Tobacco withdrawal symptoms mediate motivation to reinstate smoking during abstinence.

Abstract

Withdrawal-based theories of addiction hypothesize that motivation to reinstate drug use following acute abstinence is mediated by withdrawal symptoms. Experimental tests of this hypothesis in the tobacco literature are scant and may be subject to methodological limitations. This study utilized a robust within-subject laboratory experimental design to investigate the extent to which composite tobacco withdrawal symptomatology level and three unique withdrawal components (i.e., low positive affect, negative affect, and urge to smoke) mediated the effect of smoking abstinence on motivation to reinstate smoking. Smokers (10≥cig/day; N=286) attended two counterbalanced sessions at which abstinence duration was differentially manipulated (1-hour vs. 17-hours). At both sessions, participants reported current withdrawal symptoms and subsequently completed a task in which they were monetarily rewarded proportional to the length of time they delayed initiating smoking, with shorter latency reflecting stronger motivation to reinstate smoking. Abstinence reduced latency to smoking initiation and positive affect and increased composite withdrawal symptom level, urge, and negative affect. Abstinence-induced reductions in latency to initiating smoking were mediated by each withdrawal component, with stronger effects operating through urge. Combined analyses suggested that urge, negative affect, and low positive affect operate through empirically-unique mediational pathways. Secondary analyses suggested similar effects on smoking quantity, few differences among specific urge and affect subtypes, and that dependence amplifies some abstinence effects. This study provides the first experimental evidence that within-person variation in abstinence impacts motivation to reinstate drug use through withdrawal. Urge, negative affect, and low positive affect may reflect unique withdrawal-mediated mechanisms underlying tobacco addiction.

Negative affect subtypes and craving differentially predict long-term cessation success among smokers achieving initial abstinence

“…Part of these findings is in accord with a previous clinical report that craving mediated the relation between depressive symptoms and relapse rates among substance users (Witkiewitz and Bowen 2010). The present results are also congruent with findings that high-arousal NA subtypes (e.g., anger and anxiety) versus low-arousal NAs (e.g., depression) appears to be stronger mediators of the relation of abstinence and reinstatement of smoking in laboratory settings (Aguirre et al 2015). Future research should continue to examine likely differences among the subtypes of affective symptoms with respect to their direct and/or indirect impact on relapse risks.…”

Addiction is driven by excessive goal-directed drug choice under negative affect: translational critique of habit and compulsion theory

“…This failure to support habit theory was found in both clinical (tests 5-8) and non-clinical samples (1)(2)(3)(4). Furthermore, the failure to support habit theory cannot be attributed to the use of concurrent choice procedures (which tend to discourage habitual learning as noted earlier) because all of the tests in Table 2 used concurrent choice procedures, both those that failed (test [1][2][3][4][5][6][7][8] and those that notionally supported habit theory (test 9-11).…”

“…The self-medication account specifies psychiatric symptoms, which increase during abstinence, as the main driver of persistent drug use [5]. Although individual sensitivity to a multidimensional withdrawal syndrome and other negative states is associated with problematic substance use, there remains debate as to which component of withdrawal is most important [6], how this relates to psychiatric comorbidity [7,8], and whether negative states prime drug seeking automatically [9] or via value-based decision making [10,11]. This work forms the basis of the goal-directed choice under negative affect account evaluated at length later.…”

Current major depression is associated with greater sensitivity to the motivational effect of both negative mood induction and abstinence on tobacco-seeking behavior

“…The study demonstrated sensitivities in clinical depression which had previously only been associated with sub-clinical depression and hedonic traits (Audrain-McGovern et al, 2014; Cook et al, 2004; Fucito and Juliano, 2009; Leventhal et al, 2013; Leventhal et al, 2014; Leventhal et al, 2009; Perkins et al, 2010). As individual differences in sensitivity to negative mood/stress induced craving (Back et al, 2010; Brady et al, 2006; Cooney et al, 1997; Higley et al, 2011; Sinha et al, 2011; Sinha et al, 2006) and abstinence induced craving (Aguirre et al, 2015; Ferguson et al, 2006; McCarthy et al, 2008; Piper et al, 2008; Zuo et al, 2016) predict a higher risk of relapse, these sensitivities arguably underpin dependence, persistence and relapse, and should be targeted to improve treatment outcomes.…”