Haruka Minami

A preliminary, randomized trial of aerobic exercise for alcohol dependence

Interventions targeting physical activity may be valuable as an adjunct to alcohol treatment, but have been relatively untested. In the current study, alcohol dependent, physically sedentary patients were randomized to: a 12-week moderate-intensity, group aerobic exercise intervention (AE; n=25) or a brief advice to exercise intervention (BA-E; n=23). Results showed that individuals in AE reported significantly fewer drinking and heavy drinking days, relative to BA-E during treatment. Furthermore adherence to AE strengthened the beneficial effect of intervention on alcohol use outcomes. While high levels of moderate-intensity exercise appeared to facilitate alcohol recovery regardless of intervention arm, attending the group-based AE intervention seemed to further enhance the positive effects of exercise on alcohol use. Study findings indicate that a moderate intensity, group aerobic exercise intervention is an efficacious adjunct to alcohol treatment. Improving adherence to the intervention may enhance its beneficial effects on alcohol use.

Development and preliminary randomized controlled trial of a distress tolerance treatment for smokers with a history of early lapse.

INTRODUCTION An inability to tolerate distress is a significant predictor of early smoking lapse following a cessation attempt. We conducted a preliminary randomized controlled trial to compare a distress tolerance (DT) treatment that incorporated elements of exposure-based therapies and Acceptance and Commitment Therapy to standard smoking cessation treatment (ST). METHODS Smokers with a history of early lapse in prior quit attempts received either DT (N = 27; 9 2-hr group and 6 50-min individual sessions) or ST (N = 22; 6 90-min group and 1 20-min individual session), plus 8 weeks of transdermal nicotine patch. RESULTS At the end of behavioral treatment, odds of abstinence among participants receiving DT were 6.46 times greater than among participants receiving ST (66.7% vs. 31.8%), equivalent to a medium- to large-effect size. Odds of abstinence for DT were still 1.73 times greater at 8 weeks, corresponding to a small- to medium-effect size, although neither this difference nor those at 13 and 26 weeks were statistically significant. Furthermore, of those who lapsed to smoking during the first week postquit, DT participants had more than 4 times greater odds of abstinence than ST participants at the end of treatment. Relative to ST, DT participants also reported a larger decrease in experiential avoidance, a hypothesized DT treatment mediator, prior to quit day. The trajectory of negative mood and withdrawal symptoms in DT differed from ST and was largely consistent with hypotheses. CONCLUSIONS Reasons for the decrease in abstinence in DT after treatment discontinuation and suggestions for future research are discussed.

Motivational Interviewing to Reduce Substance Use in Adolescents with Psychiatric Comorbidity.

Substance use among adolescents with one or more psychiatric disorders is a significant public health concern. In this study, 151 psychiatrically hospitalized adolescents, ages 13-17 with comorbid psychiatric and substance use disorders, were randomized to a two-session Motivational Interviewing intervention to reduce substance use plus treatment as usual (MI) vs. treatment as usual only (TAU). Results indicated that the MI group had a longer latency to first use of any substance following hospital discharge relative to TAU (36 days versus 11 days). Adolescents who received MI also reported less total use of substances and less use of marijuana during the first 6 months post-discharge, although this effect was not significant across 12 months. Finally, MI was associated with a significant reduction in rule-breaking behaviors at 6-month follow-up. Future directions are discussed, including means of extending effects beyond 6 months and dissemination of the intervention to community-based settings.

An exploratory analysis of changes in mood, anxiety and craving from pre- to post-single sessions of exercise, over 12 weeks, among patients with alcohol dependence

Aerobic exercise is currently being studied as a relapse prevention strategy for individuals with alcohol use disorders. Negative affect and cravings predict relapse. The acute effects of moderate-intensity exercise have been shown to improve mood and reduce craving. The current study examined the acute effects of exercise on changes in mood, anxiety, and craving from pre- to post-exercise at each week of a 12-week moderate intensity exercise intervention with sedentary alcohol dependent adults. Twenty-six participants in the exercise condition of a larger randomized clinical trial (Brown et al., 2014) exercised in small groups at moderate intensity for 20 to 40 minutes per session. Participants rated mood, anxiety, and cravings in the present moment before and after each exercise session over the course of the 12-week intervention. Data analyses focused on effect size and interval estimation. Joinpoint analysis was used to model longitudinal trends. Increases in mood and decreases in anxiety and craving were apparent at every session. Effect size estimates revealed that average change from pre- to post-exercise was in the small to medium range with some individual sessions reaching the large range. Joinpoint analyses revealed that the pre-post exercise changes in mood increased, anxiety remained stable, and craving diminished across the 12 weeks. This study provides provisional support for a change in mood, anxiety and alcohol cravings for the role of exercise in the early recovery period for alcohol dependence. Acute single bouts of moderate-intensity exercise may help individuals with alcohol dependence manage mood, anxiety, and craving thereby reducing relapse risk, but further research is needed with a more rigorous study design.

