Smoking Craving Research Articles

Reframing tobacco dependency management in acute care: A case study

Effective tobacco dependence treatment within acute care tends to be inadequate. The purpose of the Utilizing best practices to Manage Acute care patients Tobacco Dependency (UMAT) was to implement and evaluate an evidence-based intervention to support healthcare staff to effectively manage nicotine withdrawal symptoms of acute surgical patients. Data collection for this one-year longitudinal case study included: relevant patient experiences and staff reported practice, medication usage, and chart review. Over the year each data source suggested changes in tobacco dependence treatment. Key changes in patient survey responses (N=55) included a decrease in daily smoking and cigarette cravings. Of patients who used nicotine replacement therapy, they reported an increase in symptom relief. Staff (N=45) were surveyed at baseline, mid-point and end of study. Reported rates of assessing smoking status did not change over the year, but assessment of withdrawal symptoms emerged as daily practice and questions about cessation diminished. Also delivery of nicotine replacement therapy products increased over the year. Chart reviews showed a shift in content from documenting smoking behavior to withdrawal symptoms and administration of nicotine replacements; also frequency of comments increased. In summary, the evidence-based intervention influenced unit norms and reframed the culture related to tobacco dependence treatment.

Electronic Cigarettes for Smoking Cessation: A Systematic Review.

Electronic cigarettes (e-cigarettes) have been steadily increasing in popularity among smokers, most of whom report using them to quit smoking. This study systematically reviews the current literature on the effectiveness of e-cigarettes as cessation aids. We searched PubMed, MEDLINE, PsycINFO, CINAHL, ERIC, ROVER, Scopus, ISI Web of Science, Cochrane Library, the Ontario Tobacco Research Unit (OTRU) library catalogue, and various gray literature sources. We included all English-language, empirical quantitative and qualitative papers that investigated primary cessation outcomes (smoking abstinence or reduction) or secondary outcomes (abstinence-related withdrawal symptoms and craving reductions) and were published on or before February 1, 2016. Literature searches identified 2855 references. After removing duplicates and screening for eligibility, 62 relevant references were reviewed and appraised. In accordance with the GRADE system, the quality of the evidence in support of e-cigarettes' effectiveness in helping smokers quit was assessed as very low to low, and the evidence on smoking reduction was assessed as very low to moderate. The majority of included studies found that e-cigarettes, especially second-generation types, could alleviate smoking withdrawal symptoms and cravings in laboratory settings. While the majority of studies demonstrate a positive relationship between e-cigarette use and smoking cessation, the evidence remains inconclusive due to the low quality of the research published to date. Well-designed randomized controlled trials and longitudinal, population studies are needed to further elucidate the role of e-cigarettes in smoking cessation. This is the most comprehensive systematic evidence review to examine the relationship between e-cigarette use and smoking cessation among smokers. This review offers balanced and rigorous qualitative and quantitative analyses of published evidence on the effectiveness of e-cigarette use for smoking abstinence and reduction as well as important outcomes such as withdrawal symptoms and craving to smoke. While inconclusive due to low quality, overall the existing literature suggests e-cigarettes may be helpful for some smokers for quitting or reducing smoking. However, more carefully designed and scientifically sound studies are urgently needed to establish unequivocally the long-term cessation effects of e-cigarettes and to better understand of how and when e-cigarettes may be helpful.

An mHealth intervention: Associations between Theory of Planned Behaviour constructs for physical activity and longitudinal smoking related behavioural data.

