Smoking-related Cues Research Articles

Smoking addiction: the shift from head to hands: Approach bias towards smoking-related cues in low-dependent versus dependent smokers.

The dual process theory is central to several models of addiction, implying both an increase of stimulus salience and deficits in inhibitory control. Our major aim is to provide behavioral evidence for an approach bias tendency in smokers and more specifically during smoking cue exposure. The second aim is to examine whether this bias differs in low-dependent versus dependent smokers. Thirty-two smokers (17 low dependent and 15 dependent; cut-off FTND of 4) and 28 non-smokers performed a modified Go/NoGo task using tobacco-related words and neutral words as stimuli. Smokers generally made more mistakes and tended to be faster for smoking-related cues specifically. Low dependents acknowledged more their dependency in declarative questionnaires while making more errors and being slower specifically on smoking cues; dependent smokers were less prone to indicate their addiction, but were faster and accurate when it came to picking the smoking cues. These results suggest that a shift has operated from a mental preoccupation with smoking in the low-dependent group, to smoking as a motor habit in our dependent group. This finding invites experts to rethink smoking addiction in the light of this crucial moment, namely, the shift "from head to hands".

Nicotine deprivation elevates neural representation of smoking-related cues in object-sensitive visual cortex: a proof of concept study

ObjectiveIn the current study, we use functional magnetic resonance imaging (fMRI) and multi-voxel pattern analysis (MVPA) to investigate whether tobacco addiction biases basic visual processing in favour of smoking-related images. We hypothesize that the neural representation of smoking-related stimuli in the lateral occipital complex (LOC) is elevated after a period of nicotine deprivation compared to a satiated state, but that this is not the case for object categories unrelated to smoking.MethodsCurrent smokers (≥10 cigarettes a day) underwent two fMRI scanning sessions: one after 10 h of nicotine abstinence and the other one after smoking ad libitum. Regional blood oxygenated level-dependent (BOLD) response was measured while participants were presented with 24 blocks of 8 colour-matched pictures of cigarettes, pencils or chairs. The functional data of 10 participants were analysed through a pattern classification approach.ResultsIn bilateral LOC clusters, the classifier was able to discriminate between patterns of activity elicited by visually similar smoking-related (cigarettes) and neutral objects (pencils) above empirically estimated chance levels only during deprivation (mean = 61.0%, chance (permutations) = 50.0%, p = .01) but not during satiation (mean = 53.5%, chance (permutations) = 49.9%, ns.). For all other stimulus contrasts, there was no difference in discriminability between the deprived and satiated conditions.ConclusionThe discriminability between smoking and non-smoking visual objects was elevated in object-selective brain region LOC after a period of nicotine abstinence. This indicates that attention bias likely affects basic visual object processing.

The dopamine D2 receptor mediates approach-avoidance tendencies in smokers.

Dopamine D2 receptors (DRD2) have been strongly implicated in reward processing of natural stimuli and drugs. Using the approach-avoidance task (AAT), we recently demonstrated that smokers show an increased approach-bias toward smoking-related cues but not toward naturally rewarding stimuli. Here, we examined the contribution of the DRD2 Taq1B polymorphism to smokers' and non-smokers' responsivity toward smoking versus naturally rewarding stimuli in the AAT. Smokers carrying the minor B1 allele of the DRD2 Taq1B polymorphism showed reduced approach behavior for food-related pictures compared to non-smokers with the same allele. In the group of smokers, a higher approach-bias toward smoking-related compared to food-related pictures was found in carriers of the B1 allele. This pattern was not evident in smokers homozygous for the B2 allele. In addition, smokers with the B1 allele reported fewer attempts to quit smoking relative to smokers homozygous for the B2 allele. This is the first study demonstrating that behavioral shifts in response to smoking relative to natural rewards in smokers are mediated by the DRD2 Taq1B polymorphism. Our results indicate a reduced natural-reward brain reactivity in smokers with a genetically determined decrease in dopaminergic activity (i.e., reduction of DRD2 availability). It remains to be determined whether this pattern might be related to a different outcome after psychological cessation interventions, i.e., AAT modification paradigms, in smokers.

