LISTENING TO NICOTINE:

Abstract— In recent years, theoretical models of drug motivation and drug dependence have downplayed the role of withdrawal symptoms in the maintenance of addiction. During this same period, strong links between drug use and measures of negative affect have been uncovered in empirical research. In this article we examine these trends in the context of research on smoking. Evidence is presented from two recent studies on smoking relapse that highlight the intimate connection between withdrawal symptomatology and negative affect Specifically, these studies reveal that (a) single-occasion measures of withdrawal symptoms or other markers of physical dependence do not contribute incremental validity in preceding relapse relative to measures of negative affect (b) the trajectory of withdrawal symptoms is highly idiosyncratic, (c) exacerbations cannot be tightly coupled with pharmacological events. (d) the temporal dynamics of withdrawal reflect fluctuations in negative affect, and (e) differences in the trajectory of withdrawal symptoms index relapse vulnerability. We conclude that a broadened view of withdrawal recognizing its probable affective bases will enhance its explanatory power and suggest new treatment strategies.     

易感人格的工作记忆特征对药物成瘾的调节机制

药物成瘾是指持续使用成瘾药物, 出现耐受性和戒断症状并严重阻碍正常社会功能的精神疾病。工作记忆在调节药物成瘾行为中扮演了中心角色：在神经易感性和易感人格特质基础上, 低工作记忆容量导致危险决策和去抑制性, 进而影响寻求药物和复吸行为。目前的研究基于已经产生成瘾的个体, 无法区别神经易感性、人格特质以及工作记忆缺陷是药物成瘾的原因还是结果; 而且, 仅从认知角度研究药物成瘾的原因, 会忽视该行为受多个因素影响的事实。     

Addiction motivation reformulated: an affective processing model of negative reinforcement

This article offers a reformulation of the negative reinforcement model of drug addiction and proposes that the escape and avoidance of negative affect is the prepotent motive for addictive drug use. The authors posit that negative affect is the motivational core of the withdrawal syndrome and argue that, through repeated cycles of drug use and withdrawal, addicted organisms learn to detect interoceptive cues of negative affect preconsciously. Thus, the motivational basis of much drug use is opaque and tends not to reflect cognitive control. When either stressors or abstinence causes negative affect to grow and enter consciousness, increasing negative affect biases information processing in ways that promote renewed drug administration. After explicating their model, the authors address previous critiques of negative reinforcement models in light of their reformulation and review predictions generated by their model.     

The acute effects of nicotine on positive and negative affect in adolescent smokers

Although adolescent cigarette smoking remains a critical public health concern, little is known about the reinforcing mechanisms governing smoking in this vulnerable population. To assess predictions derived from both positive and negative reinforcement models of drug use, the authors measured the acute effects of nicotine, as administered via tobacco cigarettes, on both positive and negative affect in a group of 15- to 18-year-old smokers. A matched group of nonsmokers served as a comparison group. Findings revealed that whereas adolescents who smoked a cigarette experienced reductions in both positive and negative affect, the observed reductions in negative affect were moderated by nicotine content of the cigarette (high yield vs. denicotinized), level of nicotine dependence, level of baseline craving, and smoking expectancies pertinent to negative affect regulation. Nonsmokers experienced no change in affect over the 10-min assessment period, and no interaction effects were observed for positive affect. Overall, the findings conform to a negative reinforcement model of nicotine effects and strongly suggest that, even among young light smokers, nicotine dependence and resultant withdrawal symptomatology may serve as motivating factors governing smoking behavior.     

Plasticity associated with escalated operant ethanol self-administration during acute withdrawal in ethanol-dependent rats requires intact matrix metalloproteinase systems

