Nicholas H. Caskey

Anxiolytic effects of smoking associated with four stressors

There is a widespread belief that cigarette smoking alleviates stress. The literature reveals conflicting results on the anxiolytic effects of smoking. This study was designed to replicate a report that smoking (a) reduced subjective anxiety induced by stressful anagrams and (b) increased pain threshold for a cold pain task. This study (N = 15) included two other stressors: white noise and an auditory vigilance task. A significant Time x Condition (smoking vs. deprived) interaction was found for Spielberger State Anxiety Inventory scores in the anagram task. A borderline significant interaction effect was found for the cold pain task. No significant effects were found with the two other tasks. These results provide partial support for the popular notion that smoking mitigates stress-induced anxiety. No difference was found between the smoking and deprived conditions for either pain threshold or pain endurance.

The effects of dopaminergic D2 stimulation and blockade on smoking behavior.

Researchers have hypothesized that dopamine mediates the reinforcing effects of stimulant drugs, including nicotine. Three experiments tested whether manipulating dopamine would alter human smoking behavior. Experiments used double-blind, repeated measures designs. In Experiment 1, 4 participants were given haloperidol (a dopamine antagonist; placebo, 0.5, and 1.0 mg) on 3 occasions. The smoking rate was faster in the 1.0 mg versus the placebo condition. In Experiment 2, 12 participants were given haloperidol (2.0 mg) and placebo on 2 occasions. The intercigarette interval was shorter at the expected time of peak drug concentration. In Experiment 3, 5 participants were given bromocriptine (a dopamine agonist, 2.5 mg) and placebo on 2 occasions. The smoking rate was significantly slower with bromocriptine. These results suggest that blockade of D2 receptors increases smoking whereas their stimulation decreases smoking.

Modulating tobacco smoking rates by dopaminergic stimulation and blockade

This study was designed to demonstrate that dopaminergic stimulation would result in decreased smoking behavior and nicotine intake, whereas dopaminergic blockade would result in increased smoking behavior and nicotine intake, in the same subjects. In prior human studies, a dopaminergic antagonist, haloperidol, increased smoking and/or nicotine intake, and a dopamine agonist, bromocriptine, decreased smoking. The smoking behavior of 20 heavy smokers was observed on two separate visits in a randomized, double-blind, repeated-measures-within-subject design. In the drug-reversal design, either bromocriptine (2.5 mg) or haloperidol (2.0 mg) was administered at each 5-h session, during which subjects smoked their own cigarettes ad libitum. Smoking topography was measured using a thermistor flow detector apparatus. Subjects smoked their cigarettes faster (p<0.05) and total puffing time was greater (p<0.05) with haloperidol than with bromocriptine. There was a trend for both a shorter latency to smoke (p<0.10, one-tailed) during time of expected peak drug concentration and for a shorter inter-cigarette interval with haloperidol than with bromocriptine (p<0.10, one-tailed). Shiffman-Jarvik Withdrawal Scale craving subscale scores increased significantly more with haloperidol than with bromocriptine (p<0.05). Mean Profile of Mood States (POMS) scores differed significantly for only one subscale (Confusion: bromocriptine>haloperidol; p<0.05). These data support the hypothesis that nicotine mediates reinforcement from smoking via dopamine, and that smoking behavior can be manipulated within the same subjects in opposite directions by alternately stimulating and blocking dopamine.

Rapid smoking of menthol and nonmenthol cigarettes by black and white smokers.

White subjects took significantly more puffs of cigarette smoke before stopping than did black subjects in a modified, controlled-dose rapid smoking procedure. Paradoxically, however, no racial differences were detected for changes in carbon monoxide levels, or changes in cardiovascular variables (systolic and diastolic blood pressure, and heart rate). Due to the cooling and topical anesthetic properties of menthol, it was hypothesized that menthol and regular cigarette smokers would take more puffs from menthol cigarettes than from regular cigarettes before stopping in the controlled-dose rapid smoking procedure. However, no difference was observed for the number of puffs taken from regular as opposed to menthol cigarettes (cigarette type condition) and no differences were found for Cigarette Preference (regular smokers vs. menthol smokers).

The effects of smoking-related sensory cues on psychological stress

Previous studies have shown that the sensory cues of cigarette smoking are important for smoking satisfaction and craving reduction. Sensory cues in the absence of pharmacological doses of nicotine have been found to be moderately satisfying and to reduce craving. The current study was conducted to determine if administration of the sensory cues of cigarette smoking with minimal nicotine would also provide relief from mild anxiety associated with anticipation of a difficult anagram test. This test has previously been shown to be sensitive to the anxiety relieving effects of cigarette smoking. Compared to the placebo control condition, the sensory condition caused a significant alleviation of the stress as measured by components of the Spielberger scale for anxiety. The addition of cigarette smoke containing 0.5 mg of nicotine to the sensory cues caused a slight though nonsignificant enhancement of the stress alleviation. These results demonstrate that sensory cues of smoking can provide similar effects as nicotine containing cigarettes with regard to stress alleviation. Previous studies had shown that sensory cues are important for the consumptive aspects of smoking (i.e., smoking satisfaction and craving reduction). The current study shows that sensory cues are important for other effects of smoking as well.

Effects of a Late-Life Suicide Risk-Assessment Training on Multidisciplinary Healthcare Providers

Older adults are among the highest at risk for completing suicide, and they are more likely to seek mental health services from providers outside of traditional mental health care, but providers across the spectrum of care have limited training in suicide risk assessment and management and particularly lack training in suicide prevention for older adults. An educational program was developed to increase awareness and improve suicide risk assessment and management training for a range of healthcare providers who may see older adults in their care settings. One hundred thirty‐two participants from two Veterans Affairs Medical Centers participated in a 6.5‐hour‐long workshop in the assessment and management of suicide risk in older adults. Participants were asked to complete pre‐ and postworkshop case notes and report on subjective changes in knowledge, attitudes, and confidence in assessment and managing suicide risk in older adults. Participants included social workers, nurses, physicians, psychologists, and occupational therapists from a variety of care settings, including outpatient and inpatient medical, outpatient and inpatient mental health, specialty clinics, home, and community. After the workshop, participants demonstrated improvement in the overall quality of case notes (P = .001), greater ability to recognize important conceptual suicide risk categories (P = .003), and reported heightened awareness of the importance of late‐life suicide. The results suggest that educational training may have beneficial effect on the ability of multidisciplinary care providers to identify and manage suicide risk in elderly adults.