Smoking Reward Research Articles

Seeing Through the Blind: Belief About Treatment Randomization and Smoking Cessation Outcome Among People With Current or Past Major Depressive Disorder Who Smoke in a Placebo-Controlled Trial of Varenicline.

Blinding participants to randomization is a cornerstone of science. However, participant beliefs about their allocation can influence outcomes. We examined blind integrity, the association between trial arm belief and cessation, and potential mechanisms linking treatment arm and treatment arm belief among people with major depressive disorder (MDD) who smoke receiving varenicline in a placebo-controlled trial. 175 participants were asked at the end of treatment (EOT) if they thought they received placebo, varenicline, or were not sure. We assessed the relationship between treatment arm belief and actual treatment allocation, examined the association between treatment arm belief and EOT cessation, and evaluated changes in craving, withdrawal, side effects, depression symptoms, and smoking reward as mediators through which treatment arm was believed. Treatment arm belief was significantly associated with actual arm assignment (χ2(2) = 13.0, p = .002). Participants in the varenicline arm were >3 times as likely to believe they were taking varenicline, versus "not sure" (RR = 3.05 [1.41-6.60], p = .005). Participants in the placebo arm were just as likely to believe they were taking placebo versus "not sure" (χ2[2] = 0.75, p = .69). Controlling for treatment arm, belief that one received varenicline was significantly associated with an increase in cessation rate (OR = 5.91 [2.06-16.92], p = .001). Change in the rewarding experience of smoking may mediate participant ability to discern getting varenicline (B = 0.077 [0.002-0.192], p < .05). Participants receiving varenicline can discern that they received varenicline and this belief is associated with higher cessation rates. Research is needed to continue to examine how participants correctly identify their allocation to varenicline. Data come from the trial NCT02378714. The present study adds to the sparse literature on blind integrity, particularly in the field of tobacco cessation. Randomized clinical trial participants can discern their assignment to varenicline, and believing that one received varenicline was associated with significantly higher cessation rates. Identifying treatment arm allocation may be associated with changes in the rewarding aspects of smoking that have been well documented with varenicline use. Masking allocation to varenicline is challenging. The effects of this medication in clinical trials may represent both pharmacological effects and participants' abilities to recognize that they are receiving the medication.

Treatment adherence in a smoking cessation clinical trial for individuals with current or past major depressive disorder: Predictors and association with cessation

IntroductionIndividuals with major depressive disorder (MDD) exhibit high rates of tobacco use and lower responsiveness to tobacco cessation treatments. Treatment adherence is a strong predictor of treatment outcomes in the general population but has not been evaluated in this under-served community of smokers with MDD. MethodsWe used data from a randomized clinical trial on smoking cessation treatment among 300 smokers with MDD to examine the rate of adherence (medication and counseling), the association of adherence with cessation outcomes, and factors associated with adherence, including demographic and smoking characteristics, psychiatric characteristics, smoking cessation processes (e.g., withdrawal, reinforcers), and treatment-related side effects (e.g., nausea). ResultsOverall, 43.7% of participants were adherent with medication and 63.0% were adherent with counseling. Medication adherence was significantly associated with cessation, with 32.1% of adherent vs. 13.0% of non-adherent participants quitting smoking at EOT. Counseling adherence was also significantly associated with cessation, with 32.3% of adherent vs. 2.7% of non-adherent participants quitting smoking. Multivariate regression models showed that medication adherence was associated with higher engagement in complementary reinforcers and higher baseline smoking reward, while counseling adherence was associated with identifying as female, lower alcohol use and nicotine dependence, higher baseline smoking reward, and higher engagement in substitute and complementary reinforcers within the first weeks of medication use. ConclusionsAs with the general population of smokers, non-adherence to treatment in smokers experiencing depression is widespread and a significant barrier to cessation. Interventions that target reinforcers may improve rates of treatment adherence.