Anhedonia and Abstinence as Predictors of the Subjective Pleasantness of Positive, Negative, and Smoking-Related Pictures.

Anhedonia-diminished interest or pleasure in response to rewards-is a dimension implicated in several psychiatric disorders linked to smoking. This laboratory study sought to identify motivational mechanisms linking anhedonia and tobacco addiction by testing the hypothesis that anhedonia, abstinence, and their interaction would predict excesses and deficits in the perceived pleasantness of smoking-related and positive pictures, respectively. We assessed the pleasantness of negative pictures as a secondary outcome. After a baseline session involving self-report measures of anhedonia and other factors, 125 regular smokers attended two counterbalanced experimental sessions (overnight abstinent and non-abstinent) at which they rated the pleasantness of positive, smoking-related, negative, and neutral (control) pictures presented via computer. The difference in pleasantness ratings of positive, smoking-related, and negative pictures relative to neutral pictures served as the index of participants' appraisal of the motivational salience of nondrug reward, drug reward, and aversive signals, respectively. With and without adjusting for sex and depressive symptoms, greater anhedonia significantly or marginally predicted greater pleasantness of smoking (vs. neutral), lower pleasantness of positive (vs. neutral), less unpleasantness of negative (vs. neutral) pictures (|βs| = 0.18 to 0.35, ps = .007 to .07). Anhedonia by abstinence interaction effects on pleasantness ratings of each stimulus category (vs. neutral) were not significant (|βs| ≤ 0.02, ps ≥ .36). Anhedonia and abstinence additively increase the salience of smoking-related cues in anhedonic smokers. Smoking cessation efforts that attenuate sensitization to smoking stimuli may benefit anhedonic smokers early in quit attempts. Taken together, these findings provide tentative evidence that anhedonia is associated with a relative imbalance in the motivational salience of drug relative to nondrug rewards and may be associated with a generalized hypo-reactivity to both positive and negative stimuli. Though some prior smoking research has evidenced this relative imbalance in anhedonia with self-report or a smoking-choice task, we additionally show that this pattern may extend to hyper-affective reactivity to smoking-related stimuli being coincident with hypo-affective reactivity to nondrug-related positive stimuli (ie, may extend to greater pleasantness ratings of smoking pictures being accompanied by lower pleasantness ratings of positive pictures).

Intranasal oxytocin dampens cue-elicited cigarette craving in daily smokers: a pilot study.

Despite moderate success with pharmacological and behavioral treatments, smoking relapse rates remain high, and many smokers report that smoking cues lead to relapse. Therefore, treatments that target cue reactivity are needed. One candidate for reducing craving is the neuropeptide oxytocin (OT). Here, we investigated the effects of intranasal OT on two types of craving for cigarettes: craving following overnight abstinence and craving elicited by smoking-related cues. In this within-subject, placebo-controlled pilot study, smokers (N=17) abstained from smoking for 12 h before attending two sessions randomized to intranasal OT or placebo (i.e. saline nasal spray). On each session, participants received two doses of OT (20 IU) or placebo at 1-h intervals, and rated craving before and after each dose. Spontaneous cigarette craving was assessed after the first spray, and cue-elicited craving was assessed following the second spray. OT did not reduce levels of spontaneous craving after the first spray, but significantly dampened cue-induced smoking craving. These results provide preliminary evidence that OT can reduce cue-induced smoking craving in smokers. These findings provide an important link between preclinical and clinical studies aimed at examining the effectiveness of OT as a novel treatment for drug craving.

Applying the ‘Cognitive Bias Modification’ concept to smoking cessation – A Systematic Review

