Failure to improve cigarette smoking abstinence with transdermal selegiline + cognitive behavior therapy.
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ABSTRACT:
SUBMITTER: Killen JD
PROVIDER: S-EPMC3749242 | biostudies-literature | 2010 Sep
REPOSITORIES: biostudies-literature
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Failure to improve cigarette smoking abstinence with transdermal selegiline + cognitive behavior therapy.
Killen Joel D JD Fortmann Stephen P SP Murphy Greer M GM Hayward Chris C Fong Dalea D Lowenthal Kimberly K Bryson Susan W SW Killen Diana T DT Schatzberg Alan F AF
Addiction (Abingdon, England) 20100901 9
<h4>Aims</h4>To examine the effectiveness of transdermal selegiline for producing cigarette smoking abstinence.<h4>Design</h4>Adult smokers were randomly assigned to receive selegiline transdermal system (STS) or placebo given for 8 weeks. All participants received cognitive behavior therapy (CBT). Follow-ups were conducted at 25 and 52 weeks.<h4>Setting</h4>Community smoking cessation clinic.<h4>Participants</h4>243 adult smokers (> or =18 years of age; > or =10 cigarettes/day).<h4>Measures</h4 ...[more]
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Project description:IntroductionCurrent treatments for smoking cessation have limited efficacy. A potential pharmaceutical treatment for smoking cessation is selegiline, a selective and irreversible monoamine oxidase B inhibitor. A few clinical trials have been carried out using selegiline but the results have been mixed. We sought to determine if genetic markers in cholinergic loci in the 15q24 chromosomal region predict response to smoking cessation therapy with selegiline.MethodsWe performed an 8-week double-blind, placebo-controlled clinical trial of the selegiline transdermal system in heavy smokers, with follow-up at weeks 25 and 52. Eight single nucleotide polymorphisms (SNPs) in the 15q24 region, which contains the genes for the nicotinic acetylcholine receptor subunits CHRNA5, CHRNA3, and CHRNB4, were investigated for association with treatment response.ResultsThe CHRNB4 promoter SNP rs3813567 was associated with both point prevalence abstinence and post-quit craving. Carriers of the minor C allele treated with selegiline showed lower rates of abstinence and higher levels of craving than selegiline-treated non-carriers, indicating that the rs3813567 C allele adversely affects abstinence in selegiline-treated smokers. This effect was not present among placebo-treated smokers. Selegiline-treated smokers with the CHRNA5 rs680244 GG genotype had lower post-quit craving, and unlike placebo-treated GG-carrying smokers, did not experience a post-quit increase in depressive symptoms.ConclusionsVariants in genes encoding cholinergic receptors affect abstinence, craving and mood in selegiline-treated smokers. Selegiline primarily affects dopamine levels in the brain, but cholinergic input affects nicotine-induced dopaminergic activity. These markers may have value in identifying those likely to respond to selegiline for smoking cessation.
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Project description:The study objectives were to examine smoking abstinence and reinstatement effects on subjective experience and cognitive performance among adolescent smokers.Adolescents (aged 14-17 years, 60 daily smokers and 32 nonsmokers) participated. Participants completed baseline assessments (Session 1) and returned to the laboratory 1-3 days later to repeat assessments (Session 2); half of the smokers were randomly assigned to 15-17 hr tobacco abstinence preceding Session 2.During Session 2, abstaining smokers reported significantly greater increases in withdrawal symptoms, smoking urges, and negative affect compared with smokers who did not abstain and compared with nonsmokers. Smoking reinstatement reversed abstinence effects, returning to baseline levels for smoking urges and negative affect. Abstaining smokers showed significantly enhanced cognitive performance on two of six tasks (two-letter search compared with nonabstaining smokers; serial reaction time compared with nonsmokers); smoking reinstatement resulted in significant decrements on these two tasks relative to nonabstaining smokers.Effects of smoking abstinence and reinstatement on self-report measures are consistent with earlier research with adolescent as well as adult smokers and may help to elucidate the motivational underpinnings of smoking maintenance among adolescent smokers. Effects found on cognitive performance were contrary to hypotheses; further research is needed to understand better the role of cognitive performance effects in smoking maintenance among adolescents.
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Project description:Despite awareness of negative health outcomes associated with smoking, pregnant smokers might reduce their tobacco consumption thinking that a low smoking rate reduces smoking-related negative birth outcomes. We aimed to assess in a clinical sample whether there is a smoking rate that would not impact on birth weight (BW).Pregnant smokers ?18 years, gestational age of 9-20 weeks of amenorrhea, motivated to quit smoking, smoking ?5 cigarettes/day (cpd) and their newborns (381 singleton, live births) were included in this secondary analysis of a French smoking cessation trial.The mean BW when the mother quit smoking was 3417 g (95 % CI: 3098-3738 g); when smoking >0<5 cpd, 3081g (3003-3159 g); when smoking 5-9 cpd, 3043 g (2930-3157 g); and when smoking ?10 cpd, 2831 g (2596-3157 g) (p = .006). The corresponding effect sizes ranged from medium to large (Cohen's d for BW: 0.54, 0.57 and 0.85) compared to BW when the mother quit. In the multivariable analysis, adjusted for all significant confounders, when the mother smoked on average >0<5 cpd, the loss in BW was 228 g; when smoking 5-9 cpd, 251 g; and when smoking ?10 cpd, 262 g (all p ? .02) compared to newborns' BW of mothers who stopped smoking since quit date.Even low cigarette consumption during pregnancy is associated with BW loss. All efforts should be made to help pregnant smokers quit completely during their pregnancy.As an alternative to quitting smoking, pregnant smokers reduce their smoking rate thinking that this diminishes smoking-related negative health outcomes. No study has established whether low smoking rate (more than 0 but less than 5 cpd) during pregnancy impacts BW compared to abstinence from smoking. Among treatment-seeking pregnant smokers BW of newborns of mothers who smoked even less than 5 cpd was significantly lower than of those whose mothers quit; effect sizes of different consumption levels on BW ranged from moderate (>0<5 cpd) to large (?10 cpd). Even low smoking rate is associated with reduced BW compared to complete maternal smoking abstinence.
