Incubation of Cue-Induced Cigarette Craving During Abstinence in Human Smokers

Abstract

Background Abstinent drug users remain at risk for relapse long after withdrawal subsides. Animal studies indicate that responses to drug-related cues not only persist, but increase, with abstinence, a phenomenon termed “incubation of drug craving”. It is unknown if cue-induced craving increases, decreases, or remains constant with abstinence in humans. We investigated effects of abstinence on cue-induced craving in cigarette smokers. Methods Eighty-six non-treatment-seeking, adult smokers (≥ 10 cigarettes daily) were paid to abstain for 7 (Group 1), 14 (Group 2), or 35 (Groups 3, 4) days. Abstinence was verified daily. Groups 1, 2, and 3 underwent a single cue session on the final abstinence day (7, 14, or 35). Group 4 viewed cues on days 7, 14, and 35. Results Between and within groups, smoking-cue-induced craving increased with abstinence on some measures. Cue-induced craving was greater in Group 3 (35-day) compared to Group 1 (7-day). Within Group 4, cue-induced craving was greater at 35 than 14 days. Cue-induced craving did not decrease with abstinence on any measure. Conclusions We present initial evidence of incubation of cue-induced craving in humans. The observation that cue-induced craving increases with abstinence, even as “background” craving and withdrawal symptoms subside, may have treatment implications.

Compound Stimulus Presentation and the Norepinephrine Reuptake Inhibitor Atomoxetine Enhance Long-Term Extinction of Cocaine-Seeking Behavior

“…Notably, evidence suggests that relapse risk remains high or even grows ('incubates') over periods of abstinence (Grimm et al, 2001;Bossert et al, 2005;Lu et al, 2004;Bedi et al, 2011). Therefore, rather than evaluating drug-seeking behavior immediately after extinction training, we conducted our tests 4 weeks later to allow potential spontaneous recovery of responding and to assess the longevity of any effects on extinction following this 'incubation' period.…”

Will peak provoked craving prove superior to cue–reactivity?

“…Recent animal studies have suggested that the drugseeking response to drug-related cues increases with prolonged drug abstinence [12,13], and human studies have indicated similarly that cue-induced cigarette craving increases across the time-course of abstinence [14]. This suggests a complex and dynamic relationship between cue-induced craving and abstinence, including potentially abstinence-induced craving.…”

“…It is therefore perhaps unsurprising that they correlate only minimally with self-report measures of craving [11], despite both ostensibly capturing a common underlying construct. What this illustrates is that ostensibly objective measures of psychological phenomena which have good face validity may lack basic psychometric properties such as acceptable internal reliability.Recent animal studies have suggested that the drugseeking response to drug-related cues increases with prolonged drug abstinence [12,13], and human studies have indicated similarly that cue-induced cigarette craving increases across the time-course of abstinence [14]. This suggests a complex and dynamic relationship between cue-induced craving and abstinence, including potentially abstinence-induced craving.…”

Le craving comme symptôme central de la toxicomanie : de ses fondements neurobiologiques à sa pertinence clinique

“…Des témoignages recueillis auprès d'utilisateurs abstinents confirment que la présence de stimuli associés à la consommation o 2 prolonge encore davantage la sensation de craving, ce que l'on appelle la période « d'incubation » (Bedi et al, 2011). Par exemple, des exconsommateurs d'héroïne rapportent avoir ressenti du craving jusqu'à trois mois après l'arrêt de la consommation, 50 % décrivant un niveau d'intensité aussi élevé après un mois que durant la première semaine d'abstinence (Dhawan, Kumar, Yadav et Tripathi, 2002).…”