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.     

Drug Tolerance, Drug Addiction, and Drug Anticipation

ABSTRACT— Environmental cues associated with drugs often elicit withdrawal symptoms and relapse to drug use. Such cues also modulate drug tolerance. The contribution of drug-associated stimuli to withdrawal and tolerance is emphasized in a Pavlovian-conditioning analysis of drug administration. Conditional responses occur in the presence of cues that have been associated with the drug in the past, such as the setting in which the drug was taken. These conditional responses mediate the expression of tolerance and withdrawal symptoms. Recently, it has become apparent that internal predrug cues, as well as environmental cues, elicit pharmacological conditional responses that contribute to tolerance and withdrawal. Such internal cues include cognitive or proprioceptive cues incidental to self-administration, drug-onset cues that are experienced shortly after administration, and emotional cues. According to the conditioning analysis, addiction treatment should incorporate learning principles to extinguish the association between stimuli (environmental and internal) present at the time of drug administration and the effects of the addictive drug.     

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.     

Smoking withdrawal dynamics in unaided quitters

Considerable research shows that withdrawal severity is inconsistently related to smoking cessation outcomes. This may result from measurement problems or failure to scrutinize important dimensions of the withdrawal experience. Two recent studies demonstrated that withdrawal elevation and variations in the time course of withdrawal were related to relapse in smokers treated with the nicotine patch (T. M. Piasecki, M. C. Fiore, & T. B. Baker, 1998). This article reports a conceptual replication and extension of those findings in unaided quitters. Evidence for temporal heterogeneity was found across different types of withdrawal symptoms. Patterns or slopes of affect and urge reports over time predicted smoking status at follow-up, as did mean elevation in withdrawal symptoms. These results suggest that affect and urge withdrawal symptoms make independent contributions to relapse and that relapse is related to both symptom severity and trajectory.     

LISTENING TO SMOKING RESEARCHERS:

Abstract— The work of Baker and his colleagues indicates that a broadened view of withdrawal that recognizes its probable affective bases will suggest new treatment strategies for the treatment of smoking and, by extension, drug dependence. This commentary briefly reviews the current status of treating drug dependence by addressing negative affect and emphasizes that clinical research which allows for building more complex models, of individual change over time holds promise for clearer understanding of the role of negative affect among drug abusers and thus more effective treatments. Although clinical treatments for drug dependence have long recognized the significance of negative affect we are far from a thorough understanding of the role of negative affect in withdrawal, craving, and relapse to drug use.     

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.     

Suicide schema in schizophrenia: the effect of emotional reactivity, negative symptoms and schema elaboration

Suicide risk is thought to increase with a greater potential for activation of suicide-related schemas. Suicide schemas are less likely to be activated with reductions of emotional range associated with certain negative symptoms of schizophrenia. The study tested whether suicide risk would increase in patients with recent onset schizophrenia with increased potential for suicide schema activation as indicated by lower levels of specific negative symptoms that reflected emotional reactivity, namely emotional withdrawal and blunted affect. A logistic regression analysis of baseline data of 278 recent onset schizophrenic patients with a measure of suicide behaviour as the dependent variable and negative symptoms, delusions, hallucinations, depression, gender, episode, ethnicity, education, age, duration of untreated psychosis and substance use as independent variables was carried out. Emotional withdrawal, but not blunted affect was significant and negatively associated, and depression positively associated with suicide behaviour. There was evidence to indicate that restricted emotions are associated with reduced suicide risk as predicted.     

在美国样本中母亲抑郁症状与儿童退缩的关系:教养行为的中介作用

本研究通过使用美国国家儿童健康与人类发育研究所的纵向研究数据建立分层线性模型,探究在儿童的早期发展中,母亲抑郁症状对儿童的社会性退缩的影响,以及母亲的教养行为在这一关系中的中介作用,结果发现：（1）在儿童24~54个月期间,随着母亲抑郁症状的升高,儿童的社会性退缩也随之升高;（2）母亲抑郁症对儿童社会性退缩的影响存在着性别差异,与女孩相比,男孩的社会性退缩更容易受到母亲抑郁症状的影响;（3）在男孩中,消极的教养行为在母亲抑郁症状与男孩的社会性退缩之间起到了中介作用,而在女孩中,这一中介作用并不显著。     

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。     

Psychological treatment of hypnotic-dependent insomnia in a primarily older adult sample

Objective

This study tested cognitive behavior therapy (CBT) in hypnotic-dependent, late middle-age and older adults with insomnia.

