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Randomized Controlled Trial
. 2014 Oct;39(10):1484-90.
doi: 10.1016/j.addbeh.2014.05.008. Epub 2014 May 28.

The impact of pre-cessation varenicline on behavioral economic indices of smoking reinforcement

Nicolas J Schlienz  1 , Larry W Hawk Jr  2 , Stephen T Tiffany  3 , Richard J O'Connor  4 , Martin C Mahoney  4
Affiliations
Randomized Controlled Trial

The impact of pre-cessation varenicline on behavioral economic indices of smoking reinforcement

Nicolas J Schlienz et al. Addict Behav. 2014 Oct.

Abstract

Background: Varenicline was developed to aid smoking cessation by reducing smoking reinforcement. The present study tests this reinforcement-reduction hypothesis among smokers preparing to quit.

Method: After a one-week baseline, treatment-seeking smokers were randomized to receive three weeks of varenicline or placebo (Weeks 2-4). During each of the four weeks of the study, smokers completed a hypothetical cigarette purchase task (CPT) via handheld devices in their natural environment. Behavioral economic measures of simulated smoking if cigarettes were free (demand intensity), sensitivity of consumption to increasing price (elasticity), and price at which purchases would drop to 0 (breakpoint) were estimated.

Results: The exponential demand equation fit the purchase task data well across subjects and time. As predicted, demand intensity decreased and sensitivity to price (elasticity) increased over time. However, changes in demand intensity did not differ by treatment group. Contrary to our hypothesis that varenicline would increase sensitivity to price, the placebo group tended to become more elastic in their purchases during Weeks 2 and 3; the groups did not differ in elasticity at Week 4. Breakpoint did not vary by group, time, or their interaction.

Conclusion: Simulated smoking demand can be validly assessed in the natural environment of treatment-seeking smokers. Simulated demand indices of smoking reinforcement diminished as smokers approached their target quit date. However, there was no evidence that varenicline facilitated these changes over a three-week period, leaving open the mechanisms by which varenicline reduces smoking rate prior to cessation and improves long-term abstinence.

Keywords: Behavioral economics; Cigarette purchase task; Smoking reinforcement; Smoking reward; Varenicline.

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Figures

Figure 1
Figure 1
Participant Disposition
Figure 2
Figure 2
Cigarette purchase demand curves for placebo (circles) and varenicline (squares) groups at baseline (panel a) and each week of the drug manipulation (panels b-d). Data are plotted in log units: x-axis is log (US dollars); y-axis is log (cigarettes purchased)
Figure 3
Figure 3
Mean demand intensity (panel a), demand elasticity (panel b), and breakpoint (panel c). Bars represent standard error of the mean (SEM).
See this image and copyright information in PMC

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