Abstract. Background: In recent years, new neurocognitive explanatory approaches such as dual-process theories offer significant progress in understanding long-term relapse in substance use disorders. Based on such explanatory concepts stemming from basic research, novel methods of intervention have been deduced which focus on directly changing cognitive biases. The efficacy of these Cognitive Bias Modification (CBM) concepts has been evaluated in a growing number of studies in the context of different substance use and addictive disorders. By now, there are also first findings for using CBM in the context of smoking. Objectives: To evaluate the empirical evidence, whether CBM qualifies i) for reducing attentional or approach bias towards smoking-related cues, ii) for effectively reducing the high relapse rates in smoking cessation, iii) for the reduction of smoking behaviour and iv) craving. Methods: The systematic evidence search has been carried out in clinical databases (Cochrane Library, PsycArticles, PSYNDEX, PsycINFO, Medline) as well as via manual reverse search. Finally, 12 studies have been identified which met the inclusion criteria (RCT, CBM interventions for smokers; outcomes: change in attentional or approach bias, craving, number of cigarettes smoked, abstinence). Results: Despite the heterogeneity of the studies in terms of sample selection, realisation of interventions and methodological aspects, the findings collectively indicate that different forms and ‘dosages’ of CBM interventions can influence attentional or approach bias in smokers. Also, positive effects on craving and motivation to quit could be detected. Effects on smoking behaviour are inconsistent and often statistically non-significant. First online applications showed encouraging results. Discussion: The results concerning the efficacy of CBM in smoking cessation are still rudimentary and inconsistent. However, a large portion of the studies was not conducted under naturalistic conditions, but rather in laboratories with non-treatment seekers or participants partially motivated to quit. Despite these limitations, the findings can be evaluated as encouraging. The results suggest that CBM will be implemented in routine care as an adjunct intervention within a behavioural therapy-oriented cessation programme. However, specific studies which assess the efficacy of CBM as a component for relapse prevention in smoking cessation intervention in routine care are still lacking.

Visual cue-specific craving is diminished in stressed smokers

ABSTRACTBackground: Craving among smokers is increased by stress and exposure to smoking-related visual cues. However, few experimental studies have tested both elicitors concurrently and considered how exposures may interact to influence craving. Objective: The current study examined craving in response to stress and visual cue exposure, separately and in succession, in order to better understand the relationship between craving elicitation and the elicitor. Method: Thirty-nine smokers (21 males) who forwent smoking for 30 minutes were randomized to complete a stress task and a visual cue task in counterbalanced orders (creating the experimental groups); for the cue task, counterbalanced blocks of neutral, motivational control, and smoking images were presented. Self-reported craving was assessed after each block of visual stimuli and stress task, and after a recovery period following each task. Results: As expected, the stress and smoking images generated greater craving than neutral or motivational control images (p < .001). Interactions indicated craving in those who completed the stress task first differed from those who completed the visual cues task first (p < .05), such that stress task craving was greater than all image type craving (all p’s < .05) only if the visual cue task was completed first. Conversely, craving was stable across image types when the stress task was completed first. Conclusions: Findings indicate when smokers are stressed, visual cues have little additive effect on craving, and different types of visual cues elicit comparable craving. These findings may imply that once stressed, smokers will crave cigarettes comparably notwithstanding whether they are exposed to smoking image cues.

Electrophysiological mechanisms of biased response to smoking-related cues in young smokers

Cigarette smoking during young adult may result in serious health issues in later life. Hence, it is extremely necessary to study the smoking neurophysiological mechanisms in this critical transitional period. However, few studies revealed the electrophysiological mechanisms of cognitive processing biases in young adult smokers. In present study, nineteen young smokers with 12h abstinent and 19 matched nonsmokers were recruited. By employing event-related potentials (ERP) measurements during a smoking cue induced craving task, electrophysiological brain responses were compared between the young adult smokers and nonsmokers. The Slow Positive Wave (SPW) amplitude of smoking-related cues was enhanced in young adult smokers compared with nonsmokers. In addition, increased P300/SPW component of smoking-related cues relative to neutral cues were found in young adult smokers. Meanwhile, a positive correlation between Cigarette Per Day (CPD) and the amplitude of ERPs wave (P300/SPW) at anterior (Fz), central (Cz) were observed in young adult smokers. Our findings provided direct electrophysiological evidence for the cognitive processing bias of smoking cue and may shed new insights into the smoking behavior in young adult smokers.

Neural correlates of 12-h abstinence-induced craving in young adult smokers: a resting-state study.