The moderating role of experiential avoidance in the relationships between internal distress and smoking behavior during a quit attempt.

Recent smoking cessation studies have shown that decreasing experiential avoidance (EA; i.e., tendency to reduce or avoid internal distress) improves success, but to date none have examined the moderating effect of EA on the role of specific internal distress in smoking cessation. This study examined whether prequit general EA (Acceptance and Action Questionnaire) and smoking-specific EA (Avoidance and Inflexibility Scale) moderated the relations between 4 measures of postquit internal distress (depressive symptoms, negative affect, physical withdrawal symptoms, craving) and smoking. Forty adult smokers participated in a randomized controlled trial of distress tolerance treatment for smokers with a history of early lapse. Multilevel models showed that prequit smoking-specific EA, but not general EA, significantly moderated the relationship between all measures of internal distress, except craving, and smoking over 13 weeks postquit. When examined over 26 weeks, these relations remained unchanged for all, but the moderating effect became trend-level for depressive symptoms. Significant associations between postquit internal distress and smoking were found only in those with high prequit smoking-specific EA. Moreover, prequit smoking-specific EA did not predict postquit levels or changes in internal distress, suggesting that decreasing smoking-specific EA prequit may not reduce internal distress, but may instead reduce smoking risk in response to such distress during a quit attempt. Results mainly supported hypothesized relations, but only for smoking-specific EA. Smoking cessation interventions focusing on EA reduction may especially benefit those vulnerable to greater postquit depressive and withdrawal symptoms, and those who smoke to regulate aversive internal states. (PsycINFO Database Record

Relations among affect, abstinence motivation and confidence, and daily smoking lapse risk.

This study tested the hypothesis that changes in momentary affect, abstinence motivation, and confidence would predict lapse risk over the next 12-24 hr using Ecological Momentary Assessment (EMA) data from smokers attempting to quit smoking. One hundred and three adult, daily, treatment-seeking smokers recorded their momentary affect, motivation to quit, abstinence confidence, and smoking behaviors in near real time with multiple EMA reports per day using electronic diaries postquit. Multilevel models indicated that initial levels of negative affect were associated with smoking, even after controlling for earlier smoking status, and that short-term increases in negative affect predicted lapses up to 12, but not 24, hr later. Positive affect had significant effects on subsequent abstinence confidence, but not motivation to quit. High levels of motivation appeared to reduce increases in lapse risk that occur over hours although momentary changes in confidence did not predict lapse risk over 12 hr. Negative affect had short-lived effects on lapse risk, whereas higher levels of motivation protected against the risk of lapsing that accumulates over hours. An increase in positive affect was associated with greater confidence to quit, but such changes in confidence did not reduce short-term lapse risk, contrary to expectations. Relations observed among affect, cognitions, and lapse seem to depend critically on the timing of assessments.

Independent and interactive effects of real-time risk factors on later temptations and lapses among smokers trying to quit

PURPOSE The current study sought to expand our understanding of relapse mechanisms by identifying the independent and interactive effects of real-time risk factors on temptations and the ability to resist temptations in smokers during a quit attempt. PROCEDURES This study was a secondary analysis of data from 109 adult, treatment-seeking daily smokers. Ecological momentary assessment data was collected 4 times a day for 21 days following a quit attempt and was used to assess affect, urge, impulsiveness, recent cigarette exposure, and alcohol use as predictors of temptations to smoke and smoking up to 8h later. All smokers received nicotine replacement therapy and smoking cessation counseling. FINDINGS In multinomial hierarchical linear models, there were significant main (agitation odds ratio (OR)=1.22, 95% CI=1.02-1.48; urge OR=1.60, 95% CI=1.35-1.92; nicotine dependence measured by WISDM OR=1.04, 95% CI=1.01-1.08) and interactive effects (agitation×urge OR=1.12, 95% CI=1.01-1.27; urge×cigarette exposure OR=1.38, 95% CI=1.10-1.76; positive affect×impulsiveness OR=2.44, 95% CI=1.02-5.86) on the odds of temptations occurring, relative to abstinence without temptation. In contrast, prior smoking (OR=3.46, 95% CI=2.58-4.63), higher distress (OR=1.30, 95% CI=1.06-1.60), and recent alcohol use (OR=3.71, 95% CI=1.40-9.89) predicted smoking versus resisting temptation, and momentary impulsiveness was related to smoking for individuals with higher baseline impulsiveness (OR=1.12, 95% CI=1.04-1.22). CONCLUSIONS The risk factors and combinations of factors associated with temptations and smoking lapses differ, suggesting a need for separate models of temptation and lapse.