Event Abstract Back to Event An mHealth intervention: Associations between Theory of Planned Behaviour constructs for physical activity and longitudinal smoking related behavioural data. Mary Hassandra1*, Risto Heikkinen2, Tarja Kettunen3 and Taru Lintunen1 1 University of Jyvaskyla, Department of Sport Sciences, Finland 2 Statistical Analysis Services, Finland 3 University of Jyvaskyla, Department of Health Sciences, Finland Background Physical activity behaviour is considered as a satisfactory additional aid method for quit smoking programs. Moreover, laboratory based studies provide strong evidence that physical activity acutely reduces cigarette cravings. An mHealth app (Physical over Smoking: Ph.o.S.) was developed to be used as a support tool for quitters to manage their cigarette cravings and help us testing the acute effectiveness of exercise on quitters under real-life conditions. Aim Aim of this study was to examine the associations between three explanatory variables of TPB-PA (attitudes, intention and perceived behavioural control for physical activity behaviour) on 3 smoking related response variables (number of cigarettes smoked, number of relapses and number of cravings), over a 3 month follow up period after quit smoking. Time, group and interaction of group X time were also examined. Method A quit smoking program (3 weekly sessions) which incorporated physical activity promotion applied to smokers who aimed to quit smoking. After the quit day each participant assigned randomly to a group of users of the mHealth app or to a group of non-users. Users received a short training to use the Ph.o.S app when experience cigarette cravings. The Ph.o.S app suggested short physical activities as a way to manage cravings. Forty four quitters (19 females) were assigned to a group of app users (n=25) and to a group of non-users (n=19). All participants completed the TPB - PA questionnaire immediately after their quit day and after that they reported their number of cigarettes smoked, number of relapses and number of cravings the last 7 days, at 3 days, 1, 2, 3, 4, 8, and 12 weeks after. Results Perceived Behavioural Control for Physical Activity (PBC-PA) behaviour predicted the number of relapses and cigarettes smoked for a follow up period of 3 months. Higher PBC-PA indicated lower number of relapses and smoked cigarettes during the 3 month follow up period. Time trends of cigarettes smoked and number of cravings was significantly different between groups. The number of cigarettes smoked didn’t increase as fast in users group as in non-users group, whereas cravings decreased faster in non-users group. Conclusion The results support previous literature suggesting that a possible mechanism behind the beneficial effects of exercise on decreasing smoking behaviour might be the increased perceived behavioural control over exercise that has an effect on the control to smoking behaviour. Moreover, using exercise to manage after quit smoking cravings can delay further smoking behaviour relapses. Keywords: mHealth, Exercise, Smoking, Theory of Planned Behavior, Generalized linear mixed model Conference: 2nd Behaviour Change Conference: Digital Health and Wellbeing, London, United Kingdom, 24 Feb - 25 Feb, 2016. Presentation Type: Poster presentation Topic: Academic Citation: Hassandra M, Heikkinen R, Kettunen T and Lintunen T (2016). An mHealth intervention: Associations between Theory of Planned Behaviour constructs for physical activity and longitudinal smoking related behavioural data.. Front. Public Health. Conference Abstract: 2nd Behaviour Change Conference: Digital Health and Wellbeing. doi: 10.3389/conf.FPUBH.2016.01.00105 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 27 Nov 2015; Published Online: 09 Jan 2016. * Correspondence: Dr. Mary Hassandra, University of Jyvaskyla, Department of Sport Sciences, Jyvaskyla, Finland, maria.m.chasandra@jyu.fi Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Mary Hassandra Risto Heikkinen Tarja Kettunen Taru Lintunen Google Mary Hassandra Risto Heikkinen Tarja Kettunen Taru Lintunen Google Scholar Mary Hassandra Risto Heikkinen Tarja Kettunen Taru Lintunen PubMed Mary Hassandra Risto Heikkinen Tarja Kettunen Taru Lintunen Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Neural Sensitivity to Smoking Stimuli Is Associated With Cigarette Craving in Adolescent Smokers

PurposeAdolescents initiate cigarette smoking at disproportionately high rates, despite widespread knowledge of its health-compromising and long-term consequences. Psychosocial factors clearly play a role in adolescent smoking initiation, but the role of the developing adolescent brain in this behavior remains unclear. The goal of the present study was to determine whether greater neural sensitivity to smoking cues in adolescents compared to adults underlies increased proclivity toward smoking behavior and craving. MethodsWe addressed this question in a sample of adolescent (n = 39) and adult (n = 39) smokers and nonsmokers by assessing craving in response to smoking videos that featured late adolescents/young adults while participants underwent functional magnetic resonance imaging. ResultsVentral striatal activation mediated the relationship between video-induced craving and subsequent desires to smoke following the scan in adolescent smokers only. We also found that functional coupling between striatal and cortical regions was associated with increased craving in adolescent smokers. ConclusionsThese novel results demonstrate that adolescent smokers may be more neurobiologically responsive to smoking stimuli than adults, perhaps because of ongoing ontogenetic changes in adolescents that normatively occur in frontostriatal circuitry.

Assessing the effectiveness of High Intensity Interval Training (HIIT) for smoking cessation in women: HIIT to quit study protocol.

