Effects of biochemical validation of self-reported cigarette smoking on treatment success and on misreporting abstinence

Many investigators have reported that cigarette smokers who are trying to quit often falsely report being abstinent at the end of treatment. Unfortunately, much of the previous research designed to investigate this problem has been flawed, making the results difficult to interpret. We attempted to avoid these flaws and to investigate the measurement of alveolar carbon monoxide (CO) levels to validate self-reported smoking rates at the end of treatment. Participants in behavioral cessation clinics were randomly assigned to one of three conditions that varied in timing of exposure to information regarding CO measurement: at the beginning of treatment (demonstration of CO measurement, discussion of smoking effects on CO levels, and notification that individual CO levels would be measured at the conclusion of the clinic), at the end of treatment (demonstration, discussion, and notification of CO measurement prior to self-reports of smoking levels), or at the end of treatment (demonstration and discussion of CO measurement subsequent to self-reports of smoking levels). CO levels of all participants were measured at the end of treatment after they reported their current smoking levels. Only 16% of self-reports of abstinence were not verified by CO measurement. Smokers who observed the CO demonstration at the beginning of treatment were significantly more likely than the other two groups to achieve abstinence at the end of treatment and significantly less likely to misreport abstinence. Clinical and research implications of these results are discussed.     

Effects of an Internet-based voucher reinforcement program for smoking abstinence: a feasibility study

The present study tested the feasibility of an Internet-based method to obtain objective evidence of smoking abstinence and to deliver vouchers for evidence of abstinence. Four heavy smokers participated in this 4-week study. Twice daily, participants made video recordings of themselves providing a breath carbon monoxide (CO) sample with a Web camera. The video was sent electronically to the smoking clinic. Participants could earn vouchers for gradual reductions in breath CO during an initial shaping condition, and then for achieving abstinence (CO < or = 4 ppm). Vouchers could be exchanged for merchandise at select Internet vendors. Relative to baseline conditions, participants substantially reduced their smoke intake, and 3 achieved sustained periods of abstinence. The study suggests that an Internet-based voucher reinforcement program is a feasible method to promote abstinence from cigarette smoking.     

Relapse dynamics during smoking cessation: recurrent abstinence violation effects and lapse-relapse progression

Smoking cessation is a process that unfolds over time and is characterized by intermittent lapses. We used parametric recurrent event survival analyses to better understand the dynamic relationship between a set of Abstinence Violation Effect (AVE, Marlatt & Gordon, 1985) responses to lapsing and subsequent lapse-relapse progression. Participants were 203 smokers who achieved abstinence and responded to items assessing three core components of the AVE (internal attribution, abstinence self-efficacy and guilt) following a total of 1,001 lapse episodes in near real time. Neither self-blame, self-efficacy, nor guilt following participants' first lapse predicted relapse. Controlling for responses to their first lapse, responses to each additional lapse did prospectively predict lapse progression, such that drops in self-efficacy were associated with accelerated progression to a subsequent lapse (HR = 1.09, CI = 1.02-1.15), while increases in internal attributions of blame actually protected against lapsing (HR = 0.98, CI = 0.97-0.99). Treatment with nicotine patches slowed recurrent lapse progression (HR = 0.58, CI = 0.48-0.70), but this effect dissipated over multiple lapses, and was moderated by elevated ratings of postlapse guilt (HR = 1.08, CI = 1.01-1.18), which predicted accelerated progression within the active patch group, while protecting against lapse in the placebo group. Results highlight the dynamic nature of lapse responses during smoking cessation, indicating that self-efficacy predicts progression from one lapse to the next, while attributions of self-blame and guilt influenced progression in unexpected ways.     

Nicotine fading,self-monitoring and cigarette fading to produce cigarette abstinence or controlled smoking

This study developed and evaluated a smoking-treatment program. Twelve subjects were randomly assigned to one of two groups within a multiple baseline design. Subjects were first given a nicotine-fading and self-monitoring procedure for 3 weeks in which they changed their cigarette brands each week to ones containing progressively less nicotine and tar and plotted their daily intake of the two substances. Those subjects unable to quit smoking were then given a cigarette-fading procedure in which they systematically reduced the number of cigarettes smoked for 3 weeks. The study had two goals: (1) to achieve a reasonable percentage of abstinence; and (2) to reduce non-abstainers' smoking to a ‘safer’ level by having them smoke very low tar and nicotine cigarettes. The 12-month follow-up results revealed that 33% of the subjects were abstinent and all non-abstainers were smoking cigarettes lower in tar and nicotine than their baseline brands. Half the non-abstainers had decreased their smoking rate relative to baseline while the other half had increased. The subjects decreased their daily nicotine intake by 13.3 mg (81.6% reduction from baseline) and tar intake by 218.2 mg (85.5% reduction from baseline). These results suggest that the study's goals were achieved and that the non-aversive combined procedure could be used to treat not only habitual smokers but also those with cardiovascular and respiratory problems who cannot be treated by smoking-cessation procedures that use cigarette smoke as the aversive stimulus. Finally, a least-restrictive model for treating smoking is proposed and discussed.     

