The effect of bupropion on nicotine craving and withdrawal.

RATIONALE AND OBJECTIVES: Bupropion has demonstrated efficacy for smoking cessation. Given the importance of nicotine craving and withdrawal in the smoking cessation process, the current study examined the effects of bupropion on these parameters during smoking abstinence. METHODS: During a 2-day Baseline phase with ad lib smoking, 91 non-depressed smokers (who were not trying to quit permanently) were administered measures of nicotine craving, withdrawal symptoms, and timed measures of cognitive performance five times daily. Participants were then assigned randomly to a 14-day treatment regimen with bupropion 300 mg/day, bupropion 150 mg/day, or placebo. Thereafter, the above measures were re-administered during 3 days of abstinence on a closed research ward. RESULTS: Relative to placebo, 300 mg bupropion significantly reduced abstinence-associated increases in rated depression, difficulty concentrating, and irritability, and attenuated a decrease in positive affect. The results also suggested that bupropion might have a positive effect on performance measures during the withdrawal period. No effects were observed on craving, anxiety, restlessness, or hunger. The lack of findings on craving measures may be explained by a floor effect; except on the first day of abstinence, neither drug nor placebo groups showed much craving elevation during abstinence. CONCLUSIONS: Study results indicate that bupropion ameliorates some nicotine withdrawal symptoms.

Effects of naltrexone with nicotine replacement on smoking cue reactivity: preliminary results.

Although several studies have examined the effects of opioid antagonists on smoking behavior, there have been no reports of the potentially therapeutic combination of naltrexone and nicotine replacement therapy. The primary objective of the present study was to determine whether naltrexone reduced reactivity to smoking cues among abstinent smokers treated with nicotine replacement. Twenty participants were instructed to abstain from smoking cigarettes for 9 h while using nicotine replacement therapy. Participants were subsequently treated with either naltrexone (50 mg) or placebo before being exposed to smoking cues. Results indicated that the smokers who received the placebo responded to smoking cue exposure with increases in urge to smoke and increases in negative affect. Participants who received naltrexone did not show any increase in urge or negative affect and showed a decrease in withdrawal symptoms after exposure to smoking cues. Although preliminary, the findings suggest that naltrexone may work in combination with nicotine replacement therapies to block the effects of smoking stimuli in abstinent smokers.

Temptations to smoke after quitting: a comparison of lapsers and maintainers.

This study addresses whether characteristics of temptations to smoke differ for participants who quit smoking and maintain abstinence compared to those who quit and then lapse. Participants used hand-held computers to record temptations and were beeped at random for base-rate assessments. We used generalized estimating equations to compare 1,851 temptation episodes and 5,192 random assessments recorded by 151 participants (116 lapsers, 35 maintainers) over 1-23 days of abstinence. Compared to randomly sampled occasions, temptations were marked by greater negative affect, restlessness, attention disturbance, and exposure to smoking cues; participants were also more likely to be eating or drinking during temptations. Temptations reported by lapsers and maintainers did not differ in any respect, including their reported coping. The results highlight situational variance over individual differences.

Nicotine withdrawal in chippers and regular smokers: subjective and cognitive effects.

From previous studies, chippers (very light, long-time cigarette smokers) seem not to be nicotine dependent, despite decades of smoking. The effect of tobacco deprivation on chippers' withdrawal reactions was examined. Matched groups of 26 chippers and 25 regular smokers were studied while abstaining or smoking for 2-day blocks, with assessments administered 5 times daily by palm-top computers. As hypothesized, chippers showed no changes as a result of nicotine deprivation. In contrast, regular smokers demonstrated distinct changes in craving, mood, arousal, and sleep disturbance. The computers also tested participants' cognitive performance. Unlike chippers, regular smokers' performance on complex tasks was slower under deprivation; the effect could not be explained by changes in motor performance or simple reaction time. Results suggest performance may have been improved by nicotine rather than by worsened by withdrawal.

Dynamic effects of self-efficacy on smoking lapse and relapse.

Self-efficacy (SE) is thought to be critical to success in smoking cessation both as an individual difference and as a dynamic process after a quit attempt. In this study, 214 smokers used palm-top computers to record day-to-day variations in SE during 4 weeks after quitting. SE remained at high and stable levels prior to a 1st lapse but decreased and became more variable thereafter. The authors used event history models with time-varying covariates to assess the effect of daily SE on lapse and relapse risk. Daily SE measures predicted an initial lapse on the subsequent day. However, this relationship was accounted for by stable baseline differences in SE (assessed by questionnaire), rather than by day-to-day dynamics in SE. Progression from 1st lapse to relapse was also examined. In this instance, daily SE predicted subsequent relapse risk, even when baseline SE and concurrent smoking were accounted for, suggesting the importance of SE dynamics for this stage of the relapse process.

