Behavioural tasks sensitive to acute abstinence and predictive of smoking cessation success: a systematic review and meta-analysis.

Meryem Grabski,H Valerie Curran,Stephen M Husbands,Marcus R Munafò,Meg Fluharty,David J Nutt,Tom P Freeman

doi:10.1111/add.13507

Abstract

Background and aimsPerformance on cognitive tasks may be sensitive to acute smoking abstinence and may also predict whether quit attempts fail. Our aim was to conduct a systematic review and meta‐analysis to identify cognitive tasks sensitive to acute abstinence and predictive of smoking cessation success.MethodsEmbase, Medline, PsycInfo and Web of Science were searched up to March 2016. Studies were included if they enrolled adults and assessed smoking using a quantitative measure. Studies were combined in a random effects meta‐analysis.ResultsWe included 42 acute abstinence studies and 13 cessation studies. There was evidence for an effect of abstinence on delay discounting [d = 0.26, 95% confidence interval (CI) = 0.07–0.45, P = 0.005], response inhibition (d = 0.48, 95% CI = 0.26–0.70, P < 0.001), mental arithmetic (d = 0.38, 95% CI = 0.06–0.70, P = 0.018), and recognition memory (d = 0.46, 95% CI = 0.23–0.70, P < 0.001). In contrast, performance on the Stroop (d = 0 .17, 95% CI = −0.17–0.51, P = 0.333) and smoking Stroop (d = 0.03, 95% CI = −0.11–0.17, P = 0.675) task was not influenced by abstinence. We found only weak evidence for an effect of acute abstinence on dot probe task performance (d = 0.15, 95% CI = −0.01–0.32, P = 0.072). The design of the cessation studies was too heterogeneous to permit meta‐analysis.ConclusionsCompared with satiated smokers, acutely abstinent smokers display higher delay discounting, lower response inhibition, impaired arithmetic and recognition memory performance. However, reaction‐time measures of cognitive bias appear to be unaffected by acute tobacco abstinence. Conclusions about cognitive tasks that predict smoking cessation success were limited by methodological inconsistencies.

Highlights

In economically developed countries cigarette smoking is the greatest preventable cause of death, and world-wide more than 5 million people die prematurely each year from this [1]
Meta-analyses were conducted on all tasks that were reported by three or more studies, resulting in the analyses of seven types of tasks from acute abstinence studies
The analysis of the delay discounting task indicated that short-term, smaller rewards were preferred over long-term, larger rewards, indicating higher impulsivity in abstinent smokers

Summary

Introduction

In economically developed countries cigarette smoking is the greatest preventable cause of death, and world-wide more than 5 million people die prematurely each year from this [1]. Despite the fact that most smokers are aware of the risk smoking poses to their health, many fail to quit permanently. A behavioural outcome that is linked to withdrawal symptoms can act as a marker to indicate the efficacy of a treatment in a time- and cost-effective way. Due to the fact that task performance has been linked to short-term abstinence [7,8,9] and to long-term cessation outcomes [10,11], this might represent a behavioural marker for treatment development efforts. Performance on cognitive tasks may be sensitive to acute smoking abstinence and may predict whether quit attempts fail. Our aim was to conduct a systematic review and meta-analysis to identify cognitive tasks sensitive to acute abstinence and predictive of smoking cessation success

Objectives

Methods

Conclusion