Effects of cigarette smoking on lexical decision-making

10 habitual smokers, aged 19-25 yr., were randomly assigned to smoke either a very low nicotine "Placebo" cigarette (.05-mg nicotine delivery as estimated by the FTC method) or a Nicotine cigarette (.7-mg estimated nicotine delivery). Each participant was asked to abstain from smoking for 4 to 7 hr. prior to testing. After completing a presmoking test of lexical decision-making, participants smoked either a Nicotine or Placebo cigarette and were then retested for reaction times and accuracy on the lexical decision test. When presented the most difficult lexical decisions, participants responded significantly faster after smoking a Nicotine cigarette than they did before smoking; smoking a Placebo cigarette did not affect reaction times. Response accuracy was unaffected by smoking either kind of cigarette. These results suggest that smoking a nicotine cigarette may improve attention or memory retrieval after several hours of smoking abstinence.     

Effects of attentional-focus instructions on movement kinematics

BackgroundRecent research has shown that internal (body-related) attention-focus instructions disrupt motor learning and performance, whereas paying attention to the environmental effects of movements (external focus) leads to better performance than an internal focus [see, for reviews, Wulf, G. (2007). Attentional focus and motor learning: a review of 10 years of research. E-Journal Bewegung und Training, 1, 4–14.; Wulf, G., &; Prinz, W. (2001). Directing attention to movement effects enhances learning: a review. Psychonomic Bulletin &; Review, 8, 648–660.]. However, Beilock's studies [Beilock, S. L., Bertenthal, B. I., McCoy, A. M., &; Carr, T. H. (2004). Haste does not always make waste: expertise, direction of attention, and speed versus accuracy in performing sensorimotor skills. Psychonomic Bulletin &; Review, 11, 373–379.] suggest that an internal focus is detrimental in experts but not in novices. Because detrimental effects of consciously attending to movements have generally been measured by performance scores such as accuracy scores or reaction times, it remains unclear how internal and external attentional-focus instructions influence movement kinematics when learning a new skill. To fill this gap, the present study investigated attentional-focus effects on a biomechanical level.MethodsA video of an expert juggler demonstrating a two-ball juggling task was presented to juggling novices. Experimental groups were given either body-related (internal group) or ball-related (external group) verbal instructions or no attention-guiding instructions (control group). In the retention phase without attention-guiding instructions, the body-movement and ball-flight aspects of performance focused on in the verbal instruction were subjected to biomechanical analyses.Results and ConclusionsJuggling performance improved equally in all three groups. However, internally vs. externally instructed acquisition phases had differential effects on the kinematics of the upper body as well as ball trajectories when performing the juggling task. Remarkably, ball trajectories in the control group who received no specific attentional cueing were similar to those in the externally instructed group. This suggests that task-relevant information is picked up independently of instructions, and that external instructions provide redundant information. Internal instructions for object-related tasks, however, may confront novice learners with the need to process additional information. As a result, task difficulty might be unnecessarily enhanced in an observational learning setting.     

Practicing and arguing for abstinence from smoking: A test of the double forced compliance paradigm

An experiment was conducted within a new paradigm for Festinger's theory of dissonance (1957): the double forced compliance paradigm (Joule, 1986a). Double compliance was used to test dissonance reduction following the execution of not just one, as in the classical paradigm, but two forced compliance behaviours. The first behaviour involved abstinence from smoking, and the second, writing a text for or against smoking. Based on the radical conception of the theory of dissonance (Beauvois and Joule, 1981; Joule, 1986b), subjects were expected to find tobacco deprivation more difficult after having written a text against smoking than before, and easier after having written a text in favour of smoking. The results confirmed these predictions.     

Reaction time and movement time after active and passive smoking

Reaction time and movement time were studied following active and passive smoking in two groups of 20 women. All subjects were tested under a clean air and smoky air condition and the results showed that, while there was no difference between groups for either measure in the clear air condition, the active smokers had faster reaction time and movement time in the smoky air condition. Smoky air had no significant effect on the responses of the passive smoking group.     

Effects of acute and prolonged opiate abstinence on extinction behaviour in rats.

We examined the role of withdrawal in relapse to drug-seeking and drug-taking by testing the effects of opiate abstinence on extinction behaviour in rats trained to self-administer heroin. Male Long-Evans rats responded for IV heroin under a heterogeneous chain (VI 120 s; FR 1) schedule in which "seeking" responses preceded a "taking" response which produced a drug infusion. Responding was then measured in extinction during acute (6, 12, and 24 hr) and prolonged (3, 6, 12, and 25 day) abstinence. Sucrose consumption and somatic withdrawal were assessed at each testing period. During acute abstinence, responses on the "drug-seeking" manipulandum increased at 24 hr, whereas responses on the "drug-taking" manipulandum increased at 6 hr. Both responses were elevated during the 12-day abstinence test. Sucrose consumption was reduced and somatic withdrawal scores were increased in opiate-experienced rats at each test period. Results suggest that heroin abstinence has different effects on drug-seeking and drug-taking and that these effects do not temporally coincide with somatic measures of opioid withdrawal.     