Natural and synthetic estrogens specifically alter nicotine demand and cue-induced nicotine seeking in female rats

Women have more difficulty maintaining smoking cessation than men, and experience greater withdrawal symptomatology as well as higher prevalence of relapse. Further, currently available treatments for smoking cessation, such as the nicotine patch and varenicline, have been shown to be less effective in women. Fluctuations in ovarian hormones across the menstrual cycle can affect craving and smoking relapse propensity. In addition, many women who smoke use some form of oral contraceptives, which most often contain ethinyl estradiol (EE), a synthetic, orally bio-available estrogen that is currently prescribed to women chronically and has been shown to alter smoking reward in women. The current study examined the impact of 17β-estradiol (E2), the prominent endogenous form of the steroid hormone estrogen, as well as EE, on nicotine self-administration, demand, and reinstatement following ovariectomy (OVX) or sham surgery. OVX vehicle-treated female rats consumed less nicotine, had lower intensity of demand, and reinstated less compared to sham vehicle-treated female rats. OVX-E2 and OVX-EE treatment groups showed a rebound of nicotine intake later in training, and Q0 levels of consumption were partially rescued in both groups. Further, E2 but not EE reversed the abolishment of reinstated nicotine seeking induced by OVX. Taken together, these results demonstrate that natural and synthetic estrogens play a critical role in mediating the neurobehavioral effects of nicotine, and future studies are essential for our understanding of how synthetic hormones contained within oral contraceptives interact with smoking.

Cortisol Concentration as Predictor of Tobacco Initiation in Adolescents: Results From a Population-Based Swedish Cohort

PurposeStress potentiates the smoking reward, decreases the ability to resist smoking, and increases the risk of smoking relapse in adulthood. This study aimed to clarify if salivary cortisol, as an indicator of stress, may be prospectively associated with the onset and phenotype of tobacco use in adolescents. MethodsThis study was based on a cohort of Swedish adolescents, among whom saliva specimens were collected from a nested sample. We included adolescents with salivary cortisol measurements and without a history of tobacco use (n = 381, aged 13–14 years). Quartiles of morning and afternoon cortisol concentration and cortisol area under the curve were considered as predictors. We categorized tobacco use according to the product mainly used: cigarette smoking, snus use, or either type of tobacco. For each product use, two outcomes were considered: initiation and duration of use. Poisson regression models were used to calculate rate ratios. ResultsA quartile increase in morning cortisol levels and cortisol area under the curve was consistently associated with a 1.2- to 1.4-fold increased risk of initiation of cigarette smoking snus use, or any tobacco use. Similar results were obtained examining the dose–response relationship and using the duration of use as outcome. No associations were apparent between afternoon cortisol concentration and any of the outcomes. All associations were similar between sexes. ConclusionsMorning cortisol concentration, an indicator of hypothalamic–pituitary–adrenal axis activation, is prospectively associated with tobacco use in adolescents. Whether this activation indicates the cumulative effect of stressors during the life course remains to be elucidated.

Rapid Brain Nicotine Uptake from Electronic Cigarettes.

This study sought to determine brain nicotine kinetics from use of the increasingly popular electronic cigarette (E-cig). Methods: In 17 E-cig users (9 men and 8 women), brain uptake of nicotine after inhalation from E-cigs was directly assessed using 11C-nicotine PET. The brain nicotine kinetics were compared with those from smoking combustible cigarettes (C-cigs). Results: A single puff of E-cig vapor caused the nicotine concentration in the brain to rise quickly (mean time to reach 50% of maximum brain nicotine concentration, 27 s), with a peak amplitude 25% higher in women than men, resembling previous observations with C-cigs. Nonetheless, the accumulation from E-cigs (24%) was less than that from C-cigs (32%) in both men and women. Conclusion: E-cigs can deliver nicotine to the brain with a rapidity similar to that of C-cigs. Therefore, to the extent that rapid brain uptake promotes smoking reward, E-cigs might maintain a degree of nicotine dependence and also serve as a noncombustible substitute for cigarettes.

