Smoking remains a leading preventable cause of mortality and morbidity. While it is relatively easy to develop nicotine dependence, it remains difficult to quit. Craving has been linked to nicotine dependence and the purpose of this competing renewal is to improve understanding of emotional and cognitive processes related to craving that underlie addiction. Because most lab-based craving studies involve subjects who do not expect to use the drug, the emotion experienced during such cravings tends to be negative. Outside the lab, however, cravings occur in conjunction with a variety of expectations regarding drug use, and in some cases are associated with positive anticipatory emotional states. A premise of the proposed study is that the loss of these positive "anticipatory" cravings after quitting constitutes a major challenge to remaining abstinent. The proposed laboratory research will apply theory and methods from experimental psychology to examine situational and individual difference factors that moderate the diverse effects of craving on affect and cognition, with particular emphasis on these positive craving states. The proposed study (n=300) will test the impact of treatment-seeking status (active vs. quitting smokers) and perceived smoking opportunity on a novel set of craving-related responses derived from basic research in emotion and cognitive science. To induce craving, abstinent smokers will be exposed to smoking cues, and instructions related to smoking opportunity will be manipulated. We also aim to evaluate the moderating effect of individual differences in personality, anhedonia, working memory, and dopamine-regulating gene variation on cravings. In addition, the proposed study will provide the first test to determine whether facial reactivity to smoking cues (coded using the Facial Action Coding System), can uniquely predict smoking relapse over an 8-week period following quitting. If successful, this test would offer early identification of those at high risk for relapse and suggest new directions for targeting affective processes in treatment. By tying craving to responses that are meaningfully linked to smoking, and that vary in different contexts and across individuals, the project aims to identify distinct craving patterns that may contribute to relapse risk. Irrespective of the outcome, the study will provide critical data regarding observable effects of an important but understudied form of anticipatory craving linked to positive affect, which will improve understanding of factors contributing to the etiology of nicotine addiction. In addition, identification of different emotional and cognitive experiences associated with positive cravings may lead to new directions for treatment that address the anhedonia and dysphoria smokers experience specifically as a result of losing these positive anticipatory experiences.
Craving is a cardinal feature of smoking addiction, which remains the leading cause of preventable mortality in the US. Despite its importance, research has relatively ignored the positive affect-related cravings often experienced by smokers while anticipating the smoking of their next cigarette. Understanding "positive" cravings, determining who is most sensitive to experiencing them, and examining the degree to which facial coding of these craving experiences can predict subsequent relapse, will advance knowledge regarding the emotional mechanisms underlying relapse and will suggest new directions for treatment that address the anhedonia and dysphoria smokers experience specifically as a result of losing these positive anticipatory experiences.
|Sayette, Michael A; Tiffany, Stephen T (2013) Peak provoked craving: an alternative to smoking cue-reactivity. Addiction 108:1019-25|