BackgroundSmoking and physical inactivity are major risk factors for heart disease. Linking strategies that promote improvements in fitness and assist quitting smoking has potential to address both these risk factors simultaneously. The objective of this study is to compare the effects of two exercise interventions (high intensity interval training (HIIT) and lifestyle physical activity) on smoking cessation in female smokers.Method/designThis study will use a randomised controlled trial design. Participants: Women aged 18–55 years who smoke ≥ 5 cigarettes/day, and want to quit smoking. Intervention: all participants will receive usual care for quitting smoking. Group 1 - will complete two gym-based supervised HIIT sessions/week and one home-based HIIT session/week. At each training session participants will be asked to complete four 4-min (4 × 4 min) intervals at approximately 90 % of maximum heart rate interspersed with 3- min recovery periods. Group 2 - participants will receive a resource pack and pedometer, and will be asked to use the 10,000 steps log book to record steps and other physical activities. The aim will be to increase daily steps to 10,000 steps/day. Analysis will be intention to treat and measures will include smoking cessation, withdrawal and cravings, fitness, physical activity, and well-being.DiscussionThe study builds on previous research suggesting that exercise intensity may influence the efficacy of exercise as a smoking cessation intervention. The hypothesis is that HIIT will improve fitness and assist women to quit smoking.Australian New Zealand Clinical Trials RegistryACTRN12614001255673 (Registration date 02/12/2014)

Adolescent and Young Adult Smokers Who Self-Identify as Nonsmokers: Relationship With Cigarette-Related Withdrawal and Cravings.

Examine the extent to which low-nicotine dependent daily smokers identify themselves as nonsmokers (smoking nonsmokers) over time, and examine the effect of nicotine-related withdrawal symptoms and cravings in predicting self-identified smoking status. Longitudinal. National Youth Smoking Cessation Survey 2003-2005. One hundred thirty-two adolescents and young adults (16-24 years). A questionnaire was used to assess smoking identity, withdrawal, cravings, and smoking intensity parameters. Multivariable logistic regression analysis. Among the 132 smoking nonsmokers at baseline, 45% remained smoking nonsmokers at the 2-year follow-up, with 55% transitioning to smoking (i.e., self-identified as smoking smokers in the interim). After adjustments, participants exhibiting greater restlessness and cravings over time, respectively, had 3.59 (p = .01) and 4.31 (p = .008) greater odds of being a smoking nonsmoker at baseline but then transitioning into a smoking smoker at 2-year follow-up. These findings may have implications with respect to interventions emphasizing withdrawal and craving symptoms. Further, given that some youth smokers self-identify as nonsmokers, and do so over time, potential intervention efforts may be pointed toward cognitive-related strategies at improving self-perceptions.

Effects of transcranial direct current stimulation (tDCS) on cognition, symptoms, and smoking in schizophrenia: A randomized controlled study

Schizophrenia is characterized by cognitive deficits which persist after acute symptoms have been treated or resolved. Transcranial direct current stimulation (tDCS) has been reported to improve cognition and reduce smoking craving in healthy subjects but has not been as carefully evaluated in a randomized controlled study for these effects in schizophrenia. We conducted a randomized double-blind, sham-controlled study of the effects of 5 sessions of tDCS (2 milliamps for 20minutes) on cognition, psychiatric symptoms, and smoking and cigarette craving in 37 outpatients with schizophrenia or schizoaffective disorder who were current smokers. Thirty subjects provided evaluable data on the MATRICS Consensus Cognitive Battery (MCCB), with the primary outcome measure, the MCCB Composite score. Active compared to sham tDCS subjects showed significant improvements after the fifth tDCS session in MCCB Composite score (p=0.008) and on the MCCB Working Memory (p=0.002) and Attention-Vigilance (p=0.027) domain scores, with large effect sizes. MCCB Composite and Working Memory domain scores remained significant at Benjamini–Hochberg corrected significance levels (α=0.05). There were no statistically significant effects on secondary outcome measures of psychiatric symptoms (PANSS scores), hallucinations, cigarette craving, or cigarettes smoked. The positive effects of tDCS on cognitive performance suggest a potential efficacious treatment for cognitive deficits in partially recovered chronic schizophrenia outpatients that should be further investigated.