Menthol cigarette smoking is associated with greater subjective reward, satisfaction, and “throat hit”, but not greater behavioral economic demand

AimsThe cooling and minty flavor of menthol in cigarettes has been hypothesized to mask the harshness of inhaled cigarette smoke, contributing to menthol's appeal and subjective reinforcement and linking menthol use to smoking initiation, progression, nicotine dependence, and difficulty quitting. This study examined differences between menthol and non-menthol smokers on behavioral economic indices of reinforcing efficacy (i.e., demand) and subjective response to smoking (i.e., satisfaction, reward, “throat hit,” aversion) and the association between measurements of reinforcement and subjective response. Design600 current adult smokers were recruited from an online smoking cessation program. Following website enrollment, individuals completed a self-report measurement of subjective response to smoking (reward, satisfaction, aversion, “throat hit”), and a modified cigarette purchase task (CPT) to assess behavioral economic cigarette demand. FindingsIn bivariate and adjusted ANOVA models, menthol smokers reported greater subjective reward, satisfaction, and positive sensations in the throat (“throat hit”) from smoking compared to non-menthol smokers; and those outcomes were also correlated with greater nicotine dependence and lower likelihood of a past-year quit attempt. Although cigarette demand was associated with smoking level, subjective smoking reward, and nicotine dependence, there were no differences in smoking demand between menthol vs. non-menthol smokers. ConclusionsThe pleasurable aspects of menthol vs non-menthol smoking may be a mechanism linking it to greater nicotine dependence and difficulty quitting. A menthol ban could decrease population-level cigarette consumption by restricting smokers' access to a highly rewarding cigarette flavoring.

Initial application of a human laboratory model for estimating the motivational substitutability of e-cigarettes for combustible cigarettes.

This pilot study tested a novel human laboratory model for estimating the extent to which electronic cigarettes (e-cigarettes) serve as motivational substitutes for combustible cigarettes. The model assesses 3 parameters of substitutability, including the: (a) increase in motivational reward value of e-cigarettes after tobacco deprivation; (b) reduction in the reward value of combustible cigarettes after e-cigarette administration; and (c) comparability of the withdrawal-suppressing effects of e-cigarettes versus combustible cigarettes. Dual users (daily smokers, vaped 4+ days/week, M age = 35.3) attended 4 visits after 16-h tobacco product abstinence. For 2 visits, participants completed withdrawal measures and a task assessing smoking's reward value preceded by either: satiation by vaping or sustained tobacco product deprivation. For 2 other visits, participants completed withdrawal measures and a task assessing vaping's reward value preceded by either: continued deprivation versus satiation by smoking. Tobacco product deprivation (vs. satiation by smoking) increased vaping's reward value, indicated by nonsignificantly greater likelihood of initiating vaping versus abstaining for money (d = -.26; adjusted p [padj] = .08) and more vaping episodes purchased (β = .22; padj = .08). Satiation by vaping (vs. deprivation) nonsignificantly reduced smoking initiation (d = .46; padj = .09) and significantly decreased number of cigarettes purchased (β = -.29; padj = .04). Relative to deprivation, vaping suppressed withdrawal-related negative affect, smoking and vape urge, and anhedonia (ds ≥ .54). The magnitude of vaping-induced and smoking-induced withdrawal suppression did not significantly differ for all outcomes other than smoking urge, which was more strongly reduced by smoking (d = -1.57) than vaping (d = -.64). Future application and extension of this model may advance tobacco regulatory science and policy addressing e-cigarette use among smokers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Mediators of the effect of nicotine pre-treatment on quitting smoking.