Repeated cycles of ethanol intoxication and withdrawal associated with dependence induce neuroadaptations in a variety of brain systems. Withdrawal-induced negative emotional states can be ameliorated by ethanol consumption; a learned process termed negative reinforcement. Accordingly, a dependence-induced phenotype is escalated ethanol self-administration. Matrix metalloproteinases (MMPs) are proteolytic enzymes which degrade the extracellular matrix to allow for synaptic reorganization and plasticity. To test the hypothesis that an intact MMP system is required for animals to learn about the negative reinforcing effects of ethanol and display escalated self-administration during acute withdrawal when ethanol-dependent, male Wistar rats were trained to self-administer ethanol and then assigned to either acute or chronic MMP inhibition treatment groups. The chronic treatment group received intracerebroventricular (ICV) infusions of the broad spectrum MMP inhibitor FN-439 or artificial cerebrospinal fluid (aCSF) via osmotic minipumps during a 1 month ethanol dependence induction period and subsequent post-dependence induction self-administration sessions that occurred during acute withdrawal. The acute treatment group only received ICV FN-439 or aCSF on the day of self-administration sessions following dependence induction during acute withdrawal. The results showed that inhibition of MMPs attenuated escalated ethanol self-administration following chronic and acute exposure conditions. Furthermore, once learning (i.e., plasticity) had occurred, MMP inhibition had no impact on escalated response patterns and animals previously subjected to MMP inhibition that did not escalate evidenced normal escalations in operant ethanol self-administration once FN-439 treatments were terminated. Thus, the present data identified that an intact MMP system is required for the escalated responding that occurs during acute withdrawal in dependent animals and implicate such escalation as a learned response.     

工作记忆训练对药物成瘾者认知功能的改善及其机制

对处于戒断期的各类药物成瘾群体进行认知训练，训练后药物成瘾个体认知能力得到改善，成瘾症状也得到了一定缓解。认知训练能够加速药物成瘾者大脑受损区域的自发性恢复，尤其是使影响个体抑制控制能力的中脑边缘多巴胺系统和前额叶系统发生功能性和结构性的积极变化，实现药物成瘾个体高级认知能力的改善。今后可以从不同类别的药物成瘾是否全部具有可逆性，设置的认知训练任务能否起到改善认知能力的效果，药物成瘾个体训练的性别差异以及训练效果的保持时间等角度进行研究。     

Using mediational models to explore the nature of tobacco motivation and tobacco treatment effects

Various theories have proposed mechanisms for drug motivation and relapse. For instance, negative reinforcement theories focus on the alleviation of withdrawal. However, other theories and some data cast doubt on the importance of withdrawal as a motivator of addictive drug use. Using data from a randomized double-blind placebo-controlled smoking cessation treatment study (N=608), this research examined the impact of withdrawal on drug motivation and the ability to maintain abstinence. Withdrawal was experimentally manipulated by randomly assigning participants to receive active bupropion versus placebo. Mediation analyses revealed that active bupropion reduced the amount of withdrawal and craving that individuals reported in the 1st week post quit; modest support was also found for smaller declines in positive affect. These effects, in turn, were all positively associated with posttreatment abstinence. These results implicate withdrawal as an important factor in motivating persistent tobacco use.     

Stigma and Discrimination in Health-Care Provision to Drug Users: The Role of Values, Affect, and Deservingness Judgments

This study examined the role of values, affect, and deservingness judgments in health professionals' views of patients with stigmatized conditions (e.g., drug dependence). Participants were 277 nurses who responded to a survey containing 2 scenarios of a nurse providing high- or low-quality care to a patient with a condition related to prolonged use of alcohol or heroin. Affective responses to the patient were more positive for nurses with higher self-transcendence values, and more negative for nurses with higher conservation values. Deservingness judgments were predicted by positive and negative affect toward the patient, but not by attributions of responsibility for drug use. Deservingness judgments emerged as strong predictors of nurses' satisfaction with the provision of high- or low-quality care. The findings imply that the deservingness judgments made by nurses reflected strong entitlement norms concerning the provision of proper care for patients that were independent of patients' perceived responsibility for their condition.     

Pharmacologic and Behavioral Withdrawal From Addictive Drugs

ABSTRACT— Recent theories suggest that drug withdrawal does not motivate drug use and relapse. However, data now show that withdrawal produces complex changes over time in at least two symptoms (i.e., negative affect and urges) that are highly predictive of relapse. Evidence suggests that falling levels of the drug in the blood and interruption of the drug self-administration ritual both affect these symptoms. Both of these forms of withdrawal motivate renewed drug use in addicted individuals.     