Effects of task strain, social conflict, and emotional activation on ambulatory cardiovascular activity: daily life consequences of recurring stress in a multiethnic adult sample.

Ambulatory blood pressure (ABP) may be an independent predictor of cardiovascular endpoints, but little is known about its psychosocial determinants. The acute effects of psychosocial processes on cardiovascular activity during daily life were examined by random-effects regression. Healthy adults (N = 120) were monitored over a 6-day period with ABP monitors and computer-assisted self-report assessments. Task strain, social conflict, and emotional activation were rated following each ABP measurement, as were activity, posture, and other covariates. Results show that blood pressure (BP) and heart rate (HR) were elevated during periods of emotional activation (high negative affect or high arousal). Diastolic BP was lower during periods involving high decisional control, and HR was lower during high-control, low-demand activities. There were substantial individual differences in the effects of psychosocial influences on ambulatory cardiovascular activity. Psychological factors are reliable determinants of ABP, which may account in part for the unique predictive value of ABP.

Remember that? A comparison of real-time versus retrospective recall of smoking lapses.

Research and treatment assessments often rely on retrospective recall of events. The accuracy of recall was tested using accounts of smoking lapse episodes from 127 participants who had quit smoking, and lapses and temptations were recorded in near-real time using a hand-held computer. These computer records were compared with retrospective accounts elicited 12 weeks later, with a focus on recall of lapses in 4 content domains: mood, activity, episode Triggers, and abstinence violation effects. Recall of lapses was quite poor: Average kappas for items ranged from 0.18 to 0.27. Mean profile rs assessing recall for the overall pattern of behavior were .36, .30, .33, and .44 for these domains, respectively. In recall, participants overestimated their negative affect and the number of cigarettes they had smoked during the lapse, and their recall was influenced by current smoking status. The findings suggest caution in the use of recall in research and intervention.

First lapses to smoking: within-subjects analysis of real-time reports.

Studies of smoking relapse and temptation episodes have relied on retrospective recall and confounded between- and within-subject variability. Real-time data on temptations and lapses to smoke were gathered using palm-top computers. We made within-subject comparisons of the initial lapse, a temptation episode, and base rate data obtained through randomly scheduled assessments. Negative affect discriminated all three situations, with lapses worse than temptations, and temptations worse than random situations. Participants attributed lapses to negative mood and smoking cues, whereas temptations were more often attributed to behavioral transitions. Participants were 12 times more likely to report coping in temptations than in lapses. However, only cognitive (vs. behavioral) coping strategies were effective. Lapses (vs. the other situations) were more likely to occur when smoking was permitted, when cigarettes were easily available, and in the presence of other smokers. The results have clinical implications, and the computerized monitoring methods may be applicable to an array of clinical research problems.

Progression from a smoking lapse to relapse: prediction from abstinence violation effects, nicotine dependence, and lapse characteristics.

Determinants of progression from an initial smoking lapse to relapse, using prospective data from 133 participants were examined. Participants used palm-top computers to record their first lapse, and their reaction to it, within minutes of the event, and were followed for 3 months to assess subsequent smoking. Indicators of the Abstinence Violation Effect--self-efficacy, attributions, and affective reactions to the lapse--generally failed to predict progression to relapse, but participants who felt like giving up after the first lapse progressed more rapidly to a second lapse. Participants who attempted restorative coping were less likely to progress to another lapse on the same day. Those whose lapses were triggered by stress progressed more quickly, whereas those triggered by eating and drinking or accompanied by alcohol consumption progressed more slowly. More nicotine-dependent participants progressed more rapidly toward relapse, but neither the amount smoked in the first lapse nor its subjective reinforcement predicted progression.

Does smoking abstinence self-efficacy vary across situations? Identifying context-specificity within the Relapse Situation Efficacy Questionnaire.

According to self-efficacy and relapse theories. abstinence self-efficacy (ASE) ratings should be context-specific: they should vary across situations. This variability may be important, as it could signal high-risk for relapse situations. In this study, confirmatory factor analysis was used to identify situational variability in a novel ASE assessment (Relapse Situation Efficacy Questionnaire. or RSEQ). Results supported a hierarchical structure, where both context-specific and unidimensional measures of ASE exist within the assessment. Context-specific factors included Negative Affect, Positive Affect, Restrictive Situations (to smoking). Idle Time, Social-Food Situations, Low Arousal, and Craving. Multiple context-specific factors and the aggregate factor predicted cessation outcome, even after controlling for concurrent smoking rate. However, the context rated with the least confidence proved to be the best outcome predictor, suggesting the existence of "Achilles' heel" situations. These data indicate the internal and predictive validity of the RSEQ.

