Thomas H. Brandon

Pretreatment task persistence predicts smoking cessation outcome.

R. Eisenbergers (1992) learned industriousness theory states that individuals display differing degrees of persistence depending on their history of reinforcement for effortful behavior. These differences may influence the development, maintenance, and cessation of addictive behaviors. In cross-sectional studies, E. P. Quinn, T. H. Brandon, and A. L. Copeland (1996) found that cigarette smokers were less persistent than nonsmokers, and R. A. Brown, C. W. Lejuez, C. W. Kahler, and D. R. Strong (2002) found that smokers who had previously abstained for 3 months were more persistent than those who had never quit. The present study extended these findings by using a prospective design. A pretreatment measure of task persistence (mirror tracing) completed by 144 smokers predicted sustained abstinence throughout 12 months of follow-up. Moreover, persistence predicted outcome independent of other significant predictors: gender, nicotine dependence, negative affect, and self-efficacy.

Motivational interviewing with personalized feedback: a brief intervention for motivating smokers with schizophrenia to seek treatment for tobacco dependence

Individuals with schizophrenia have a much higher prevalence of tobacco smoking, a lower cessation rate, and a higher incidence of tobacco-related diseases than the general population. The initial challenge has been to motivate these individuals to quit smoking. This study tested whether motivational interviewing is effective in motivating smokers with schizophrenia or schizoaffective disorder to seek tobacco dependence treatment. Participants (N = 78) were randomly assigned to receive a 1-session motivational interviewing (MI) intervention, standard psychoeducational counseling, or advice only. As hypothesized, a greater proportion of participants receiving the MI intervention contacted a tobacco dependence treatment provider (32%, 11%, and 0%, respectively) and attended the 1st session of counseling (28%, 9%. and 0%) by the 1-month follow-up as compared with those receiving comparison interventions.

Reactivity to instructed smoking availability and environmental cues: evidence with urge and reaction time.

Reactivity to drug-related cues has been proposed as a possible mechanism to explain maintenance of drug use and relapse. This study examined whether cognitions associated with drug use (the belief that nicotine is available for use) also elicit reactivity. Smokers (N = 132) were randomly assigned in a 2 (Smoking Availability) x 2 (Smoking Stimuli) factorial design. Reactivity was measured by self-reported urge and probe reaction time. A main effect for availability was found in that participants who had been told that they could smoke shortly reported greater urges than those who had been told that smoking would not be permitted for 3 hr. Moreover, smoking-related stimuli produced increases in urge ratings only when participants had been told that smoking would be available shortly. Probe reaction time, in contrast, increased in the presence of smoking stimuli only when participants were told that cigarettes were unavailable. The theoretical and treatment implications of drug availability as a moderator of cue reactivity, as well as the utility of reaction time as an index if drug use motivation, are discussed.

Classical conditioning of environmental cues to cigarette smoking.

Smoking-related cues tend to produce urges and cardiac responses in smokers. This reactivity has been assumed to reflect prior classical conditioning. However, little direct evidence exists supporting the notion that environmental cues can be classically conditioned to cigarette smoking. In this study, 8 smokers received 22 daily trials during which 2 cue complexes (comprising visual, olfactory, and auditory stimuli) were paired with smoking (CS+ trials) and not smoking (CS- trials). Reactivity to the environmental cues, as measured by self-report of urge and pulse rate, increased across CS+ trials, diverging from responses in the CS- trials. Reactivity was stronger among light smokers and those who verbalized awareness of smoking contingencies. Findings indicate that environmental cues can be classically conditioned to smoking.

The increasing recalcitrance of smokers in clinical trials

It has been suggested that a consequence of the declining prevalence of smoking in the United States over the past 25 years is that the population of remaining smokers is becoming more difficult to treat. That is, compared to smokers of years past, todays smokers are more likely to be highly nicotine dependent, have comorbid psychiatric and substance abuse disorders, have less education, and be of lower economic status. If this is indeed the case, there should be found declining abstinence rates in published clinical trials, when the type of treatment is held constant. To test this hypothesis, a literature search was conducted for group-administered multicomponent smoking cessation trials that emphasized coping skills training. Twenty-three studies published between 1977 and 1996 were identified. As predicted, robust negative correlations were found between year of publication and end-of-treatment abstinence rates. Using point-prevalence abstinence rates from later follow-up points produced somewhat weaker associations. Controlling for the use of biochemical verification or nicotine replacement therapies did not alter the findings. In summary, the efficacy of clinical trials--with treatment held constant--appears to be declining. One possible cause is the increasing recalcitrance of those individuals who continue to smoke despite social, regulatory, and medical pressures to quit.

Pain, nicotine, and smoking: research findings and mechanistic considerations.