Cellular mechanisms underlying neuronal excitability during morphine withdrawal in physical dependence: lessons from the magnocellular oxytocin system

Opiates are used clinically as analgesics, but their euphoric actions can lead to continued use and to dependence and addiction. While there are many factors involved in drug abuse, avoidance of stressful withdrawal symptoms is a key feature of addiction and its treatment. Fundamental to this is the need to understand the cellular processes that induce dependence and lead to the withdrawal syndrome. Many neurones in the brain express opioid receptors but only a few types of neurone develop dependence during chronic morphine exposure. The physiology of opiate-dependent cells is altered such that they require the continued presence of the drug to function normally and this is revealed, in cells that are inhibited by initial acute exposure to opiate, by a rebound hyperexcitation upon opiate withdrawal. Hypothalamic oxytocin neurones robustly develop morphine dependence and provide an exceptional opportunity to probe the cellular mechanisms underlying morphine dependence and withdrawal excitation. Although expression of morphine withdrawal excitation by oxytocin cells requires afferent inputs, the underlying mechanisms appear to reside within the oxytocin neurones themselves and probably involve changes in the intrinsic membrane properties of these neurones.     

情绪大脑机制研究的进展

文章综述情绪大脑机制研究的最新进展。情绪的脑机制——大脑回路,包括前额皮层、杏仁核、海马、前部扣带回、腹侧纹状体等。前额皮层中的不对称性与趋近和退缩系统有关,左前额皮层与趋近系统和积极感情有关,右前额皮层与消极感情和退缩有关。杏仁核易被消极的感情刺激所激活,尤其是恐惧。海马在情绪的背景调节中起着重要作用。前额皮层和杏仁核激活不对称性的个体差异是情绪个体差异的生理基础。情绪的中枢回路有可塑性。     

Reduction of anxiety sensitivity in relation to nicotine withdrawal symptoms during smoking cessation: an examination among successful quitters

Anxiety sensitivity has been implicated as a potential risk factor for post-quit withdrawal symptoms. The present study examined relations between the extent of change in anxiety sensitivity and the course of nicotine withdrawal symptoms experienced during the initial two weeks of a quit attempt among treatment-seeking smokers. The sample consisted of 29 adult daily smokers (34% female; M_age = 47.7, SD = 13.1) who successfully quit and maintained their abstinence. After adjusting for the effects of gender, treatment condition, use of nicotine replacement therapy, nicotine dependence, alcohol use problems, baseline levels of anxiety sensitivity, and reductions in negative affect, greater reductions in anxiety sensitivity were related to faster decreases in withdrawal symptoms. The current data suggest that there may be merit to employ anxiety sensitivity reduction methods for the management of emergent withdrawal symptoms in smoking cessation treatment.     

On beyond urine: clinically useful assessment instruments in the treatment of drug dependence

Although there are a wealth of clinically useful, brief, and low-cost assessment instruments available for use with drug-dependent populations, relatively few are broadly used in clinical practice. With an emphasis on: (1). the multidimensional nature of drug users' problems; and (2). assessments that can be integrated into empirically validated treatments, clinically useful assessments in four general categories (evaluation and diagnosis of drug dependence, identifying concurrent disorders and problems, treatment planning, and evaluation of treatment outcome) are briefly summarized. Progress in the field of drug abuse treatment has been significantly hampered by the failure to adopt, across research and clinical settings, a common set of assessments.     

Compulsive exercise or exercise dependence? Clarifying conceptualizations of exercise in the context of eating disorder pathology

ObjectiveMaladaptive exercise relates to eating disorder (ED) pathology and impairment in clinical and non-clinical populations. At present, two different conceptualizations of maladaptive exercise are often studied in relation to ED pathology: compulsive exercise and exercise dependence. Compulsive exercise functions to avoid negative affect (e.g., guilt and anxiety) associated with not exercising, whereas exercise dependence is associated with tolerance to exercise benefits and avoidance of exercise withdrawal. At present, clinicians and researchers struggle to determine the most appropriate term for describing problematic exercise in individuals with ED pathology. This study aimed to directly compare these conceptualizations of maladaptive exercise in relation to severity of ED pathology.DesignThis study examined cross-sectional data.MethodUndergraduate participants (N = 235, 78% female) with elevated ED pathology completed the Eating Disorder Examination Questionnaire (EDE-Q), Compulsive Exercise Test (CET), and Exercise Dependence Scale (EDS). Multiple linear regression analyses evaluated associations between EDE-Q and CET and EDS scores and dominance analysis determined which qualities of exercise were uniquely associated with EDE-Q scores.ResultsResults suggest that compulsive qualities of exercise, including exercise to control shape and weight and to avoid negative affect are more strongly associated with severity of ED pathology than qualities of exercise dependence.ConclusionsClinicians and researchers working with ED populations can benefit from prioritizing assessments that capture compulsive qualities of exercise. Additionally, these results suggest that interventions that effectively target other compulsive behaviors (e.g., exposure and response prevention) may be promising treatment options for problematic exercise in the context of EDs.     

