Incubation of Cue-Induced Cigarette Craving During Abstinence in Human Smokers

doi:10.1016/j.biopsych.2010.07.014

Biological Psychiatry

Volume 69, Issue 7, 1 April 2011, Pages 708-711

https://doi.org/10.1016/j.biopsych.2010.07.014 Get rights and content

Background

Abstinent drug users remain at risk for relapse long after withdrawal subsides. Animal studies indicate that responses to drug-related cues not only persist but increase with abstinence, a phenomenon termed “incubation of drug craving.” It is unknown whether cue-induced craving increases, decreases, or remains constant with abstinence in humans. We investigated effects of abstinence on cue-induced craving in cigarette smokers.

Methods

Eighty-six non–treatment-seeking, adult smokers (≥10 cigarettes daily) were paid to abstain for 7 (Group 1), 14 (Group 2), or 35 (Groups 3 and 4) days. Abstinence was verified daily. Groups 1, 2, and 3 underwent a single cue session on the final abstinence day (7, 14, or 35). Group 4 viewed cues on Days 7, 14, and 35.

Results

Between and within groups, smoking-cue–induced craving increased with abstinence on some measures. Cue-induced craving was greater in Group 3 (35-day) compared with Group 1 (7-day). Within Group 4, cue-induced craving was greater at 35 than 14 days. Cue-induced craving did not decrease with abstinence on any measure.

Conclusions

We present initial evidence of incubation of cue-induced craving in humans. The observation that cue-induced craving increases with abstinence, even as “background” craving and withdrawal symptoms subside, might have treatment implications.

Section snippets

Methods and Materials

Non–treatment-seeking, healthy male and female adult smokers (≥10 cigarettes daily) were recruited. Candidates were excluded for medical or psychiatric contraindications (Supplement 1). Participants provided written informed consent as approved by the University of Chicago and National Institute on Drug Abuse Institutional Review Boards.

The main design was between-subjects. Participants were randomly allocated to three groups: Group 1 abstained from smoking for 7 days, Group 2 for 14 days, and

Results

Eighty-six participants completed the study (Figure S1 and Tables S1 and S2 in Supplement 1). Approximately one-half of the participants began but did not complete abstinence; this proportion did not differ across groups (Supplement 1). Compared with neutral cues, smoking cues increased TCQ-SF Total, QSU-B Factors 1 and 2, and PANAS Negative Affect; these were included in further analyses. Smoking cues did not preferentially affect physiological measures. Daily withdrawal symptoms progressively

Discussion

Here, we present initial evidence that cue-induced craving in cigarette smokers does not decline with increasing abstinence up to 35 days. Even as daily craving declined, craving in response to smoking cues remained robust and, on some measures, actually increased with abstinence. This finding is broadly consistent with incubation studies in nonhumans (9, 11), which use lever-pressing to measure drug-seeking or “craving”. Time-dependent increases in conditioned craving occurred despite

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Brief ReportIncubation of Cue-Induced Cigarette Craving During Abstinence in Human Smokers

Background

Methods

Results

Conclusions

Section snippets

Methods and Materials

Results

Discussion

Eur J Pharmacol

Addict Behav

Biol Psychiatry

Relapse rates in addiction programs

J Clin Psychol

Predictors of smoking relapse by duration of abstinence: Findings from the International Tobacco Control (ITC) Four Country Survey

Addiction

Meta-analysis of cue-reactivity in addiction research

Addiction

Context-induced relapse to drug seeking: A review

Philos Trans R Soc Lond B Biol Sci

What does cue-reactivity have to offer clinical research?

Addiction

Identifying the neural circuitry of alcohol craving and relapse vulnerability

Addict Biol

Incubation of cocaine craving after withdrawal

Nature

Brief Report
Incubation of Cue-Induced Cigarette Craving During Abstinence in Human Smokers