Tobacco addiction and chronic pain represent 2 highly prevalent and comorbid conditions that engender substantial burdens upon individuals and systems. Interrelations between pain and smoking have been of clinical and empirical interest for decades, and research in this area has increased dramatically over the past 5 years. We conceptualize the interaction of pain and smoking as a prototypical example of the biopsychosocial model. Accordingly, we extrapolated from behavioral, cognitive, affective, biomedical, and social perspectives to propose causal mechanisms that may contribute to the observed comorbidity between these 2 conditions. The extant literature was 1st dichotomized into investigations of either effects of smoking on pain or effects of pain on smoking. We then integrated these findings to present a reciprocal model of pain and smoking that is hypothesized to interact in the manner of a positive feedback loop, resulting in greater pain and increased smoking. Finally, we proposed directions for future research and discussed clinical implications for smokers with comorbid pain disorders. We observed modest evidence that smoking may be a risk factor in the multifactorial etiology of some chronically painful conditions and that pain may come to serve as a potent motivator of smoking. We also found that whereas animal studies yielded consistent support for direct pain-inhibitory effects of nicotine and tobacco, results from human studies were much less consistent. Future research in the emerging area of pain and smoking has the potential to inform theoretical and clinical applications with respect to tobacco smoking, chronic pain, and their comorbid presentation. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

Affect, expectancies, urges, and smoking: Do they conform to models of drug motivation and relapse?

Social-learning models of drug motivation and relapse often include the constructs of affect and drug expectancies. Most research has taken a molar approach to examining relations between these constructs and level of drug use. An experiment examined the roles of affect and expectancies in multiple measures of situation-specific motivation to smoke tobacco. Undergraduate smokers (n = 101) received either a positive or negative mood manipulation (false feedback on an intelligence test). Self-reported urge was influenced by both negative affect and expectancies for positive reinforcement from smoking. Actual consumption was related only to smoking expectancies and only among abstaining smokers. Affect by expectancy interactions were also found. Findings support a limited role of affect and expectancies in smoking motivation. Poor coherence among the motivational indexes challenges the assumptions of existing models of drug motivation.

Preventing Relapse Among Former Smokers A Comparison of Minimal Interventions Through Telephone and Mail

This study compared 2 minimal interventions for reducing relapse in ex-smokers. One intervention involved 12-month access to a telephone hot line. In the other intervention, 8 relapse-prevention booklets were mailed to participants over 1 year. The 2 interventions were crossed in a 2 x 2 factorial design, yielding control, hot-line-only, mailings-only, and combined conditions. The criterion of at least 1 week of abstinence at baseline was met by 584 participants, 446 of whom also completed a 12-month assessment. Repeated mailings, but not the hot line, reduced relapse for those participants who had been abstinent for less than 3 months at baseline. At follow-up, 12% of those in the mailings conditions were smoking again compared with 35% in the nonmailing conditions. As predicted, both interventions were effective at attenuating the association between depressive symptoms and poor outcome found in the control condition.

Assessing tobacco use by cancer patients and facilitating cessation: an American Association for Cancer Research policy statement.

When diagnosed with cancer, patients can immediately make a meaningful positive impact on their health by stopping their tobacco use. Scientific evidence clearly shows that tobacco use in patients with cancer leads to poorer outcomes. The specific biological processes driving tobacco consumptions interference in cancer therapy are the subject of continuing research, but the evidence is clear that tobacco use in patients with cancer leads to decreased treatment efficacy and safety, decreased survival, decreased quality of life, increased treatment-related toxicity, and increased risk of cancer recurrence and second primary tumors. Data suggest that tobacco cessation can improve outcomes and survival in patients with cancer, yet full execution of evidence-based cessation interventions is infrequent in oncology settings. Therefore, both improved provision of cessation assistance to all patients with cancer who use tobacco or have recently quit and further study of the deleterious effects of tobacco use and benefits of tobacco cessation on cancer progression and treatment are needed and recommended by the American Association for Cancer Research. Progress on both fronts begins with universal assessment and documentation of tobacco use as a standard of quality cancer care regardless of treatment setting and will be further facilitated through the development of reliable, valid, and standard measures of tobacco use, incorporation of evidence-based procedures into quality and accreditation procedures, and the development of appropriate training, clinical infrastructure, and incentives for delivery of tobacco cessation interventions. Clin Cancer Res; 19(8); 1941–8. ©2013 AACR.

The increasing recalcitrance of smokers in clinical trials II: Pharmacotherapy trials

Irvin and Brandon (Nicotine & Tobacco Research, 2, 79-84, 2000) reported a significant decline in reported abstinence rates between 1977 and 1996 from clinical trials of cognitive-behavioral smoking cessation treatments based on coping skills training. The present study extends that approach to the analysis of pharmacotherapy trials. A literature search identified 59 studies, published between 1983 and 2000 and conducted in the U.S., that reported post-cessation abstinence rates after treatment with nicotine gum, nicotine patch or any type of placebo medication. Across all three types of treatment conditions and four post-cessation assessment points, negative correlations between publication year and abstinence rates were found. The strongest pattern of negative correlations was found for the placebo conditions. However, the correlations for placebo conditions could be accounted for by the simultaneous shift toward treatments offered in individual rather than group format. No other methodological or subject variable appeared to mediate the declining outcomes. Findings are discussed with respect to the theory that the population of remaining smokers is becoming progressively more dependent and difficult to treat.