Using smoking cessation medications for several weeks prior to quitting smoking facilitates quitting success, but how it does so is not clear. Candidate theories are that pre-cessation medication enhances self-efficacy, facilitates medication adherence post-quit, induces aversion to smoking, reduces reward from smoking or reduces the drive to smoke. We investigated these pathways using data from a large trial of nicotine pre-loading, using mediation analysis. Randomized controlled trial of nicotine pre-loading. Potential mediators were assessed at baseline and 1week into the pre-loading (3weeks prior to quitting). In addition to this, urges to smoke in abstainers were assessed 1week after the target quit date. England. A total of 1792 smokers who wanted to quit attending specialist smoking cessation services in England were enrolled between 13 August 2012 and 10 March 2015. Participants were randomized to either standard smoking cessation medications accompanied by behavioural support or the same treatment supplemented by nicotine 'pre-loading', i.e. 4weeks of 21mg nicotine patch use prior to quitting. The primary outcome, selected for its proximity in time to potential mediators, was biochemically validated abstinence from smoking at 4weeks post-target quit date. Potential mediators included the Modified Cigarette Evaluation Questionnaire, with subscales assessing satisfaction, reward, craving and aversion; ratings of strength and frequency of urges to smoke; the Mood and Physical Symptoms Scale assessing cigarette withdrawal symptoms; two items from the Nicotine Dependence Syndrome Scale assessing smoking stereotypy; self-reported reduction in cigarettes per day and in carbon monoxide (CO) reading; post-target quit day (TQD) medication adherence; self-efficacy; nausea. Pre-loading reduced urges to smoke at 3weeks pre-quit (P<0.001) and exhaled CO concentrations (P<0.001), and also urges to smoke post-quit in abstainers (P=0.001). At 3weeks pre-quit, it also reduced cigarette consumption, enjoyment of and satisfaction from smoking and smoking reward and increased nausea, aversion (all P<0.001) and smoking stereotypy (P=0.003). Only the first three variables, however (reduced smoke intake and reduced urges to smoke pre- and post-quit), mediated abstinence from smoking at 4weeks and only the latter two mediated abstinence at 6months (indirect mediating effects P<0.05). Nicotine pre-loading appears to facilitate smoking abstinence by reducing urges to smoke and smoke intake before quitting and urges to smoke after quitting.

A Novel Approach to Extinguish Smoking Reward

Addictive substances hijack reward learning. Investigators examined methods to reverse this process in 87 treatment-seeking smokers, who were

Blunted striatal response to monetary reward anticipation during smoking abstinence predicts lapse during a contingency-managed quit attempt.

Tobacco smoking is associated with dysregulated reward processing within the striatum, characterized by hypersensitivity to smoking rewards and hyposensitivity to non-smoking rewards. This bias toward smoking reward at the expense of alternative rewards is further exacerbated by deprivation from smoking, which may contribute to difficulty maintaining abstinence during a quit attempt. We examined whether abstinence-induced changes in striatal processing of rewards predicted lapse likelihood during a quit attempt supported by contingency management (CM), in which abstinence from smoking was reinforced with money. Thirty-six non-treatment-seeking smokers participated in two functional MRI (fMRI) sessions, one following 24-h abstinence and one following smoking as usual. During each scan, participants completed a rewarded guessing task designed to elicit striatal activation in which they could earn smoking and monetary rewards delivered after the scan. Participants then engaged in a 3-week CM-supported quit attempt. As previously reported, 24-h abstinence was associated with increased striatal activation in anticipation of smoking reward and decreased activation in anticipation of monetary reward. Individuals exhibiting greater decrements in right striatal activation to monetary reward during abstinence (controlling for activation during non-abstinence) were more likely to lapse during CM (p < 0.025), even when controlling for other predictors of lapse outcome (e.g., craving); no association was seen for smoking reward. These results are consistent with a growing number of studies indicating the specific importance of disrupted striatal processing of non-drug reward in nicotine dependence and highlight the importance of individual differences in abstinence-induced deficits in striatal function for smoking cessation.

Smoking Through a Topography Device Diminishes Some of the Acute Rewarding Effects of Smoking.