Smoking-specific experiential avoidance cognition: Explanatory relevance to pre- and post-cessation nicotine withdrawal, craving, and negative affect

BackgroundNegative-reinforcement based cognitive processes have been implicated in the maintenance of cigarette smoking. Given the expectation that smoking will attenuate aversive internal experiences, smokers may be particularly unwilling to experience or remain in contact with smoking-related distress (i.e., experiential avoidance). Yet, there is little known about a cognitive-based process termed smoking-specific experiential avoidance with regard to withdrawal, craving, or negative affect during a quit attempt. MethodData were collected from adult daily smokers (n=259) participating in a larger smoking cessation trial. Pre- and post-quit experiences of nicotine withdrawal, craving, and negative affect were examined in terms of cognitive-based smoking-specific experimental avoidance, measured by the Avoidance and Inflexibility Scale (AIS). ResultsResults indicated that baseline smoking-specific experiential avoidance was associated with greater overall levels of withdrawal, craving, and negative affect at treatment initiation (pre-cessation). Reductions in smoking-specific experiential avoidance from baseline to quit day were associated with increased likelihood of quit day abstinence. Such reductions were also predictive of lower levels of nicotine withdrawal, craving, and negative affect on quit day. Also, less reduction in experiential avoidance was associated with experiencing greater withdrawal in the early phase of quitting. DiscussionThe impact of cognitive-based experiential avoidance pertaining to smoking impacts both pre- and post-cessation experiences in terms of negative affect, withdrawal, and smoking cravings and may represent an important treatment target.

Imagine that: Examining the Influence of Exercise Imagery on Cigarette Cravings and Withdrawal Symptoms

Evidence highlights that an acute bout of exercise can contribute to reductions in cravings and withdrawal symptoms. However, it is unknown how low in intensity or movement one can go before these effects no longer exist. The current study examined if exercise imagery could contribute to reductions in smoking cravings and withdrawal symptoms after a short period of abstinence (CO≤6ppm). Regular smokers (N = 29) were randomized into one of three treatment groups: exercise imagery, moderate intensity exercise, or control. Each completed questionnaires including: the Strength of Desire to Smoke item (primary outcome) and the Mood and Physical Symptoms Scale (Secondary outcomes) pre- and post-treatment. A 3 (Condition) by 2 (Time) repeated measures ANOVA showed a medium non-significant interaction effect (partial η2 = .06) favouring the exercise group for reductions in desire to smoke. A large significant interaction effect (partial η2 = .24) was found for tension. Medium-to-large non-significant interaction effects favouring the exercise group were found for various withdrawal symptoms. These data, taken together, suggest that exercise imagery is not as powerful as moderate intensity exercise in reducing cravings and withdrawal symptoms following temporary abstinence. Implications and future directions are discussed.

Treatment of tobacco addiction using the Feeling-State Addiction Protocol (FSAP) of the Eye Movement Desensitization and Reprocessing (EMDR) treatment

Background Compulsions and cravings for smoking have been the subject of behavioral treatment. EMDR [1] is an established, effective treatment of trauma-based disorders [2]. Its use in the treatment of addictions and compulsions is relatively new. Although there are ways of targeting irrational positive affect via EMDR [3]. Merging the Feeling-State Theory of Compulsions and EMDR, the Eye Movement Compulsion Protocol (EMCP) was developed. EMCP is used for fading both feelings and un-wanted behavior related to smoking. The FSAP hypothesizes that the pleasure during smoking is imprinted in the brain generating feelings like comfort, contentment and happiness [4]. Thus, when craving resurges, the Feeling-State (FS) behavior is re-enacted. The EMCP incorporates the standard eye movement technique of EMDR to reduce the FS associated with impulsion to smoke. This study aims to assess the efficacy of the FSAP in the treatment of tobacco addiction of relapsed smokers with persistent compulsions to smoke

Ecological Momentary Assessment of Posttraumatic Stress Disorder Symptoms During a Smoking Quit Attempt

Smokers with posttraumatic stress disorder (PTSD) tend to lapse more quickly following a quit attempt, which might be explained by changes in PTSD symptoms during a quit attempt. The present study examines changes in PTSD symptoms, negative affect, and craving before and during a quit attempt. Participants in this study were 52 smokers with PTSD who completed random-alarm ecological momentary assessments of PTSD symptoms, negative affect, cigarette craving, and smoking behavior throughout a prequit phase of ad hoc smoking, a phase of abstinence from smoking, and a postlapse phase. Relative to the prequit phase, the abstinent phase was marked by decreases in PTSD reexperiencing, avoidance, and numbing clusters (ps ≤ .01). The odds of PTSD symptom or negative affect variability from one reading in the ecological momentary assessment (EMA)to the next reading was decreased in PTSD reexperiencing, avoidance, and numbing clusters (ps ≤ .02). Smoking cravings were also mildly decreased in the abstinent and postlapse phases (ps < .01), although some cravings in both phases were rated at the maximum intensity. Increased craving was predicted by the previous EMA reading of PTSD symptoms. Results suggested that smoking abstinence is not associated with exacerbation of PTSD symptoms, but PTSD symptoms during abstinence were related to craving levels during the quit attempt.