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Project description:Given the lack of consensus regarding changes in temporal and probability discounting as a function of smoking abstinence in cigarette smokers, the present study comprehensively examined possible changes in these processes following a period of acute smoking abstinence consistent with elevated withdrawal symptoms and craving.Computerized temporal and probability discounting assessments were collected from cigarette smokers following normal smoking and 24-hr smoking abstinence, with the order of normal smoking and abstinence sessions counterbalanced across participants. Other conditions included commodity (money and cigarettes), sign (gains and losses), and magnitude ($50 and $1,000).Twenty four-hour smoking abstinence resulted in a reduction in expired carbon monoxide to near-zero levels and increases in withdrawal and craving. Examination of discounting parameters as a function of smoking abstinence revealed a general pattern of increase in the temporal discounting of monetary gains and losses following abstinence but not in the temporal discounting of cigarettes nor probability discounting of money or cigarettes. Pearson correlations also revealed an expected pattern of significant relationships.The present study is a comprehensive examination of temporal and probability discounting following smoking abstinence and reveals a generalized change in intertemporal decision making for monetary rewards.
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Project description:Nicotine addiction is associated with dysregulated inhibitory control (IC), mediated by corticothalamic circuitry including the right inferior frontal gyrus (rIFG). Among sated smokers, worse IC task performance and greater IC-related rIFG activity have been shown to be associated with greater relapse vulnerability. The present study investigated the effects of smoking abstinence on associations between IC task performance, rIFG activation, and smoking behavior. Smokers (N = 26, 15 female) completed an IC task (Go/Go/No-go) during fMRI scanning followed by a laboratory-based smoking relapse analog task (SRT) on two visits: once when sated and once following 24 h of smoking abstinence. During the SRT, smokers were provided with monetary rewards for incrementally delaying smoking. A significant main effect of No-go accuracy on latency to smoke during the SRT was observed when collapsing across smoking states (abstinent vs. sated). Similarly, a significant main effect of IC-related activation in rIFG on SRT performance was observed across states. The main effect of state, however, was non-significant in both of these models. Furthermore, the interaction between smoking state and No-go accuracy on SRT performance was non-significant, indicating a similar relationship between IC and lapse vulnerability under both sated and abstinent conditions. The state X rIFG activation interaction on SRT performance was likewise non-significant. Post-hoc whole brain analyses indicated that abstinence resulted in greater IC-related activity in the right middle frontal gyrus (MFG) and insula. Activation during IC in these regions was significantly associated with decreased No-go accuracy. Moreover, greater abstinence induced activity in right MFG during IC was associated with smoking sooner on the SRT. These findings are bolstered by the extant literature on the effects of nicotine on executive function and also contribute novel insights on how individual differences in behavioral and neuroimaging measures of IC may influence relapse propensity independent of smoking state.
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Project description:IntroductionThere is increasing recognition that non-daily cigarette smoking is common in early adulthood but less is known about its stability over time, or what influences transitions to heavier or nonsmoking. We examined the stability of non-daily smoking in a sample of young adults, and tested whether social and cognitive factors predicted transitions to other smoking patterns over time.Aims and methodsParticipants were 579 young adults (18-24 years old at enrollment, 52% male) who were non-daily and never-daily cigarette smokers and California residents. Participants completed 13 waves of assessment over 3 years. We used descriptive statistics to evaluate the frequency of consistent abstinence, defined as no cigarette use at two consecutive waves and no cigarette use at any subsequent waves. Cox and logistic regression were used to test predictors of consistent abstinence.ResultsWe found that 55% of participants smoked intermittently throughout the study, while 43% were consistently abstinent by the end of the study; few transitioned to daily smoking. Stopping smoking was associated with having fewer smoking friends, smoking less in social situations, having lower positive reinforcement expectancies for smoking, and having stronger intent to quit. Post hoc analyses indicated those who stopped smoking tended to report reductions in positive reinforcement expectancies and increased intent to quit in the 6 months before stopping.ConclusionsFindings suggest a substantial minority of young adult non-daily smokers may stop on their own, but that the majority continue smoking and may require intervention. Interventions for this population should address social motives and reinforcement expectancies.ImplicationsThe majority of young adults who are non-daily cigarette smokers appear to maintain this habit over an extended period and may require intervention. Interventions that focus on reducing expectancies for positive effects of and social motives for cigarette use and on increasing intent to quit smoking may be most effective.
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