The impact of anticipated and unanticipated smoking opportunities on cigarette smoking and nicotine lozenge responses

Highlights

• Unanticipated smoking opportunities lead to reduced latency to self-administration.

• Both nicotine and expectancy effects on craving were evident but varied by analyses.

• Nicotine effects on craving were most evident when analyses included entire sample.

• Expectancy effects were most robust among “believers” of the nicotine instructions.

Abstract

Background

Perceptions regarding the availability of smoking opportunities are known to affect cigarette craving; however, whether they impact actual smoking or how smokers respond to acute nicotine replacement therapy (NRT) administration is not known. This study examined the impact of pharmacological and expectancy components of NRT administration on craving and smoking in smokers anticipating or not anticipating an imminent smoking opportunity.

Methods

In total, 154 smokers (84 male) completed an experimental session in which instructions regarding the nicotine content of a lozenge (4 mg vs. no nicotine) and regarding the availability of a future smoking opportunity were manipulated. Cigarette craving was assessed before and after manipulations and lozenge administration. All participants were then allotted 1 h to self-administer as many cigarette puffs as they wished.

Results

Unanticipated smoking opportunities reduced latency to self-administration (p < 0.001), regardless of nicotine expectancy or pharmacology. When analyses included all participants, nicotine reduced intentions to smoke (p = 0.016) and withdrawal-related craving (p = 0.043) regardless of expectancy. Conversely, analyses using only “believers” of the nicotine content instructions revealed that nicotine expectancy reduced intentions to smoke (p = 0.034) and withdrawal-related craving (p = 0.047) regardless of actual nicotine administration. “Believers” also reported increased withdrawal-related craving when a smoking opportunity was perceived to be imminent (p = 0.041). These effects were not significant when analyses included all participants.

Conclusions

Findings suggest that unexpected smoking opportunities may be more appealing than expected ones regardless of perceived or actual acute NRT use. They also highlight the importance of reporting balanced placebo findings using all participants as well as “believers” only.

Introduction

Perceptions regarding the availability of a future smoking opportunity (i.e., believing one will or will not have an imminent opportunity to smoke) have been shown to have a substantial impact on cigarette craving. In a naturalistic study using cigarette-dependent flight attendants, Dar et al. (2010) demonstrated that cigarette craving increases gradually during flights, when smoking is not permitted, and peaks at the conclusion of a flight, when a smoking opportunity becomes imminent. Similar elevations in craving associated with increasing availability of a smoking opportunity have been demonstrated in laboratory based studies (Bailey et al., 2009, Dols et al., 2002, Juliano and Brandon, 1998, Sayette et al., 2003, Wertz and Sayette, 2001). To the best of our knowledge, no study to date has examined the impact of anticipating a smoking opportunity on actual smoking behaviour. However, given that craving has been found to increase with the proximity of a smoking opportunity, one might expect increased smoking behaviour during expected relative to unexpected smoking opportunities. On the other hand, recent findings suggest that laboratory animals display increased responding to obtain reinforcing substances when substances are delivered on a random as opposed to fixed schedule (Lagorio and Winger, 2014). Such findings suggest that unpredictable drug availability is associated with increased drug-related responding and thus it is possible that smokers may be more likely to engage in smoking related behaviours when unexpected opportunities to smoke occur.

Little is also known about how nicotine replacement therapies (NRTs) impact responses to anticipated and unanticipated smoking opportunities. However, because NRTs appear to be more effective in suppressing tonic or background craving as opposed to phasic or peaks in craving (Ferguson and Shiffman, 2009, Schlagintweit et al., 2014), one might expect that NRTs would be most effective when smoking opportunities are not perceived to be imminently available. NRT effects are generally attributed to the pharmacological properties of nicotine (e.g., Benowitz, 2008, Stead et al., 2012); however, there is growing evidence that suggests that non-pharmacological factors make a substantial contribution (Caggiula et al., 2001, Dar and Barrett, 2014). Balanced placebo research, which crosses instructions regarding nicotine content (told nicotine-containing vs. told nicotine-free) with actual nicotine content (contains nicotine vs. no nicotine) suggests that the belief that nicotine has been consumed reduces cigarette craving and withdrawal regardless of whether or not nicotine was actually consumed (Dar and Barrett, 2014, Darredeau and Barrett, 2010, Gottlieb et al., 1987, Schlagintweit et al., 2014).

This study aimed to (a) examine the impact of varying beliefs about the temporal proximity of a future smoking opportunity on subsequent smoking behaviour, and to (b) assess the impact of the psychological and pharmacological components of NRT administration when smoking opportunities are anticipated versus unanticipated. The study used a balanced placebo design, which manipulated participant expectancies about the nicotine content of nicotine and non-nicotine lozenges. Beliefs regarding the occurrence of a future smoking opportunity were manipulated such that some of the study participants were instructed that they could smoke during the study, while the others were told that they could not smoke until after completing the study. Subjective craving was assessed prior to and following lozenge consumption, and all participants were provided an opportunity to self-administer their preferred brand of cigarette during the final hour of the study.