Abstract SS02-02: Does it hurt to try? Effects of e-cigarette sampling on smoking behavior and motivation to quit

Abstract Electronic cigarette (e-cigarette) use continues to increase rapidly with more smokers and non-smokers beginning to try to them. The potential impact of trying e-cigarettes is not well understood, but there are concerns that they may decrease smokers' motivation to quit smoking or be used as a bridge product for current smokers when they are in situations where smoking is prohibited. Using a sample of current smokers, uninterested in quitting, a pilot clinical laboratory trial was conducted investigating the impact of e-cigarette experimentation and short-term use on smokers' motivation and confidence to quit, withdrawal symptoms, and smoking behavior. The findings suggest that for current smokers, e-cigarette experimentation increased motivation and confidence to quit smoking (p&amp;lt;.05) and these continued to increase with continued short-term use. E-cigarettes were effective in managing smoking cravings and urges and were effective in helping smokers reduce their number of cigarettes smoked per day (44% reduction). Citation Format: Theodore L. Wagener. Does it hurt to try? Effects of e-cigarette sampling on smoking behavior and motivation to quit. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr SS02-02.

Repeated Transcranial Direct Current Stimulation Prevents Abnormal Behaviors Associated with Abstinence from Chronic Nicotine Consumption

Successful available treatments to quit smoking remain scarce. Recently, the potential of transcranial direct current stimulation (tDCS) as a tool to reduce craving for nicotine has gained interest. However, there is no documented animal model to assess the neurobiological mechanisms of tDCS on addiction-related behaviors. To address this topic, we have developed a model of repeated tDCS in mice and used it to validate its effectiveness in relieving nicotine addiction. Anodal repeated tDCS was applied over the frontal cortex of Swiss female mice. The stimulation electrode (anode) was fixed directly onto the cranium, and the reference electrode was placed onto the ventral thorax. A 2 × 20 min/day stimulation paradigm for five consecutive days was used (0.2 mA). In the first study, we screened for behaviors altered by the stimulation. Second, we tested whether tDCS could alleviate abnormal behaviors associated with abstinence from nicotine consumption. In naive animals, repeated tDCS had antidepressant-like properties 3 weeks after the last stimulation, improved working memory, and decreased conditioned place preference for nicotine without affecting locomotor activity and anxiety-related behavior. Importantly, abnormal behaviors associated with chronic nicotine exposure (ie, depression-like behavior, increase in nicotine-induced place preference) were normalized by repeated tDCS. Our data show for the first time in an animal model that repeated tDCS is a promising, non-expensive clinical tool that could be used to reduce smoking craving and facilitate smoking cessation. Our animal model will be useful to investigate the mechanisms underlying the effects of tDCS on addiction and other psychiatric disorders.

Are treatment expectations related to reductions in craving and withdrawal symptoms following an acute bout of exercise?

PurposeTo examine if expectancy beliefs towards exercise reducing smoking craving and withdrawal symptoms are related to these symptoms following an acute bout of exercise for women engaged in a quit attempt involving Nicotine Replacement Therapy (NRT). MethodParticipants (n = 149) underwent the 14-week Getting Physical on Cigarettes (GPOC) trial involving exercise and NRT. Exercise expectancy beliefs were collected at baseline (prior to week 1) and at week 5 (one week after quitting smoking and beginning 21 mg patch). At week 5, participants reported craving and withdrawal symptoms immediately prior to and following a 20-minute bout of moderate intensity exercise. To be eligible for subsequent analyses, participants had to demonstrate a carbon monoxide score of <6 ppm, adhere to their NRT program, and follow their acute exercise regime at the appropriate intensity (n = 91). ResultsA significant reduction in craving and withdrawal symptoms (i.e. craving, psychological, sedation) was found from pre- to post-exercise at week 5. Exercise expectancy beliefs demonstrated a trend effect increase from baseline to week 5. Both level of exercise expectancy (week 5) and residual change in exercise expectancy (baseline to week 5) were mildly associated with residual change in psychological symptoms, and unrelated to residual changes in craving and sedation. ConclusionExercise expectancy increases are unrelated to reductions in cravings and sedation and mildly related to reductions in psychological symptoms following an acute bout of moderate intensity exercise in smokers who have recently attempted to quit.

