It has been well documented that there is a high rate of co-morbidity between alcoholism and nicotine dependence. Increasing evidence supports an important role for conditioning mechanisms in both forms of addictive behavior. Specifically, alcoholics and smokers tend to display certain patterns of responding when confronted with environmental and interoceptive stimuli that have been reliably associated with previous drug taking. This phenomenon is often termed cue reactivity, and several theoretical models have been forwarded to account for this reactivity. Given the high rate of smoking among alcoholics, it is conceivable that smoking cues or nicotine withdrawal may promote cravings for alcohol. The failure to account for this relationship in alcohol treatment may be counterproductive and may lead to an increased risk for relapse. The proposed research will examine patterns of cue reactivity among alcoholics who are currently addicted to nicotine, as well as comparison groups of alcohol-only, nicotine-only, and non-dependent controls. Study 1 will entail development and empirical validation of a set of alcohol-relevant imagery scripts that will be used, in combination with previously developed smoking- relevant imagery scripts and visual cues for alcohol and nicotine, in two subsequent cue reactivity studies. In Study 2, these imaginal and visual cues will be presented during separate phases of a cue reactivity assessment, along with standardized pleasant, neutral, and unpleasant cues as affective controls. Reactivity will be indexed across three general responses domains (i.e., verbal report, psychophysiological, and behavioral), and will include assessment of the startle eye blink reflex and a measure related to information processing models of cue reactivity (i.e., reaction time). In Study 3, all subjects will be nicotine-dependent alcoholics, and the assessment will occur during one of the three levels of nicotine withdrawal for separate groups of subjects. The results should improve our understanding of the strong association between nicotine and alcohol addiction, and will have implications for the treatment of this dual addiction.
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