Craving Predict Abstinence in an Incentive-Based Model of Smoking Relapse

Abstract

Introduction: Understanding factors that render some individuals more vulnerable to smoking relapse during the early stages of a quit attempt is critical to tailoring treatment efforts. Development of laboratory models of relapse can provide a framework for identifying underlying mechanisms that may contribute to vulnerability. Here, we explored predictors of abstinence in a novel incentive-based model of relapse.Methods: Fifty-six nontreatment seeking daily smokers completed several nicotine dependence measures prior to participating in a 1-week abstinence incentive test. During the abstinence procedure, participants earned monetary reinforcement for each biochemically verifi ed day of abstinence according to a descending schedule of reinforcement. Results:Compliance with the procedure was excellent. All but 3 participants were able to initiate abstinence; nearly 70% lapsed as incentives were reduced. Scores on the Fagerström Test for Nicotine Dependence (FTND), number of cigarettes smoked per day, and self-reported craving on the first day of abstinence each independently predicted time to lapse. The single item of time to fi rst cigarette in the morning on the FTND signifi cantly predicted time to lapse, even when controlling for other signifi cant predictors just listed. The Nicotine Dependence Syndrome Scale (NDSS) and Wisconsin Inventory of Smoking Dependence Motives did not predict lapse, but the NDSS did predict reinitiation of abstinence among those experiencing an initial lapse. Conclusions:These fi ndings partially replicate those of previous full-scale clinical trials and support the feasibility and validity of an incentive-based model of relapse. The time-limited and laboratory-based nature of this model has the potential to further investigations of underlying mechanisms contributing to relapse.

Blunted striatal response to monetary reward anticipation during smoking abstinence predicts lapse during a contingency-managed quit attempt

“…Interestingly, higher craving during the abstinence session was actually associated with lower likelihood of lapse during CM. This is in contrast with several studies that have demonstrated associations between increased craving and poorer abstinence outcomes in laboratory-based studies and smoking cessation trials (Bold et al 2013; Sweitzer et al 2013a; Van Zundert et al 2012) but see also (Wray et al 2013). Thus, it is possible that the availability of monetary incentives for abstinence may have enhanced extrinsic motivation to quit and thereby disrupted the association between subjective craving for cigarettes (and potentially increased striatal anticipation for smoking reward) and actual smoking behavior.…”

Working Memory-Related Neural Activity Predicts Future Smoking Relapse

“…Forward stepwise regression with a probability of 0.2 for removal and 0.1 for entry was used to select predictors for a logistic regression model (STATA logistic) of dichotomized 7-day relapse. Sex, age, and nicotine dependence level (Heatherton et al, 1991) were entered as baseline candidate predictors of relapse (Gourlay et al, 1994;Hymowitz et al, 1997;Japuntich et al, 2011;Sweitzer et al, 2013). Change scores (abstinence challenge minus smoking satiety) for paired data collected during abstinence challenge (MNWS, QSU-Brief, PANAS Positive, PANAS Negative, task performance (accuracy and response time), right DLPFC, left DLPFC, MF/CG, vmPFC, and PCC) were also included in the model.…”

“…Therefore, we examined task performance and BOLD signal acquired during performance of 3-back trials (minus BOLD signal acquired during performance of 0-back trials to account for task-related cognitive processes other than working memory). We required age and nicotine dependence to be entered based on clinical relevance (Hymowitz et al, 1997;Sweitzer et al, 2013); sex was nonsignificant, and allowed to dropout. Following logistic regression, receiver operating characteristic (ROC) analysis was used to assess the predictive potential of the models (Steyerberg, 2008).…”

Relationships Between Trait Urgency, Smoking Reinforcement Expectancies, and Nicotine Dependence

“…Scores range from 0–10 with higher scores indicating higher levels of dependence. Past work illustrates that FTND demonstrates good reliability and predictive and convergent validity to other measures of nicotine dependence [33] and dependence-relevant processes, including nicotine withdrawal [34], craving [35], biomarkers indicative of tobacco exposure [36], and abstinence following cessation [33, 37, 38]. …”