Studying the neural correlates of craving to smoke in young adulthood is of great importance to improve treatment outcomes in nicotine dependence. Previous nicotine dependence studies mainly focused on the neural substrates of craving elicited by smoking-related cues. More explicit attention to abstinence-induced craving during resting state in nicotine dependence has the potential to yield valuable information about craving, and characterizing this kind of craving is critical for developing effective interventions. Twenty-five young male smokers were enrolled in the present study. A within-subject experiment design was carried out to compare regional homogeneity (ReHo) between 12-h smoking abstinence and smoking satiety conditions during resting state in young adult smokers. Then, the ReHo changes associated with smoking abstinence (compared with satiety) were further examined for correlations with abstinence-induced changes in subjective craving. We found young adult smokers in abstinence state (compared with satiety) had higher ReHo in brain regions in fronto-striatal circuits including bilateral caudate, anterior cingulate cortex (ACC) and bilateral dorsal lateral prefrontal cortex (DLPFC), as well as brain regions in default mode network (DMN) including posterior cingulate cortex (PCC)/precuneus and angular gyrus. Additionally, we found the ReHo changes of the ACC and the bilateral caudate were positively correlated with the changes in craving induced by abstinence (i.e., abstinence minus satiety) in young adult smokers. The present findings improve the understanding of the effects of acute smoking abstinence on spontaneous brain activity and may contribute new insights into the neural mechanism of abstinence-induced craving in nicotine dependence.

Assessment of Tobacco-Related Approach and Attentional Biases in Smokers, Cravers, Ex-Smokers, and Non-Smokers.

According to theories of addictive behaviors, approach and attentional biases toward smoking-related cues play a crucial role in tobacco dependence. Several studies have investigated these biases by using various paradigms in different sample types. However, this heterogeneity makes it difficult to compare and evaluate the results. The present study aimed to address this problem, via (i) a structural comparison of different measures of approach-avoidance and a measure of smoking-related attentional biases, and (ii) using within one study different representative samples in the context of tobacco dependence. Three measures of approach-avoidance were employed: an Approach Avoidance Task (AAT), a Stimulus Response Compatibility Task (SRC), and a Single Target Implicit Association Test (ST-IAT). To assess attentional biases, a modified Stroop task including smoking-related words was administered. The study included four groups: n = 58 smokers, n = 57 non-smokers, n = 52 cravers, and n = 54 ex-smokers. We expected to find strong tobacco-related approach biases and attentional biases in smokers and cravers. However, the general pattern of results did not confirm these expectations. Approach responses assessed during the AAT and SRC did not differ between groups. Moreover, the Stroop did not show the expected interference effect. For the ST-IAT, cravers had stronger approach associations toward smoking-related cues, whereas non-smokers showed stronger avoidance associations. However, no such differences in approach-avoidance associations were found in smokers and ex-smokers. To conclude, these data do not provide evidence for a strong role of implicit approach and attentional biases toward smoking-related cues in tobacco dependency.

Individualized real-time fMRI neurofeedback to attenuate craving in nicotine-dependent smokers

Cue-induced craving plays an important role in relapse, and the neural correlates of cue-induced craving have been elucidated using fMRI. This study examined the utility of real-time fMRI (rtfMRI) neurofeedback to strengthen self-regulation of craving-related neural activation and cue-reactivity in cigarette smokers. Nicotine-dependent smokers were randomized to rtfMRI neurofeedback or to a no-feedback control group. Participants completed 3 neuroimaging visits. Within each visit, an initial run during which smoking-related cues were used to provoke craving, an individualized craving-related region of interest (ROI) in the prefrontal cortex or anterior cingulate cortex was identified. In the rtfMRI group, activity from the ROI was fed back via a visual display during 3 subsequent runs while participants were instructed to reduce craving during cue exposure. The control group had an identical experience with no feedback provided. Forty-four nicotine-dependent smokers were recruited to participate in our study; data from the 33 participants who completed a 1-week follow-up visit were included in the analysis. Subjective craving ratings and cue-induced brain activation were lower in the rtfMRI group than in the control group. As participants were not seeking treatment, clinical outcomes are lacking. Nicotine-dependent smokers receiving rtfMRI feedback from an individualized ROI attenuated smoking cue-elicited neural activation and craving, relative to a control group. Further studies are needed in treatment-seeking smokers to determine if this intervention can translate into a clinically meaningful treatment modality.