Method

Seventy volunteers age 50 and older were randomized to CBT plus drug withdrawal, placebo biofeedback (PL) plus drug withdrawal, or drug withdrawal (MED) only. The CBT and PL groups received eight, 45 min weekly treatment sessions. The drug withdrawal protocol comprised slow tapering monitored with about six biweekly, 30 min sessions. Assessment including polysomnography (PSG), sleep diaries, hypnotic consumption, daytime functioning questionnaires, and drug screens collected at baseline, posttreatment, and 1-year follow-up.

Results

Only the CBT group showed significant sleep diary improvement, sleep onset latency significantly decreased at posttreatment. For all sleep diary measures for all groups, including MED, sleep trended to improvement from baseline to follow-up. Most PSG sleep variables did not significantly change. There were no significant between group differences in medication reduction. Compared to baseline, the three groups decreased hypnotic use at posttreatment, down 84%, and follow-up, down 66%. There was no evidence of withdrawal side-effects. Daytime functioning, including anxiety and depression, improved by posttreatment. Rigorous methodological features, including documentation of strong treatment implementation and the presence of a credible placebo, elevated the confidence due these findings.

Conclusions

Gradual drug withdrawal was associated with substantial hypnotic reduction at posttreatment and follow-up, and withdrawal side-effects were absent. When supplemented with CBT, participants accrued incremental self-reported, but not PSG, sleep benefits.     

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。     

Prior and future withdrawal and performance: A meta-analysis of their relations in panel studies

While consensus exists among researchers that withdrawal and performance are related, the ordering of these constructs in proposed models frequently varies based on the theoretical focus of the study. Specifically, several extant well-being theories predict employee withdrawal will affect future performance while several turnover theories predict employee performance will affect future withdrawal. This study systematically addresses these complementary theories by conducting a meta-analysis of panel studies measuring both withdrawal and performance at two or more time periods. After accounting for sampling and measurement error, meta-analytic regression results indicate that performance is significantly negatively related to future withdrawal (ρ = − .19) even after accounting for prior withdrawal (β = − .03). However, the relationship between withdrawal and future performance (ρ = − .20) disappeared after accounting for prior performance (β = .00), although burnout did predict future performance even after accounting for prior performance (β = − .07).     

海洛因戒除者对相关线索和负性生理线索的注意偏向

以84名海洛因戒除者和20名正常成人为被试,采用情绪stroop范式探讨了不同康复时相海洛因戒除者对海洛因相关线索和负性生理线索的注意偏向。结果发现,海洛因戒除者对表征与海洛因滥用相关的负性生理线索和表征海洛因使用行为的相关线索存在同等效力的注意偏向,且在不同康复时相内具有稳定性。该研究为解释基于戒除症状的负性情绪对于诱发依赖者药物渴求感和复吸行为的作用及整合基于对相关线索注意偏向的认知加工理论和基于对负性情绪的回避的负强化情绪加工理论提供了实验证据。     

Pavlovian conditioning of drug reactions: Some implications for problems of drug addiction

This paper reviews the classical conditioning of drug reactions, with special emphasis on the relationship of this phenomenon to drug addiction. Several aspects of drug addiction such as drug craving, high relapse tendencies, and the recurrence of withdrawal symptoms are reviewed and interpreted in light of classical conditioning theory and data. A theory is proposed that attempts to account for various aspects of the addictive process. The implications and empirical methods for testing this theory are outlined.     

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.     