A day at a time: predicting smoking lapse from daily urge.

Smokers who recently quit (N = 214) monitored smoking urges for up to 26 days after quitting. Computers administered 4-5 assessments daily at random times; participants rated urges on waking and when they experienced temptation episodes. Urge intensity after cessation did not generally exceed urges reported during baseline ad lib smoking. Urge intensity and temptation frequency consistently declined over the quit period. Controlling for urge intensity at baseline, all daily urge intensity measures predicted lapse the following day in proportional hazards survival analyses. Average duration of temptation episodes also predicted lapses; frequency of temptation did not. To isolate the effect of day-to-day variations in urges, participants' nicotine dependence and urge intensity on quit day were controlled for. Only urge intensity at waking still predicted lapse risk; this was not because of this measured being closer in time to the day's lapses. Among lapsers, urge intensity at waking and in temptations rose preceding a lapse.

Ecological momentary assessment in a behavioral drinking moderation training program.

We assessed predictors of self-reported excessive drinking (> 5 drinks) in a sample of heavy drinkers. Participants were randomly assigned to moderation training or a waiting-list control condition. They were trained in ecological momentary assessment (EMA) involving self-monitoring of drinking and other variables on a small hand-held computer, the electronic diary (ED). During the 8-week study, participants were compliant in their use of the ED for both random prompts and the entry of data related to specific drinking episodes. Generalized estimating equations were used to fit models involving predictors related to past history of drinking, aspects of the training program, drinking restraint, and episode-specific mood. The models indicated robust predictors of decreased and increased drinking. Our results suggest that EMA is a useful methodology for assessing drinking and related behaviors.

Individual differences in the context of smoking lapse episodes.

Research on relapse has often focused either on the momentary context of lapses or on stable traits that predict who will relapse. We examine the relation between the two, analyzing how individual differences relate to characteristics of initial lapses, which were recorded nearly in real time by 105 smokers using hand-held computers. More nicotine-dependent smokers lapsed under more negative affect and more intense urges, but they did not smoke more in the initial lapse. Questionnaire measures of negative affect smoking did not predict negative affect lapses. Smokers who lapsed when drinking were less nicotine dependent, but they had a history of smoking while drinking, as assessed by computer monitoring. Smokers who attempted coping but lapsed nevertheless reported less active coping styles on the Ways of Coping questionnaire. The results demonstrate the interplay between individual traits and contextual influences in smoking relapse, and they particularly highlight the role of nicotine dependence in relation to contextual factors.

Psychosocial and personality differences in chippers and regular smokers.

Tobacco chippers are an anomalous group of smokers who, while having smoked regularly for years, have avoided the clutches of nicotine dependence. In an attempt to better understand the factors associated with nondependent cigarette smoking, this paper describes a study in which matched groups of regular smokers, chippers, and nonsmokers were compared on a number of personality and psychosocial variables believed relevant to drug-seeking behavior. The strongest finding indicated that sensation seeking best discriminates among the three groups, with nonsmokers clearly viewing themselves as more socially inhibited and less interested in pursuing sensations relative to both regular smokers and chippers, both of whom evidenced comparable scores. Regular smokers evidenced less self-control, or restraint, and appeared more impulsive and unable to resist temptation, compared to chippers and nonsmokers. Surprisingly, none of the groups could be differentiated on the basis of perceived stress, coping, or social support. Even among the personality variables, however, the effect sizes were relatively small, indicating that these differences in personality cannot fully account for chipper's resistance to dependence.

Smoking typology profiles of chippers and regular smokers.

This study examined smoking patterns among chippers--light, nondependent cigarette smokers--by contrasting their smoking motives (Russell's Reasons for Smoking) and patterns (McKennell's Smoking Occasions) with those of a matched group of regular smokers. Differences between group profiles were initially confounded by differences in overall level of item endorsement, which obscured meaningful interpretation of group differences in smoking patterns. Group differences were clarified by correcting for profile elevation and scatter, as suggested by Cronbach and Gleser (1953). As expected, chippers' subscale profiles deemphasized pharmacological and addiction-related motives such as craving and habit, while emphasizing appetitive and sensory motives such as handling and pleasurable smoking. Social motives for smoking were also more prominent in chippers' smoking profiles.