The Use of Virtual Reality in the Production of Cue-Specific Craving for Cigarettes: A Meta-Analysis.

The cue-reactivity procedure has demonstrated that smokers respond with increases in subjective craving in the presence of smoking-related cues. Virtual reality is an emerging mode of cue presentation for cue-reactivity research. Despite the successful implementation of virtual reality during the last decade, no systematic review has investigated the magnitude of effects across studies. This research systematically reviewed findings from studies using virtual reality in cigarette craving assessment. Eligible studies assessed subjective craving for cigarettes in smokers exposed to smoking-related and neutral environments. Cohen's d was used to assess differences in craving between smoking-related and nonsmoking-related virtual environments. A random effects approach was used to combine effect sizes. A total of 18 studies involving 541 smokers was included in the final analyses. Environments with smoking-related cues produced significant increases in craving relative to environments without smoking-related cues. The mean overall effect size (Cohen's d) was 1.041 (SE = 0.12, 95% CI = 0.81 to 1.28, Z = 8.68, P < .001). The meta-analysis suggested that presentations of smoking cues through virtual reality can produce strong increases in craving among cigarette smokers. This strong cue-reactivity effect, which was comparable in magnitude to the craving effect sizes found with more conventional modes of cue presentation, supports the use of virtual reality for the generation of robust cue-specific craving in cue-reactivity research.

Examining the relationship between cue-induced craving and actual smoking.

Smoking cue-reactivity studies have consistently demonstrated heightened self-report craving, as well as moderate autonomic reactivity, among smokers exposed to salient drug-related cues. However, significantly fewer studies have examined whether exposure to smoking cues affects smokers' actual smoking, or examined the predictive relationship between cue-induced craving and smoking behavior. Using our well-tested pictorial cues in a cue-reactivity paradigm, we investigated the impact of smoking-related cues relative to neutral cues on subjective craving and smoking behavior (assessed via CReSS; Plowshare Technologies, Baltimore, MD) measures of latency to smoke, puff volume, and number of puffs). Further, we examined the predictive value of cue-induced craving on subsequent smoking behavior. Sixty nondeprived daily smokers completed 2 experimental sessions involving exposure to either smoking-related or neutral pictorial cues. Following initial exposure to cues, smokers rated their craving and were then allowed to smoke freely if they chose to during a subsequent 6-min cue exposure period. Result showed that exposure to smoking cues relative to neutral predicted significantly greater craving and increases in smoking behavior. Likewise, the magnitude of the difference in cue-induced craving when exposed to smoking cues relative to neutral cues (i.e., the cue-reactivity effect) was highly predictive of shorter latency to smoke, as well as increased number of puffs and puff volume.

Implicit attitudes towards smoking predict long-term relapse in abstinent smokers.

It has previously been argued that implicit attitudes toward substance-related cues drive addictive behavior. Nevertheless, it remains an open question whether behavioral markers of implicit attitude activation can be used to predict long-term relapse. The main objective of this study was to examine the relationship between implicit attitudes toward smoking-related cues and long-term relapse in abstaining smokers. Implicit attitudes toward smoking-related cues were assessed by means of the Implicit Association Test (IAT) and the evaluative priming task (EPT). Both measures were completed by a group of smokers who volunteered to quit smoking (patient group) and a group of nonsmokers (control group). Participants in the patient group completed these measures twice: once prior to smoking cessation and once after smoking cessation. Relapse was assessed by means of short telephone survey, 6months after completion of the second test session. EPT scores obtained prior to smoking cessation were related to long-term relapse and correlated with self-reported nicotine dependence as well as daily cigarette consumption. In contrast, none of the behavioral outcome measures were found to correlate with the IAT scores. These findings corroborate the idea that implicit attitudes toward substance-related cues are critically involved in long-term relapse. A potential explanation for the divergent findings obtained with the IAT and EPT is provided.

