Incubation of cue-induced cigarette craving during abstinence in human smokers

Abstract

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.

Figure 1

Effects of exposure to smoking and neutral cues on self-reported craving as a function of length of abstinence. Left Column: Single cue conditions (Groups 1, 2 and 3). Right column: Repeated cue condition (Group 4). Top Row: Tobacco Craving Questionnaire – Short Form (TCQ-SF) Total score response to cues. Second Row: Brief Questionnaire of Smoking Urges (QSU-B) Factor 1 score cue response. Third Row: QSU-B Factor 2 score cue response. Bottom Row: Positive and Negative Affect (PANAS) Negative Affect score cue response. Asterisks denote a significant difference from Group 1 (7-day abstinence), p < 0.05. % denotes a significant difference from Group 2 (14-day abstinence), p < 0.05. Data are group means (±S.E.M.).

Figure 2

Effects of length of abstinence on baseline (non-provoked) cigarette craving. Left Column: Single cue conditions (Groups 1, 2 and 3). Right column: Repeated cue condition (Group 4). Top Row: Tobacco Craving Questionnaire – Short Form (TCQ-SF) Total score baseline. Second Row: Brief Questionnaire of Smoking Urges (QSU-B) Factor 1 score cue baseline. Third Row: QSU-B Factor 2 score baseline. Bottom Row: Positive and Negative Affect (PANAS) Negative Affect score baseline. Asterisks denote significant decreases from 7 days to 35 days, p < 0.05. Data are group means (±S.E.M.).