Smoking topography (ST) devices are an important methodological tool for quantifying puffing behavior (eg, puff volume, puff velocity) as well as identifying puffing differences across individuals and situations. Available ST devices are designed such that the smoker's mouth and hands have direct contact with the device rather than the cigarette itself. Given the importance of the sensorimotor aspects of cigarette smoking in smoking reward, it is possible that ST devices may interfere with the acute rewarding effects of smoking. Despite the methodological importance of this issue, few studies have directly compared subjective reactions to smoking through a topography device to naturalistic smoking. Smokers (N = 58; 38% female) smoked their preferred brand of cigarettes one time through a portable topography device and one time naturalistically, in counterbalanced order across two laboratory sessions. Smoking behavior (eg, number of puffs) and subjective effects (eg, urge reduction, affect, smoking satisfaction) were assessed. Negative affect reduction was greater in the natural smoking condition relative to the topography condition, but differences were not significant on measures of urge, withdrawal, or positive affect. Self-reported smoking satisfaction, enjoyment of respiratory tract sensations, psychological reward, craving reduction, and other rewarding effects of smoking were also significantly greater in the naturalistic smoking condition. The effects of using a ST device on the smoking experience should be considered when it is used in research as it may diminish some of the rewarding effects of smoking. When considering the inclusion of a smoking topography device in one's research, it is important to know if use of that device will alter the smoker's experience. This study assessed affective and subjective reactions to smoking through a topography device compared to naturalistic smoking. We found that smoking satisfaction, psychological reward, enjoyment of respiratory tract sensations and other rewarding effects were all diminished when smoking through the topography device. The effects of using a smoking topography device on the smoking experience should be considered when it is used in future research.

N-acetylcysteine for therapy-resistant tobacco use disorder: a pilot study

IntroductionN-Acetylcysteine (NAC) may have efficacy in treating tobacco use disorder (TUD) by reducing craving and smoking reward. This study examines whether treatment with NAC may have a clinical efficacy in the treatment of TUD.MethodsA 12-week double blind randomized controlled trial was conducted to compare the clinical efficacy of NAC 3 g/day versus placebo. We recruited 34 outpatients with therapy resistant TUD concurrently treated with smoking-focused group behavioral therapy. Participants had assessments of daily cigarette use (primary outcome), exhaled carbon monoxide (COEXH) (secondary outcome), and quit rates as defined by COEXH<6 ppm. Depression was measured with the Hamilton Depression Rating Scale (HDRS). Data were analyzed using conventional and modified intention-to-treat endpoint analyses.ResultsNAC treatment significantly reduced the daily number of cigarettes used (Δ mean±SD = −10.9 ± 7.9 in the NAC-treated versus −3.2 ± 6.1 in the placebo group) and COEXH (Δ mean± SD = −10.4 ± 8.6 ppm in the NAC-treated versus −1.5 ± 4.5 ppm in the placebo group); 47.1% of those treated with NAC versus 21.4% of placebo-treated patients were able to quit smoking as defined by COEXH<6 ppm. NAC treatment significantly reduced the HDRS score in patients with tobacco use disorder.ConclusionsThese data show that treatment with NAC may have a clinical efficacy in TUD. NAC combined with appropriate psychotherapy appears to be an efficient treatment option for TUD.

Perceived Medication Assignment during a Placebo-Controlled Laboratory Study of Varenicline: Temporal Associations of Treatment Expectancies with Smoking-Related Outcomes

Expectancies regarding treatment assignment may influence outcomes in placebo-controlled trials above and beyond actual treatment assignment. For smoking pharmacotherapies, guessing enrollment in the active medication treatment is associated with higher abstinence rates. However, placebo-controlled trials of smoking pharmacotherapies rarely assess perceived treatment assignment and those that do only collect this information after reaching full dosage. To determine the temporal relationship between treatment expectancies and smoking-related variables, we assessed the impact of treatment guess during a placebo-controlled laboratory study of varenicline on measures of craving, smoking reward, and smoking reinforcement. We hypothesized that treatment guess at mid-titration would influence smoking-related measures at full dosage, above and beyond actual medication effects. We also explored factors related to guess stability and differences in blind fidelity between mid-drug titration and full dosage. Eighty-eight participants completed laboratory assessments at baseline, mid-titration, and full dosage that involved self-report and behavioral measures of tonic craving, cue-provoked craving, smoking reward, and smoking reinforcement. Participants guessed treatment assignment at mid-titration and full dosage. Generalized linear models confirmed that, beyond actual treatment assignment, treatment guess improved model fit for both self-report and behavioral smoking-related measures. Further, accuracy of treatment guess improved from titration to full dosage, and specific demographic factors (e.g., gender, race) were associated with type of treatment guess and guess stability across time. These results reinforce the importance of assessing perceived treatment assignment repeatedly during placebo-controlled trials and suggest that treatment expectancies during titration can affect outcomes once full dosage has been reached.