Lack of attentional retraining effects in cigarette smokers attempting cessation: A proof of concept double-blind randomised controlled trial

BackgroundObservational studies have shown that attentional bias for smoking-related cues is associated with increased craving and relapse. Laboratory experiments have shown that manipulating attentional bias may change craving. Interventions to reduce attentional bias could reduce relapse in smokers seeking to quit. We report a clinical trial of attentional retraining in treatment-seeking smokers. MethodsThis was a double-blind randomised controlled trial that took place in UK smoking cessation clinics. Smokers interested in quitting were randomised to five weekly sessions of attentional retraining (N=60) or placebo training (N=58) using a modified visual probe task from one week prior to quit day. Both groups received 21mg nicotine patches (from quit day onwards) and behavioural support. Primary outcomes included change in attentional bias reaction times four weeks after quit day on the visual probe task and craving measured weekly using the Mood and Physical Symptoms Scale. Secondary outcomes were changes in withdrawal symptoms, time to first lapse and prolonged abstinence. ResultsNo attentional bias towards smoking cues was found in the sample at baseline (mean difference=3ms, 95% CI=−2, 9). Post-training bias was not significantly lower in the retraining group compared with the placebo group (mean difference=−9ms, 95% CI=−20, 2). There was no difference between groups in change in craving (p=0.89) and prolonged abstinence at four weeks (risk ratio=1.00, 95% CI=0.70, 1.43). ConclusionsTaken with one other trial, there appears to be no effect from clinic-based attentional retraining using the visual probe task. Attentional retraining conducted out of clinic may prove more effective. Clinical trial registrationUK Clinical Trials ISRCTN 54375405.

Smoking cue reactivity in current smokers, former smokers and never smokers

IntroductionSmoking related stimuli are known to increase both subjective craving and heart rate in smokers; however, little is currently known about the effects of such stimuli in former smokers. MethodsSubjective craving and heart rate were measured in 38 never smokers, 20 former smokers, and 30 current smokers exposed to video clips containing neutral and smoking related cues. ResultsCompared with neutral cues, smoking cues significantly increased both heart rate and self-reported craving in current smokers, while in former smokers smoking cues were associated with a significant decrease in heart rate as well as with a relatively diminished increase in subjective craving. Neither craving nor heart rate was impacted by the smoking cues in never smokers. ConclusionsFindings suggest that while smoking related stimuli continue to elicit modest subjective cravings in former smokers, there appears to be a marked change in the typical physiological response associated with such stimuli.

Smoking abstinence and neurocognition: implications for cessation and relapse.

In this chapter, we review the last decade of research on the effects of smoking abstinence on various forms of neurocognition, including executive function (working memory, sustained attention, response inhibition), reward processing, and cue-reactivity. In our review we identify smoking abstinence-induced deficits in executive function mediated by effects on frontal circuitry, which in turn is known to be affected by modulation of cholinergic, dopaminergic, and other neurotransmitter systems. We also review evidence that smoking abstinence blunts reactivity to non-drug reinforcers-a finding that is consistent with results in the animal literature. Finally, our review of cue-reactivity indicates that smoking abstinence does not appear to amplify cue-provoked craving, although it may increase attentional bias to smoking-related cues. Inconsistencies across findings and potential contributing factors are discussed. In addition, we review the literature on the effects of nicotine and non-nicotine factors in neurocognition. Finally, we provide a multi-factor model and an agenda for future research on the effects of smoking abstinence on neurocognition. The model includes four distinct yet interacting factors, including: Negative Reinforcement, Drug-Reward Bias, Goal and Skill Interference, and Non-Cognitive Factors. Additional research is needed to further evaluate the scope and time-course of abstinence-induced changes in neurocognition, the mechanisms that underlie these changes and the specific role of these processes in drug reinforcement, lapse, and relapse.

Effects of varenicline and cognitive bias modification on neural response to smoking-related cues: study protocol for a randomized controlled study.

