Cigarette smoking is the leading cause of preventable death in the United States. Over 23% of adults describe themselves as current smokers with 75% of those smoking every day. Most of those daily smokers meet diagnostic criteria for nicotine dependence. Craving, generally defined as a subjective state reflecting an addict's desire to use drugs, has been implicated as the primary cause for the maintenance of drug dependence. Craving research has exploded over the past 20 years, an increase fostered in part by the development of effective methods for inducing craving under laboratory conditions. The procedure used most commonly in this research is the cue-reactivity paradigm, which assesses addicts' craving and physiological responses to drug-related stimuli. Although this paradigm has advanced our understanding of craving, there has been no experimental research of the impact of drug-related cues on addicts' craving in their natural environment. The research described in this Exploratory Developmental Research Grant application will develop a procedure for assessing cigarette smokers' reactions to smoking-related cues when those cues are presented in the natural environment of the smokers. This research will combine cue-reactivity (CR) procedures with Ecological Momentary Assessment (EMA), which has been used successfully to monitor a variety of behaviors in real time using handheld computers. The merger of these two procedures into a single paradigm provides a novel approach to studying the impact of drug-related cues on craving and smoking behavior in the natural environment. This combined CR/EMA procedure will be developed and refined in three studies to (1) evaluate the impact of a cue-reactivity manipulation administered to cigarette smokers in a natural setting using photographic and imagery cues; (2) examine the impact of in vivo cues manipulated with CREMA; and (3) compare the magnitude of cue- reactivity effects produced through the CREMA procedure with cue-reactivity assessed via laboratory- based cue-reactivity procedures. The data generated by this procedure will create a new tool to explore craving processes in the natural environment. Cigarette smoking produces over 440,000 deaths each year in the US and generates an estimated $157 billion in annual health-related economic losses. Craving, generally defined as a subjective state reflecting an addict's desire to use drugs, has been implicated as a primary cause for the maintenance of chronic smoking. This research will examine triggers of craving in the natural environment of smokers and generate important information about craving that may lead to more effective treatments for smoking. ? ? ?