Dissociated Effects of Anticipating Smoking versus Monetary Reward in the Caudate as a Function of Smoking Abstinence

Theories of addiction suggest that chronic smoking may be associated with both hypersensitivity to smoking and related cues and hyposensitivity to alternative reinforcers. However, neural responses to smoking and nonsmoking rewards are rarely evaluated within the same paradigm, leaving the extent to which both processes operate simultaneously uncertain. Behavioral evidence and theoretical models suggest that dysregulated reward processing may be more pronounced during deprivation from nicotine, but neuroimaging evidence on the effects of deprivation on reward processing is limited. The current study examined the impact of deprivation from smoking on neural processing of both smoking and monetary rewards. Two separate functional magnetic resonance imaging scans were performed in 38 daily smokers, one after smoking without restriction and one following 24 hours of abstinence. A rewarded guessing task was conducted during each scan to evaluate striatal blood oxygen level-dependent response during anticipation of both smoking and monetary rewards. A significant reward type by abstinence interaction was observed in the bilateral caudate and medial prefrontal cortex during reward anticipation. The blood oxygen level-dependent response to anticipation of smoking reward was significantly higher and anticipation of monetary rewards was significantly lower during abstinence compared with nonabstinence. Attenuation of monetary reward-related activation during abstinence was significantly correlated with abstinence-induced increases in craving and withdrawal. These results provide the first direct evidence of dissociated effects of smoking versus monetary rewards as a function of abstinence. The findings suggest an important neural pathway that may underlie the choice to smoke in lieu of alternative reinforcement during a quit attempt.

Effects of varenicline on abstinence and smoking reward following a programmed lapse.

Varenicline (Chantix®) is an efficacious first-line medication for smoking cessation. Studies suggest that one mechanism by which varenicline facilitates sustained smoking abstinence is by reducing the likelihood of relapse to smoking when a lapse, or slip, occurs during a quit attempt. The present study extends this line of research by conducting a prospective laboratory study to examine the relapse prevention effects of varenicline following a programmed lapse. Daily smokers (N = 47) completed a 5-week outpatient study in which they were randomized to receive varenicline or placebo. The first week was a medication induction period that was immediately followed by a 4-week quit attempt. A programmed lapse (2 cigarettes smoked in the laboratory) occurred on the second day of the quit attempt. Participants receiving varenicline were slower to relapse and had greater total abstinence rates following lapse exposure. Participants in the varenicline group rated lapse cigarettes lower on measures of reward and intoxication and showed increased behavioral economic demand elasticity for cigarettes (reduced cigarette purchasing at higher prices) compared with those receiving placebo. These results demonstrate a relapse prevention effect of varenicline following smoking lapse exposure and suggest that an attenuation of reward from smoking and the blunting of subjective effects of smoking may underlie and/or contribute to this effect.

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.

Smoking in Response to Negative Mood in Men Versus Women as a Function of Distress Tolerance

Negative mood situations often increase smoking behavior and reward, effects that may be greater among women and smokers low in tolerance for distress. Adult dependent smokers (N = 164; 86 men, 78 women) first completed measures of distress tolerance via self-report and by mirror-tracing and breath-holding tasks. They then participated in 2 virtually identical laboratory sessions, involving induction of negative versus neutral mood (control) via pictorial slides and music. They rated negative affect (NA) before and during mood induction and smoked their preferred brand ad libitum during the last 14 min of mood induction. Our aim was to examine mood effects on NA, smoking reward ("liking"), and smoking intake (puff volume and number) as a function of sex and distress tolerance. Negative mood induction increased NA, as planned, and smoking reward and intake compared with neutral mood. Increases in NA and puff volume due to negative mood were greater in women compared with men, as hypothesized, but no main effects of the self-report or behavioral distress tolerance measures were seen in responses to mood induction. However, unexpectedly, lower self-reported distress tolerance was associated with greater smoking intake due to negative (but not neutral) mood in men and generally due to neutral (but not negative) mood in women. Negative mood may increase smoking intake more in women compared with men. Yet, low distress tolerance may enhance smoking intake due to negative versus neutral mood differentially between women and men, suggesting that sex and distress tolerance may interact to influence smoking responses to negative mood.