Automatic approach bias towards smoking cues is present in smokers but not in ex-smokers

Drug-addicted individuals show automatic approach tendencies towards drug-related cues, i.e., an approach bias (ApB). Nevertheless, little is known about ApB in tobacco smokers and about the presence of ApB after smoking abstinence. We investigated ApB to smoking cues in heavy tobacco smokers versus never-smokers and studied its relation to smoking characteristics and craving. Second, we compared ApBs of heavy smokers with biases of abstinent heavy smokers. A group of current heavy smokers (n = 24), ex-smokers who were abstinent for at least 5years (n = 20), and never-smokers (n = 20) took part in the experiment. An indirect smoking approach avoidance task was performed, in which participants were required to respond to pictures of smoking and neutral cues by pulling (approach) or pushing (avoid) on a joystick, according to the content-irrelevant format of the picture (landscape or portrait). Craving scores were examined using the Questionnaire of Smoking Urges. Heavy smokers showed an ApB for smoking cues compared to ex-smokers and never-smokers, which correlated positively to craving scores. There were no group differences in ApB scores for ex-smokers and never-smokers. These results suggest that ApBs for smoking cues are present in heavy smokers and decrease after long-term successful smoking cessation.

Slimming World in Stop Smoking Services (SWISSS): study protocol for a randomized controlled trial

BackgroundQuitting smokers gain weight. This deters some from trying to stop smoking and may explain the increased incidence of type 2 diabetes after cessation. Dieting when stopping smoking may be counterproductive. Hunger increases cravings for smoking and tackling two behaviours together may undermine quitting success. A meta-analysis of randomized controlled trials (RCTs) showed individualized dietary support may prevent weight gain, although there is insufficient evidence whether it undermines smoking cessation. Commercial weight management providers (CWMPs), such as Slimming World, provide individualized dietary support for National Health Service (NHS) patients; however, there is no evidence that they can prevent cessation-related weight gain.Our objective is to determine whether attending Slimming World from quit date, through referral from NHS Stop Smoking Services, is more effective than usual care at preventing cessation-related weight gain.MethodsThis RCT will examine the effectiveness of usual cessation support plus referral to Slimming World compared to usual cessation support alone. Healthy weight, overweight and obese adult smokers attending Stop Smoking Services will be included. The primary outcome is weight change in quitters 12 weeks post-randomization. Multivariable linear regression analysis will compare weight change between trial arms and adjust for known predictors of cessation-related weight gain.We will recruit 320 participants, with 160 participants in each arm. An alpha error rate of 5% and 90% power will detect a 2 kg (SD = 2.5) difference in weight gain at 12 weeks, assuming 20% remain abstinent by then.DiscussionThis trial will establish whether referral to the 12-week Slimming World programme plus usual care is an effective intervention to prevent cessation-related weight gain. If so, we will seek to establish whether weight control comes at the expense of a successful quit attempt in a further non-inferiority trial.Positive results from both these trials would provide a potential solution to cessation-related weight gain, which could be rolled out across England within Stop Smoking Services to better meet the needs of 0.75 million smokers stopping with NHS support every year.Trial registrationCurrent Controlled Trials ISRCTN65705512

The brain activations for both cue-induced gaming urge and smoking craving among subjects comorbid with Internet gaming addiction and nicotine dependence

