Stress decreases the ability to resist smoking and potentiates smoking intensity and reward

Abstract

We have developed a novel human laboratory model to examine two primary aspects of stress-precipitated tobacco relapse: (1) Does stress reduce the ability to resist the first cigarette? (2) Once the first cigarette is initiated, does stress facilitate subsequent smoking? Using a within-subject design, daily smokers (n = 37) who were nicotine deprived overnight received a personalized imagery induction (stress or neutral) on two separate days, and then had the option of initiating a tobacco self-administration session or delaying initiation for up to 50 min in exchange for three levels of monetary reinforcement. Subsequently, the tobacco self-administration session entailed a 1-hour period in which subjects could choose to smoke using a smoking topography system. Following the stress induction, subjects were less able to resist smoking, smoked more intensely (increased puffs, shorter inter-puff interval, and greater peak puff velocity), and perceived greater satisfaction and reward from smoking. Stress significantly increased hypothalamus-pituitary-adrenal (HPA) axis reactivity, tobacco craving, negative emotion, and physiologic reactivity relative to the neutral condition. In addition, increased cortisol, ACTH, and tobacco craving were associated with reduced ability to resist smoking following stress. These findings have implications for understanding the impact of stress on smoking relapse and model development to assess smoking lapse behavior.

Figure 1

Timeline of study procedures for laboratory sessions. Note: Assessment of cortisol and ACTH occurred at −30 min, −15 min, +10 min, +20 min, +40 min, and +60 min from the imagery procedure and remained fixed regardless of when the termination of the delay period occurred. Assessments of craving, emotion, physiologic reactivity, and nicotine withdrawal occurred at −15min, +5min, termination of the delay period, and +30min and +60min during the self-administration period. The imagery procedure commenced at 1pm.

Figure 2

Mean delay (+/− SE) to smoking across monetary reinforcement levels and stress vs. neutral conditions. *p < .05 for paired comparisons within timepoint.

Figure 3

Mean tobacco craving for positive reinforcement (A) and for negative reinforcement (B) across time. *p < .05 for paired comparisons within timepoint.

Figure 4

Mean positive (A) and negative (B) emotion across time. *p < .05 for paired comparisons within timepoint.

Figure 5

Mean systolic blood pressure (A), diastolic blood pressure (B), and heart rate (C) across time. *p < .05 for paired comparisons within timepoint.

Figure 6

Mean cortisol (A) and ACTH (B) levels across time. *p < .05 for paired comparisons within timepoint.