Reward expectations lead to smoking uptake among depressed adolescents

Aims While the comorbidity between adolescent depression and smoking has been well documented, less is known about why smoking is disproportionately higher among depressed adolescents. Emerging research suggests that reward-related mechanisms may be important to consider. This study sought to determine whether adolescents with higher depression symptoms have greater smoking reward expectations, which in turn, influence smoking progression. Participants The sample was composed of 1393 adolescents participating in a longitudinal survey study of adolescent health behaviors. Design and Measurements In this prospective cohort study, variables were measured via self-report every six months from age 14 to age 17 resulting in six waves of data. Findings Parallel processes latent growth curve modeling indicated that higher depression symptoms across mid to late adolescence predicted a 17% increase in smoking reward expectations ( β = 3.50, z = 2.85, p = 0.004), which in turn predicted a 23% increase in the odds of smoking progression ( β = 0.206, z = 3.29, p = 0.001). The indirect effect was significant with delta method ( β indirect = 0.72, z = 3.09, p = 0.002; 95% CI = 0.26, 1.18) and bootstrap ( β indirect = 0.72, z = 2.10, p = 0.03; 95% CI = 0.05, 1.39) standard errors. Conclusions The study provides novel evidence that expectations of smoking reward facilitate smoking uptake among depressed adolescents. Smoking reward expectations may identify depressed adolescents at risk of smoking. Addressing alternative ways to meet the reward expectations rather than smoking may be an important component to consider in the preventing smoking and promoting smoking cessation among adolescents with elevated depression symptoms.

Varenicline as a smoking cessation aid in schizophrenia: Effects on smoking behavior and reward sensitivity

Rationale Smoking rates are up to five times higher in people with schizophrenia than in the general population, placing these individuals at high risk for smoking-related health problems. Varenicline, an α4β2 nicotinic acetylcholine receptor partial agonist, is a promising aid for smoking cessation in this population. To maximize treatment efficacy while minimizing risks, it is critical to identify reliable predictors of positive response to varenicline in smokers with schizophrenia.

Varenicline effects on craving, cue reactivity, and smoking reward

Varenicline is an α4β2 nicotinic acetylcholine receptor partial agonist that has been found to be effective for treating tobacco dependence. However, the subjective and behavioral mediators of its efficacy are not known. Using multiple sessions of laboratory-based assessment, this double-blind, placebo-controlled experiment was designed to test if varenicline reduced both tonic and cue-provoked tobacco cravings, and if it attenuated perceived reward from smoking. Participants in the present analysis include 100 smokers who were scheduled for three assessment sessions: at baseline, before receiving medication; at mid-run-in, 5-7 days after beginning medication; and after full dosage was reached, 12-15 days. Following overnight abstinence, each session included assessment of tonic craving, reactivity (including craving) to smoking cues, expected value of a cigarette, smoking behavior, and self-reported reward following smoking. Varenicline, compared to placebo, reduced tonic craving, cue-provoked craving by the final assessment, the expected value of cigarettes, number of puffs and time spent smoking, and self-reported reward (i.e., satisfaction) from smoking. Results showing that varenicline reduced tonic craving levels and perceived reward from smoking are consistent with reports from clinical trials, strengthening the evidence in support of these subjective mechanisms of action. This is the first placebo-controlled study to demonstrate that varenicline reduced cue-provoked cravings, thereby offering another potential mediator of its therapeutic effects. Findings may aid in the development of more targeted interventions for tobacco dependence.