Effects of Varenicline on Abstinence and Smoking Reward Following a Programmed Lapse

Abstract

Introduction: Varenicline (Chantix®) is an effi cacious fi rstline medication for smoking cessation. Studies suggest that one mechanism by which varenicline facilitates sustained smoking abstinence is by reducing the likelihood of relapse to smoking when a lapse, or slip, occurs during a quit attempt. The present study extends this line of research by conducting a prospective laboratory study to examine the relapse prevention effects of varenicline following a programmed lapse. Methods:Daily smokers ( N = 47) completed a 5-week outpatient study in which they were randomized to receive varenicline or placebo. The fi rst week was a medication induction period that was immediately followed by a 4-week quit attempt. A programmed lapse (2 cigarettes smoked in the laboratory) occurred on the second day of the quit attempt.Results: Participants receiving varenicline were slower to relapse and had greater total abstinence rates following lapse exposure. Participants in the varenicline group rated lapse cigarettes lower on measures of reward and intoxication and showed increased behavioral economic demand elasticity for cigarettes (reduced cigarette purchasing at higher prices) compared with those receiving placebo.Conclusions: These results demonstrate a relapse prevention effect of varenicline following smoking lapse exposure and suggest that an attenuation of reward from smoking and the blunting of subjective effects of smoking may underlie and/or contribute to this effect.

Economic demand predicts addiction-like behavior and therapeutic efficacy of oxytocin in the rat

“…Finally, we also found that demand reduction by oxytocin predicted attenuation of relapse behavior, supporting the value of demand as an addiction biomarker. This observation is consistent with a recent human study (47) that found a pharmacotherapy that reduced demand for cigarettes also increased the duration patients remained abstinent. Finally, although oxytocin is a peptide and therefore may not cross the blood-brain barrier, systemic administration nevertheless produces robust central activation of oxytocin neurons in supraoptic and paraventricular nuclei (48), indicating systemic oxytocin administration is a viable method of inducing central nervous system (CNS) release of oxytocin and altering CNS activity.…”

An open-label pilot trial ofN-acetylcysteine and varenicline in adult cigarette smokers

“…These results are interpreted cautiously since efficacy was not the purpose of this study, but are not surprising given previous studies that have shown similar results with VAR and NAC as monotherapies (4-6, 8-10, 17, 26). Given that participants had varying readiness to quit motivation and were provided with only minimal encouragement to quit smoking during the study, it is not unexpected that we failed to identify continuous abstinence.…”

“…VAR appears to promote abstinence through decreasing withdrawal symptoms and blunting the reward derived from smoking (7). Smokers treated with VAR compared to placebo reported cigarette smoking to be less satisfying and rewarding (8-10). The most common adverse events reported with VAR include nausea, insomnia, abnormal dreams and headache (11, 12).…”

The Behavioral Economics of Substance Use Disorders: Reinforcement Pathologies and Their Repair

“…In a wide diversity of populations, higher levels of tobacco demand are consistently associated with greater nicotine dependence (Chase et al 2013, Few et al 2012, Liao et al 2013, MacKillop & Tidey 2011, MacKillop et al 2008, Murphy et al 2011). Also consistent with a role for drug demand in substance dependence, compared with smokers receiving a placebo, those who were administered the efficacious smoking-cessation medication varenicline showed significant increases in demand elasticity for cigarettes (McClure et al 2013). …”