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Relapse to smoking during unaided cessation: clinical, cognitive and motivational predictors

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An Erratum to this article was published on 19 April 2011

Abstract

Rationale

Neurobiological models of addiction suggest that abnormalities of brain reward circuitry distort salience attribution and inhibitory control processes, which in turn contribute to high relapse rates.

Objectives

The aim of this study is to determine whether impairments of salience attribution and inhibitory control predict relapse in a pharmacologically unaided attempt at smoking cessation.

Methods

One hundred forty one smokers were assessed on indices of nicotine consumption/dependence (e.g. The Fagerström Test of Nicotine Dependence, cigarettes per day, salivary cotinine) and three trait impulsivity measures. After overnight abstinence, they completed experimental tests of cue reactivity, attentional bias to smoking cues, response to financial reward, motor impulsiveness and response inhibition (antisaccades). They then started a quit attempt with follow-up after 7 days, 1 month and 3 months; abstinence was verified via salivary cotinine levels ≤20 ng/ml.

Results

Relapse rates at each point were 52.5%, 64% and 76.3%. The strongest predictor was pre-cessation salivary cotinine; other smoking/dependence indices did not explain additional outcome variance and neither did trait impulsivity. All experimental indices except responsivity to financial reward significantly predicted a 1-week outcome. Salivary cotinine, attentional bias to smoking cues and antisaccade errors explained unique as well as shared variance. At 1 and 3 months, salivary cotinine, motor impulsiveness and cue reactivity were all individually predictive; the effects of salivary cotinine and motor impulsiveness were additive.

Conclusions

These data provide some support for the involvement of abnormal cognitive and motivational processes in sustaining smoking dependence and suggest that they might be a focus of interventions, especially in the early stages of cessation.

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Acknowledgements

This research was funded by the National Institute of Drug Abuse (grant code 3527427). We thank Drs. Kiki Nikolaou, Ian Tharp, Mary Cochrane and Atsuko Inoue for their assistance with the recruitment and testing of participants in this study.

Ethics

This study complies with the current laws and ethical requirements of the UK. It was approved by the Ethics Committee of Goldsmiths, University of London and was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.

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Authors and Affiliations

  1. Department of Psychology, Goldsmiths University of London, Lewisham Way, New Cross, London, SE14 6NW, UK

    Jane Powell & Alan Pickering

  2. School of Psychology, University of East London, Romford Road, Stratford, London, E15 4LZ, UK

    Lynne Dawkins

  3. Department of Epidemiology and Public Health, University College London, 2-16 Torrington Place, London, WC1E 6BT, UK

    Robert West

  4. Department of Neuroscience and Psychological Medicine, Institute of Psychiatry, Kings College London, De Crespigny Park, London, SE5 8AF, UK

    John Powell

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  1. Jane Powell
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  2. Lynne Dawkins
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  4. John Powell
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Corresponding author

Correspondence to Jane Powell.

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Funding

This research was funded by the National Institute of Drug Abuse (grant code 3527427).

An erratum to this article can be found at http://dx.doi.org/10.1007/s00213-011-2300-x

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Powell, J., Dawkins, L., West, R. et al. Relapse to smoking during unaided cessation: clinical, cognitive and motivational predictors. Psychopharmacology 212, 537–549 (2010). https://doi.org/10.1007/s00213-010-1975-8

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