Internet gaming addiction (IGA) has been classified as an addictive disorder in the proposed DSM 5 draft. However, whether its underlying addiction mechanism is similar to other substance use disorders has not been confirmed. The present functional magnetic resonance images study is aimed at evaluating the brain correlates of cue-induced gaming urge or smoking craving in subjects with both IGA and nicotine dependence to make a simultaneous comparison of cue induced brain reactivity for gaming and smoking. For this purpose, 16 subjects with both IGA and nicotine dependence (comorbid group) and 16 controls were recruited from the community. All subjects were made to undergo 3-T fMRIs scans while viewing images associated with online games, smoking, and neutral images, which were arranged according to an event-related design. The resultant image data was analyzed with full factorial and conjunction analysis of SPM5. The results demonstrate that anterior cingulate, and parahippocampus activates higher for both cue-induced gaming urge and smoking craving among the comorbid group in comparison to the control group. The conjunction analysis demonstrates that bilateral parahippocampal gyrus activates to a greater degree for both gaming urge and smoking craving among the comorbid group in comparison to the control group. Accordingly, the study demonstrates that both IGA and nicotine dependence share similar mechanisms of cue-induced reactivity over the fronto-limbic network, particularly for the parahippocampus. The results support that the context representation provided by the parahippocampus is a key mechanism for not only cue-induced smoking craving, but also for cue-induced gaming urge.

Nicotine Dependence Syndrome Scale and craving: Comparing nicotine-dependent individuals with and without comorbid alcohol dependence

Although several studies have explored craving for certain drugs, there is limited data describing the relationship between alcohol and nicotine craving from a multidimensional perspective among individuals with comorbid nicotine dependence (ND) and alcohol dependence (AD). We compared a group of male patients diagnosed with ND and AD (n = 160) to a group of male patients diagnosed with ND only (n = 235). Smoking- and drinking-related clinical features were measured, including craving levels and the Nicotine Dependence Syndrome Scale (NDSS), which is a multidimensional questionnaire measuring ND. Subsequently, we studied factors that influenced smoking and alcohol craving in the ND and AD group. Regarding the NDSS, the sum, priority and tolerance scores were significantly higher in the ND and AD group compared with the ND only group (P < 0.000, P < 0.000 and P = 0.001, respectively). In the comorbid group, regression analyses revealed that alcohol craving and Fagerstrom Test for Nicotine Dependence (FTND) scores contributed to nicotine craving (beta coefficient = 0.37, P = 0.005 and beta coefficient = 0.35, P = 0.026, respectively) and these two factors explained 36% of the variance). Nicotine craving appeared to be the only factor that contributed to alcohol craving (beta coefficient = 0.35, P = 0.002), and nicotine craving explained 16% of the variance. This study may help clarify the clinical relationship between comorbid alcohol and nicotine dependence and help guide the development of effective treatment strategies for ND and AD patients.

Predictors of Smoking Craving During Virtual Reality Exposure

Cue exposure treatment (CET) consists of controlled and repeated exposure to drug-related stimuli in order to reduce cue-reactivity. Virtual reality (VR) has proved to be a promising tool for exposition. However, identifying the variables that can modulate the efficacy of this technique is essential for selecting the most appropriate exposure modality. The aim of this study was to determine the relation between several individual variables and self-reported craving in smokers exposed to VR environments. Forty-six smokers were exposed to seven complex virtual environments that reproduce typical situations in which people smoke. Self-reported craving was selected as the criterion variable and three types of variables were selected as the predictor variables: related to nicotine dependence, related to anxiety and impulsivity, and related to the sense of presence in the virtual environments. Sense of presence was the only predictor of self-reported craving in all the experimental virtual environments. Nicotine dependence variables added predictive power to the model only in the virtual breakfast at home. No relation was found between anxiety or impulsivity and self-reported craving. Virtual reality technology can be very helpful for improving CET for substance use disorders. However, the use of virtual environments would make sense only insofar as the sense of presence was high. Otherwise, the effectiveness of exposure might be affected.

The Effect of Sensorimotor Replacement on Smoking Cessation and Craving

Current treatments for smoking cessation such as nicotine replacement therapy or varenicline address the primary reinforcer of smoking (nicotine), but sensorimotor stimuli (e.g. smell/taste of smoke, inhaling/exhaling, airway sensations, holding the cigarette) may act as secondary reinforcers and also contribute to smoking reward. Addressing both these aspects of smoking may help to enhance smoking cessation treatment. The aim of this review was to examine whether sensorimotor replacement can help to alleviate craving and aid smoking cessation. Three sensorimotor replacement products were examined: non-nicotine inhalators/aerosols, de-nicotinised cigarettes and electronic cigarettes. The current research suggests that sensorimotor replacement may enhance the efficacy of nicotine replacement therapy, but is unlikely to be useful if used alone. Electronic cigarettes may be the most promising approach, due to the combination of nicotine delivery and sensorimotor input.