Abstract
Despite the availability of smoking cessation strategies, smoking cue-induced craving remains a relatively untreated relapse risk factor. Utilizing nicotine-free electronic cigarettes (e-cigarettes) to extinguish the motivational influence of smoking cues may be a viable approach to address cue reactivity. In this pilot study, 26 daily tobacco smokers used nicotine-free e-cigarettes while being maintained on daily transdermal sustained-release nicotine replacement therapy (NRT) to mitigate pharmacological withdrawal. Sensitivity to cue-induced craving, measured by the rise in craving after a visual cue exposure task, was assessed at a baseline visit after smoking as usual and again after 2 weeks of nicotine-free e-cigarette and NRT use. Participants’ pattern and amount of tobacco cigarette smoking were evaluated on both visits and 1 month posttreatment. Cue-induced craving significantly decreased after the 2-week intervention, yet withdrawal scores increased during this time. One month after study completion, participants continued to report significantly lower overall cigarette craving and conventional tobacco cigarette use. Including the 34.8% that were totally abstinent, 65.2% reported smoking fewer than 10 cigarettes per week (compared to 87.2 per week at baseline for the entire group). A linear regression revealed that greater baseline cue-induced craving predicted better outcomes, whereas more withdrawal at the e-cigarette visit was related to more smoking at 1 month. This proof-of-concept pilot study suggests that the addition of ad libitum nicotine-free e-cigarettes to an existing strategy of transdermal NRT may attenuate cue-induced craving for tobacco smoking. A larger sample that is powered for detecting additional factors and longer-term outcomes is warranted.
Highlights
Even when using available smoking cessation aids, relapse rates to smoking remain high [1]
Evidence strongly indicates that transdermal nicotine replacement therapy (NRT) does not attenuate cue reactivity [3,4,5], other studies suggest that medications, such as varenicline [6], and shorter-acting NRT, such as nicotine gum/lozenge [7], blunt cue reactivity
Diary self-report (N = 24; two participants did not complete this aspect) demonstrated that tobacco smoking was reduced on the first day that transdermal NRT and e-cigarettes were provided and remained below three cigarettes/day for the remainder of the 2-week period (Figure 1)
Summary
Even when using available smoking cessation aids, relapse rates to smoking remain high [1]. Evidence strongly indicates that transdermal NRT does not attenuate cue reactivity [3,4,5], other studies suggest that medications, such as varenicline [6], and shorter-acting NRT, such as nicotine gum/lozenge [7], blunt cue reactivity Such medications are not consistently effective at reducing cue reactivity [8], and enhanced cue reactivity predicts relapse even when combined transdermal and short-acting NRT are used [9]. Extinction is one potential behavioral method, where smoking cues are decoupled from acute nicotine administration, resulting in the devaluation of the smoking cues’ motivational influence Extinction therapies, such as cue exposure therapy [10], have been historically ineffective [11] partly because of context-driven renewal [12]. There is the need to extinguish cues across real-life environments where individuals regularly smoke and encounter smoking-related stimuli
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