Impact of the hormonal milieu on the neurobiology of alcohol dependence and withdrawal

Alcoholism, or alcohol dependence, is a complex disorder with withdrawal symptoms that are often problematic for those trying to recover from their dependence. As researchers attempt to elucidate the neurobiological underpinnings of alcohol dependence and withdrawal, it is becoming clear that numerous factors, including the hormonal environment, impact the manifestations of this disorder. Of particular interest is the observation that women have fewer and less severe withdrawal symptoms than do men even though they tend to suffer greater physiological harm from excessive alcohol consumption. In this article, the authors present an overview of their understanding of how gonadal and stress hormones interact with alcohol, which results in differential neurobiological responses between males and females. Thus far, data generated from representative animal models have shown significant differences between the sexes in behavioral responses and neuroadaptations to chronic alcohol consumption and withdrawal. Accumulating evidence suggests that treatment of alcoholism, including withdrawal, should be tailored to the patient's gender and hormonal status.     

Lonely hearts: Psychological perspectives on loneliness

Loneliness is a complex set of feelings encompassing reactions to the absence of intimate and social needs. Although transient for some individuals, loneliness can be a chronic state for others. We review the developmental, social, personality, clinical, and counseling psychology literatures on loneliness with an emphasis on recent empirical findings. Chronic feelings of loneliness appear to have roots in childhood and early attachment processes. Chronically lonely individuals are more likely to be high in negative affectivity, act in a socially withdrawn fashion, lack trust in self and others, feel little control over success or failure, and generally be dissatisfied with their relationships compared to nonlonely individuals. Loneliness has also been associated with a variety of individual differences including depression, hostility, pessimism, social withdrawal, alienation, shyness, and low positive affect; loneliness is also a concomitant of more severe disorders, such as clinical depression, borderline personality, and schizophrenia. Although loneliness affects a large number of individuals and is associated with numerous negative outcomes, relatively few investigations have examined the efficacy of treatments aimed at alleviating or preventing loneliness. Several investigations raise the possibility of treating loneliness, but the absence of appropriate comparison groups casts doubt on the efficacy of many of these treatments. Correlational studies also suggest that one close friend or romantic partner may be sufficient to buffer those at risk for loneliness. Research on causal processes is sparse, however, and more research is needed to delineate which factors are antecedents and which are consequences of loneliness.     

When feeling poorly at work does not mean acting poorly at work: The moderating role of work-related emotional intelligence

It is important, both theoretically and for applied reasons, to understand who is likely to engage in counterproductive work behaviors. It is known that such behaviors are more likely to be exhibited by unhappy employees (i.e., those high in job negative affect), but this should be particularly true for individuals low in work-related emotional intelligence. The current study (N = 91) examined moderation-related hypotheses of this type in relation to five counterproductive work behaviors—abuse, sabotage, theft, withdrawal, and production deviance—among a sample of employees working at least 20 h per week. These behaviors varied positively by job negative affect and negatively by work-related emotional intelligence. In addition, the two predictors interacted for all five outcomes such that the highest levels of counterproductive work behavior were observed among employees who were high in job negative affect and low in emotional intelligence. The discussion focuses on implications for understanding counterproductive work behaviors and on the value of assessing work-related emotional intelligence as an ability that differs by employees.     

Responding to distressed infants: Does mothers’ positive versus negative affect matter for infants' behavior and physiology?