Efficacy of CBT for benzodiazepine discontinuation in patients with panic disorder: Further evaluation

Despite its acute efficacy for the treatment of panic disorder, benzodiazepines (BZs) are associated with a withdrawal syndrome that closely mimics anxiety sensations, leading to difficulty with treatment discontinuation and often disorder relapse. An exposure-based cognitive-behavioral treatment for BZ discontinuation, Panic Control Treatment for BZ Discontinuation (CBT) targets the fear of these sensations and has demonstrated efficacy in preventing disorder relapse and facilitating successful BZ discontinuation among patients with panic disorder. In this randomized controlled trial, CBT was compared to taper alone and a taper plus a relaxation condition to control for the effect of therapist contact and support among 47 patients with panic disorder seeking taper from BZs. Based on the primary outcome of successful discontinuation of BZ use, results indicate that adjunctive CBT provided additive benefits above both taper alone and taper plus relaxation, with consistently medium and large effect sizes over time that reached significance at the six month follow-up evaluation. The efficacy of CBT relative to either of the other taper conditions reflected very large and significant effect sizes at that time. These findings suggest that CBT provides specific efficacy for the successful discontinuation from BZs, even when controlling for therapist contact and relaxation training.     

Associations between symptoms of maternal postpartum depression,gestational age and infant social withdrawal: A longitudinal study in a community cohort

Infant social withdrawal is a risk factor for non-optimal child development; thus, it is important to identify risk factors associated with withdrawal. In a large community sample (N = 19,017), we investigate whether symptoms of maternal and partner postpartum depression (PPD; measured with the Edinburgh Postnatal Depression Scale) and prematurity are predictors of infant social withdrawal (measured with the Alarm Distress Baby Scale). Withdrawal was assessed at 2–3, 4–7 and 8–12 months postpartum. Linear regressions showed that prematurity predicted higher infant social withdrawal at all time points, and maternal symptoms of PPD were positively associated with withdrawal at 2–3 months. Logistic regressions showed that odds for elevated social withdrawal were increased with elevated levels of maternal symptoms of PPD at 2–3 and 8–12 months. Partner's symptoms of PPD were not associated with withdrawal. Future studies should investigate how PPD symptoms and prematurity may impact the individual development of social withdrawal.     

Smoking withdrawal dynamics: II. Improved tests of withdrawal-relapse relations

In this article, the authors assessed whether continuously scaled symptom parameters derived from growth models (T. M. Piasecki et al., 2003) are linked to smoking at long-term follow-up by using data from a large-scale clinical trial (N = 893). Results revealed that higher withdrawal intercepts, positive linear slopes, and greater volatility were all positively associated with relapse, and cigarette coefficients (indicating smoking-induced withdrawal reduction) were negatively related to relapse. In models keyed around the first lapse to smoking, those destined to lapse reported more severe withdrawal during abstinence, and withdrawal patterns discriminated groups defined according to lapse duration. The findings complement earlier heterogeneity studies in implicating the pattern of changing withdrawal symptoms over time as a factor strongly associated with smoking relapse.     

Evidence That Episodic Memory Impairment During Tobacco Abstinence Is Independent of Attentional Mechanisms

Previous studies have demonstrated reductions in episodic memory during nicotine withdrawal. However, these studies have been unable to dissociate memory reductions from losses in attention associated with tobacco abstinence. In the present study, the authors sought to determine whether episodic memory reduction is a primary effect of nicotine withdrawal during tobacco abstinence. Heavy smokers were tested when smoking normally and following 24 hrs of abstinence. Participants were tested with a recognition memory task in which items were studied under full and divided attention conditions. Forward digit span and backward digit span were also included as control measures. Withdrawal was associated with a reduction in memory performance that was independent of attention at encoding. The authors conclude that impairment of episodic memory is a primary effect of nicotine withdrawal during tobacco abstinence. Further research is required to determine if this is associated with continued use of tobacco and cessation failures.     

Antidepressant medication in the treatment of agoraphobia: A critical review

The present article critically examines research on the use of antidepressants in treating agoraphobia. A number of studies have shown certain classes of antidepressant medication, namely tricyclic antidepressants and MAO inhibitors, to have beneficial effects on certain aspects of the agoraphobic syndrome. However, these studies must be interpreted with caution in light of two major methodological shortcomings, i.e. sole reliance on paper and pencil outcome indices and the confounding of the pharmacological effects of the drug with exposure to feared situations. Recent research, aimed at correcting for these methodological problems, seriously question the efficacy of antidepressant pharmacotherapy by itself as a treatment for agoraphobia. Moreover, it is argued that the disadvantages of drug treatments namely agoraphobics' reluctance to take medication, physical side effects and relapse upon withdrawal of the medication, caution against their routine use in clinical practice.