Quality of life after quitting smoking and initiating aerobic exercise

Abstract Quitting smoking and aerobic exercise each improve health. Although smokers may be concerned that quitting smoking will reduce their quality of life (QOL), recent research has shown that cessation is associated with QOL benefits. Elements of smoking cessation interventions, such as exercise, may contribute to changes in QOL. However, it is unknown whether initiating exercise in the context of smoking cessation is associated with greater or different effects on QOL than smoking cessation alone. The current study is a secondary analysis of data from a randomized trial (n = 61) of an exercise intervention for smoking cessation. We hypothesized that smoking abstinence and engagement in exercise would have positive, additive effects on QOL at end-of-treatment, 6- and, 12-month follow-ups. Sedentary adult smokers were randomized to the exercise intervention or a health education control (HEC) group. Additionally, all participants received smoking cessation counseling and nicotine patches. Data were analyzed using actual engagement in exercise, rather than group assignment as a proxy for exercise engagement, because some HEC participants also began exercising. Abstinence was positively associated with higher total and physical health QOL at follow-up. Exercise was not associated with total QOL and only marginally associated with physical health QOL, but was positively related to overall sense of well-being. Emphasizing that smoking cessation is associated with higher QOL may help motivate smokers to initiate quit attempts.

Using ecological measures of smoking trigger exposure to predict smoking cessation milestones.

This study used ecological momentary assessment data from adult daily smokers attempting to quit smoking to assess relations between exposure to contextual risk factors and cessation failure, latency to a first smoking lapse, or progression from lapse to relapse (smoking 7 days in a row). Participants were adult, daily smokers enrolled in a randomized controlled clinical trial of bupropion SR and individual counseling who were followed to 1 year postquit. Participants reported exposure to high-risk contexts and behaviors, including being where cigarettes were available or smoking was permitted, being around others smoking in prospective, real-time assessment for 2 weeks pre- and 4 weeks postquit. Results showed that greater exposure to contextual risk factors during the prequit did not predict cessation failure. However, Cox regression survival analyses revealed that spending a greater proportion of time where cigarettes were easily available following at least 1 day of abstinence predicted shorter latency to a first lapse, even after controlling for baseline risk factors such as gender, nicotine dependence, depressive symptoms, and living with a smoker. Greater cigarette availability following a lapse was not associated with progression from lapse to relapse with or without baseline risk factors in the model. This suggests that postquit environmental risk factors, such as cigarette availability, increase lapse risk, and stable risk factors, such as living with smokers and higher baseline carbon monoxide level or depressive symptoms, remain potent predictors of progression to relapse. Real-time contextual risk assessments postquit predict lapse above and beyond stable, baseline risk factors. (PsycINFO Database Record

Effects of Depression History and Sex on the Efficacy of Sequential Versus Standard Fluoxetine for Smoking Cessation in Elevated Depressive Symptom Smokers

Objective:The potential benefits of antidepressant pharmacotherapy with fluoxetine for smoking cessation among vulnerable subpopulations of depressed smokers have not been well explored. This study examined whether the efficacy of a sequential course of fluoxetine for smoking cessation differed as a function of depression history (none vs. single vs. recurrent episodes) and sex. Methods:Data were from a randomized controlled trial that evaluated the efficacy of sequential fluoxetine treatment (SEQ-FLUOX; 16 wk, starting 8 wk prequit) in comparison with standard fluoxetine treatment (ST-FLUOX; 10 wk, starting 2 wk prequit) and transdermal nicotine patch only (TNP) for 216 smokers with elevated depressive symptoms. Results:Cox regression analyses revealed significant moderating effects of depression history (recurrent vs. single), but not sex, on the efficacy of SEQ-FLUOX versus ST-FLUOX on latency to relapse. Among smokers with recurrent major depressive disorder (MDD) episodes, those receiving SEQ-FLUOX were slower to relapse, compared with those receiving ST-FLUOX, but not relative to TNP. No such treatment difference was observed in smokers with no MDD history or a single past MDD episode. Furthermore, those with recurrent MDD receiving SEQ-FLUOX reported significantly lower levels of depressive symptoms over 26 weeks after quitting, compared with those receiving ST-FLUOX, but not relative to TNP. Conclusions:Findings suggest the possible specific benefits of treating elevated depressive symptom smokers with recurrent MDD using fluoxetine in a sequential manner (vs. standard). However, given the small sample size, the reliability of this difference is unknown. Replication with a larger sample of recurrent MDD history is needed.