BackgroundSmoking-related cues can trigger drug-seeking behaviors, and computer-based interventions that reduce cognitive biases towards such cues may be efficacious and cost-effective cessation aids. In order to optimize such interventions, there needs to be better understanding of the mechanisms underlying the effects of cognitive bias modification (CBM). Here we present a protocol for an investigation of the neural effects of CBM and varenicline in non-quitting daily smokers.Methods/DesignWe will recruit 72 daily smokers who report smoking at least 10 manufactured cigarettes or 15 roll-ups per day and who smoke within one hour of waking. Participants will attend two sessions approximately one week apart. At the first session participants will be screened for eligibility and randomized to receive either varenicline or a placebo over a seven-day period. On the final drug-taking day (day seven) participants will attend a second session and be further randomized to one of three CBM conditions (training towards smoking cues, training away from smoking cues, or control training). Participants will then undergo a functional magnetic resonance imaging scan during which they will view smoking-related pictorial cues. Primary outcome measures are changes in cognitive bias as measured by the visual dot-probe task, and neural responses to smoking-related cues. Secondary outcome measures will be cognitive bias as measured by a transfer task (modified Stroop test of smoking-related cognitive bias) and subjective mood and cigarette craving.DiscussionThis study will add to the relatively small literature examining the effects of CBM in addictions. It will address novel questions regarding the neural effects of CBM. It will also investigate whether varenicline treatment alters neural response to smoking-related cues. These findings will inform future research that can develop behavioral treatments that target relapse prevention.Trial registrationRegistered with Current Controlled Trials: ISRCTN65690030. Registered on 30 January 2014.

Winning and losing: differences in reward and punishment sensitivity between smokers and nonsmokers.

BackgroundSmokers show increased brain activation in reward processing regions in response to smoking-related cues, yet few studies have examined secondary rewards not associated with smoking (i.e., money). Inconsistencies exist in the studies that do examine secondary rewards with some studies showing increased brain activation in reward processing brain regions, while others show decreased activation or no difference in activation between smokers and nonsmokers.AimsThe goal of the current study is to see if smokers process the evaluation and delivery of equally salient real world rewards similarly or differently than nonsmokers.MethodsThe current study employed functional magnetic resonance imaging (fMRI) to examine brain responses in smokers and nonsmokers during the evaluation and delivery of monetary gains and losses.ResultsIn comparison to nonsmokers, smokers showed increased activation in the ventromedial prefrontal cortex to the evaluation of anticipated monetary losses and the brain response. Moreover, smokers compared to nonsmokers showed decreased activation in the inferior frontal gyrus to the delivery of expected monetary gains. Brain activations to both the evaluation of anticipated monetary losses and the delivery of expected monetary gains correlated with increased self-reported smoking craving to relieve negative withdrawal symptoms and craving related to positive aspects of smoking, respectively.DiscussionTogether these results indicate that smokers are hyperresponsive to the evaluation of anticipated punishment and hyporesponsive to the delivery of expected rewards. Although further research is needed, this hypersensitivity to punishments coupled with increased craving may negatively impact quit attempts as smokers anticipate the negative withdrawal symptoms associated with quitting.

Effectiveness of Coping Strategies at Alleviating Cue-Induced Craving: a Pilot Study

Introduction:Results from observational studies suggest that smoking-related cues play a role in triggering relapse. Coping strategies are among the most commonly used cessation strategies, but little is known about how they aid quitting.Aims:The aim of this pilot study was to evaluate the effect of a suite of selected coping techniques on alleviating cue-induced cravings.Methods:Thirty-seven daily smokers (Intervention: 20; Control: 17) participated in two laboratory cue-reactivity sessions, separated by approximately one week, during which craving was assessed before and after exposure to smoking-related cues. Following the first session, participants in the Intervention Group were taught a suite of coping strategies. During the second session, participants in the Intervention Group were encouraged to use these strategies.Results:Participants in the Intervention Group reported a slight decrease in craving following the acute exposure manipulation at the second session, compared to an increase in craving among participants in the Control Group. Intervention Group participants also reported a decrease in craving following prolonged exposure to the smoking cues (compared to an increase in craving among Control Group participants). In both cases, the difference between groups was more pronounced among smokers who responded to the cue-reactivity manipulation. The observed differences were not significant.Conclusions:The results of this pilot study suggest that coping techniques may be beneficial in alleviating both the initial spike in craving observed following acute cue exposure, and aid recovery during prolonged exposure. These findings need to be replicated in a larger study.