How mothers respond to infants’ distress has implications for infants’ development of self-regulation and social competence. In a sample of 35 mothers and their 4- to 8-month-old infants, we induced infant distress using an arm restraint task and compared infants’ observed affect and physiological responses under two conditions, when mothers were instructed to respond with: 1) positive affect and 2) negative affect. Based on theoretical and empirical support, we empirically evaluated two opposing hypotheses. Based on the Mutual Regulation Model and work on affect matching, we predicted that when mothers respond with negative affect versus positive affect, distressed infants’ duration of negative affect would be smaller, negative affect would be less intense, and respiratory sinus arrythmia (RSA) withdrawal would be lower. Based on social referencing theory and research, we expected that when mothers respond with positive affect versus negative affect, distressed infants’ duration of negative affect would be smaller, negative affect would be less intense, and RSA withdrawal would be lower. We found that when mothers responded to their distressed infants with negative affect versus positive affect, infants spent significantly more time in negative affect, their intensity of expressed negative affect was greater, and their RSA withdrawal was greater, suggesting that mothers’ display of mild positive affect when infants are distressed may be helpful for infants. The current findings add to accumulating evidence that mothers’ positive relative to negative affective response to their infants’ distress can produce observable differences in infants’ duration and intensity of negative affect, as well as their physiology. Findings have the potential to inform future research that investigates how mothers can most effectively reduce their infants’ distress and intervention that targets the moment-to-moment behaviors in mother-infant reciprocal interactions.     

Caffeine Expectancy Questionnaire (CaffEQ): construction, psychometric properties, and associations with caffeine use, caffeine dependence, and other related variables

Expectancies for drug effects predict drug initiation, use, cessation, and relapse, and may play a causal role in drug effects (i.e., placebo effects). Surprisingly little is known about expectancies for caffeine even though it is the most widely used psychoactive drug in the world. In a series of independent studies, the nature and scope of caffeine expectancies among caffeine consumers and nonconsumers were assessed, and a comprehensive and psychometrically sound Caffeine Expectancy Questionnaire (CaffEQ) was developed. After 2 preliminary studies, the CaffEQ was administered to 1,046 individuals from the general population along with other measures of interest (e.g., caffeine use history, anxiety). Exploratory factor analysis of the CaffEQ yielded a 7-factor solution. Subsequently, an independent sample of 665 individuals completed the CaffEQ and other measures, and a subset (n = 440) completed the CaffEQ again approximately 2 weeks later. Confirmatory factor analysis revealed good model fit, and test-retest reliability was very good. The frequency and quantity of caffeine use were associated with greater expectancies for withdrawal/dependence, energy/work enhancement, appetite suppression, social/mood enhancement, and physical performance enhancement and lower expectancies for anxiety/negative physical effects and sleep disturbance. Caffeine expectancies predicted various caffeine- associated features of substance dependence (e.g., use despite harm, withdrawal incidence and severity, perceived difficulty stopping use, tolerance). Expectancies for caffeine consumed via coffee were stronger than for caffeine consumed via soft drinks or tea. The CaffEQ should facilitate the advancement of our knowledge of caffeine and drug use in general.     

Age-based differences in treatment outcome among alcohol-dependent women

The literature suggests that women are at higher risk for negative consequences from alcohol use than men and that these risks are compounded by age. The current study investigated how alcohol-dependent women from different age groups might differ in terms of baseline functioning and treatment response. The sample consisted of 181 participants drawn from two randomized clinical trials of cognitive-behavioral treatments for alcohol-dependent women. Demographic and psychopathology data were obtained at baseline using the SCID (Structured Clinical Interview for DSM disorders) I for Axis I disorders and the SCID II or Personality Disorders Questionnaire for Axis II disorders. Social networks data were collected using the Important People and Activities Interview. Drinking data were collected at baseline and follow-up using the Timeline Follow Back Interview. ANOVAs revealed that older women had better psychosocial functioning in terms of being better educated and reporting fewer Axis I disorders. Also, older women had more supportive social networks in terms of more people, a smaller percentage of heavy drinkers, and a nondrinking spouse. Older women reported a less severe lifetime substance use history with a later age of first drink, later onset of alcohol use disorders, fewer lifetime abuse/dependence items, and less drug use. However, they reported drinking more frequently and more heavily over the 90 days prior to treatment. Finally, older women were more compliant with treatment and responded better by reducing drinking frequency and percentage of heavy drinking days. Suggestions to enhance treatment efficacy for younger women are made as well as suggestions for future research. (PsycINFO Database Record (c) 2012 APA, all rights reserved).