CRAVING FOR CIGARETTES--NICOTINE, SMOKING AND STRESS

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Cigarette smoking has been relatively refractory to pharmacological and behavioral treatment, with long term abstinence rates of less than 30%. In order to develop more efficacious treatments for smoking cessation, it is important to gain a better understanding of factors that contribute to smoking relapse. The proposed study will explore interactions between two of the most commonly reported precipitants of relapse, stress and craving. Both stress and craving have been shown to increase rates of smoking acutely and to promote relapse after smoking cessation. However, it is not well known how these two factors might interact. A previous study has shown that craving increases in stressful situations, and this is consistent with anecdotal reports. The primary purpose of this study is to replicate the effect of stress on cigarette craving. A secondary aim of this study is to explore the effects of the nicotine patch alone and in combination with denicotinized cigarettes, on stress-induced craving. Although both the nicotine patch and denicotinized cigarettes modestly reduce craving for cigarettes, each is limited in its effectiveness. However, when used in combination, particularly during early abstinence, combined use of the nicotine patch and denicotinized cigarettes may produce better craving reduction than either one alone. Moreover, the combined use of these strategies may be effective in reducing stress-induced increases in craving. We will test this hypothesis in the proposed study. Subjects will attend five laboratory sessions. On four of the sessions, subjects will wear a nicotine patch delivering either the 21 mg or 42 mg/24 hr. On two of these sessions, they will smoke a denicotinized cigarette, and on the remaining two sessions they will not smoke. In addition, on each session, subjects will complete both an easy and a difficult anagram task. In the fifth condition, subjects will wear a placebo patch and will smoke their preferred brand of cigarette during the session. The order of the five conditions will be counterbalanced across subjects. Craving for cigarettes will be measured before and after subjects are told which test they will perform, after they will perform, after they smoke (depending on condition), and after they complete each anagram test. We hypothesize that craving for cigarettes will be higher in anticipation of performing a difficult anagram task than an easy task. We expect that the higher dose of nicotine patch will be more effective than the lower dose patch at reducing this stress-induced increase in craving for cigarettes, and the efficacy of the high dose patch to be enhanced by denicotinized cigarettes.