Concordance of self-reported abstinence and measurement of expired air carbon monoxide in a self-help smoking cessation treatment

Some self-help programmes for smoking cessation obtain abstinence data entirely from participants' self-reports. This may lead to overestimation of efficacy. In the present study, the relationship between self-reported abstinence and expired-air carbon monoxide was evaluated at the 12-mo. follow-up in 200 smokers who had participated in a self-help programme for smoking cessation conducted by mail. Analysis indicated a close relationship between carbon monoxide levels and self-reports of smoking status; concordance was about 90%. Studies of the efficacy of self-help programmes for smoking cessation should include some sort of objective verification of self-reported abstinence.     

Effects of attentional focus on movement coordination complexity

Attentional focus affects performance and learning of motor tasks. An external attentional focus (on the effects of movement) can lead to more efficient and effective movements compared to an internal focus (on body movement itself). According to the “constrained action hypothesis”, an external focus facilitates fast and reflexive movement control while an internal focus leads to disruption of automatic coordination processes. Such disruption should be apparent in the complexity of movement. In this study, multiscale entropy measures were used to investigate if the external focus is related to superior coordination complexity compared to internal focus. Twenty participants were divided in two groups that balanced over an unstable platform in fourteen trials over two days, either with internal or external focus of attention instructions, followed by seven retention trials on the third day. Multiscale entropy measures were used to quantify complexity of motions of the platform, the participant, and the composite of participant and platform motions. Results were contrary to expectations. For the external focus group, despite better overall performance, multiscale entropy values of participant and composite motions were lower in some scales compared to the internal focus group, especially in the first and last days. This may be consistent with previous findings that predictability increases during learning of a balance task. Results also indicate the need to identify the correct physiological interpretation of single or multiscale entropy measures. Further investigation is needed to establish if entropy differences are causally related to performance and learning advantages of the external focus.     

Internet‐based self‐tailored deposit contracts to promote smoking reduction and abstinence

Deposit contracting may reduce costs and increase efficacy in contingency management interventions. We evaluated two Internet‐based deposit contract arrangements for smoking. In Experiment 1, nine participants deposited self‐selected amounts that could be earned back for meeting goals. During treatment, participants were reimbursed for breath samples with less than or equal to 6 parts per million carbon monoxide and met the criterion for 47% of samples compared to 1% during baseline. In Experiment 2, 10 participants’ deposits were matched up to $50. No samples met the criterion during baseline but 41.5% met it during treatment. The average deposit was $82 in Experiment 1 and $49 in Experiment 2. Participants rated the intervention favorably and sample submission rates were high. These experiments suggest that Internet‐based self‐tailored deposits are acceptable, feasible, and can promote brief reduction and abstinence in some smokers. Future research should investigate individual and intervention factors that affect long‐term cessation and uptake of deposit contracts.     

Long latency reflex regulation in human ballistic movement

Step torque perturbations were applied to adduct the index during either a 25° ballistic or a 25° slow abduction movement. Subjects were instructed to react as quickly and as forcefully as possible in the opposite direction to the perturbation. The resulting long latency reflex (LLR) EMG activity was studied in the first dorsal interosseus. The LLR measured when the perturbation occurred in the first part of the movement was not different in a ballistic movement than a ramp movement. In our experiments, the LLR was the same in the first as well as in the second part of a ballistic movement. The LLR observed when the perturbation was applied at the onset of the agonist EMG burst (before the onset of a ballistic movement) was either similar or reduced when recorded during the ballistic movement.     

Metabolic energy expenditure and the regulation of movement economy

Over the years, various psychological theories have embraced notions ofeconomy, efficiency, orleast effort to explain how complex movement sequences are organized and modified. The purpose of the present paper was to synthesize various perspectives on this issue, to identify a common hypothesis, and to propose a conceptual framework that explains how movement economy is regulated. The framework presented here postulates that adaptive movement patterns emerge as a function of the organism’s propensity to minimize metabolic energy expenditure with respect to task, environment, and organism constraints to action. An important role is also proposed for interoceptive sensory information in guiding motor skill learning and control. The paper concludes by suggesting future directions in four areas of movement economy research that contribute to understanding the learning and control of movement in both human and nonhuman organisms.     

Effects of time-based administration of abstinence reinforcement targeting opiate and cocaine use

Polydrug use is a common problem among patients in opioid-substitution treatment. Polydrug use has been reduced by administering abstinence-reinforcement contingencies in a sequence, such that a single drug is targeted until abstinence is achieved, and then an additional drug is targeted. The present study examined effects of administering abstinence-reinforcement contingencies sequentially based on time rather than on achieved abstinence. Participants accessed paid work (about $10/hr maximum) in the Therapeutic Workplace by providing urine samples 3 times per week. The urine samples were tested for opiates and cocaine. During an induction period, participants earned maximum pay independent of drug abstinence. Then, maximum pay depended upon urine samples that were negative for opiates. Two weeks later, maximum pay depended upon urine samples that were negative for both opiates and cocaine. Opiate and cocaine abstinence increased following administration of the respective contingencies. The time-based administration of abstinence reinforcement increased opiate and cocaine abstinence.