Nihms765787 PDF

HHS Public Access
Author manuscript
Psychol Addict Behav. Author manuscript; available in PMC 2017 May 01.
Author Manuscript
Published in final edited form as:

Psychol Addict Behav. 2016 May ; 30(3): 277–286. doi:10.1037/adb0000177.
In search of anticipatory cigarette cravings: The impact of

perceived smoking opportunity and motivation to seek treatment
Michael A. Sayette and John D. Dimoff
University of Pittsburgh
Abstract
Author Manuscript
Craving has long been considered central to addiction, yet it remains unclear just how it
contributes to drug use or relapse. Improved understanding of its role in addiction requires a more
fine-grained examination of craving, including the context in which it occurs. This study used a
novel set of smoking-related and unrelated stimuli to investigate responses of 227 nicotine-
deprived smokers under conditions that manipulated perceived smoking opportunity and
motivation to quit smoking. Specifically, we contrasted features of preconsumptive states when
active smokers anticipate smoking soon to states when smokers do not have this expectation.
Results indicated that under certain conditions (smokers not interested in quitting who expected to
be able to smoke soon), exposure to smoking cues becomes attractive. Specifically, these smokers
found smoking-related images to be more pleasant than did smokers who were either motivated to
quit smoking within the next month or who were informed that they would not be permitted to
smoke during the experiment. More broadly, the study raises the possibility that the loss of
Author Manuscript
routinely experienced pleasant cravings upon quitting smoking may yield challenges to staying
quit, and requires greater clinical attention.
Keywords
craving; urge; contextual factors; smoking; anticipation
The topic of craving has interested addiction researchers for decades (e.g., Jellinek, 1955;
Wikler, 1948). Clinical studies reveal a link between cravings and subsequent lapses
(Sayette, in press; Tiffany & Wray, 2012). Although interventions designed to reduce
craving have shown promise (e.g., Monti et al., 1993; O’Brien, Childress, McLellan, &
Ehrman, 1990), clearly research that better accounts for contextual factors related to craving
Author Manuscript
is needed both to improve outcome (Conklin & Tiffany, 2002; Heckman, Kovacs,
Marquinez, Meltzer, & Tsambarlis, 2013) and to enhance conceptualization of craving
(Wilson, Sayette, & Fiez, 2012).
A variety of learning-based models consider the relation between craving and addiction (see
Niaura et al., 1988; Tiffany 1990). Negative reinforcement theories view craving as an
unpleasant state, the alleviation of which motivates drug use (Siegel, 1983; Solomon &
Correspondence concerning this article should be addressed to Michael Sayette, Ph.D., Department of Psychology, 3137 Sennott
Square, University of Pittsburgh, 210 S. Bouquet St., Pittsburgh, PA 15260. ; Email: sayette@pitt.edu
Sayette and Dimoff Page 2
Corbitt, 1973; Wikler, 1973). Alternatively, appetitive motivational theories posit that drug
Author Manuscript
cues come to induce a motivational state that approximates the actual effects of the drug
(Stewart, de Wit, & Eikelboom, 1984). From this perspective, drug cues provide an
incentive, experienced as craving, to receive more of the drug (see also Bindra, 1974).
Although positive affect may trigger this drive, it is notable that the drive itself to consume
need not be experienced as pleasant. As Stewart et al. (1984) state, “a conditioned
reinforcing stimulus acts to maintain behavior not by virtue of satisfying some drive or need
but rather by acting as a persistent goad to response generation.” (p. 263).
Accordingly, with few exceptions [e.g., Baker, Morse, and Sherman’s (1987) dual affect
model of craving] cravings are considered either to be aversive states that must be alleviated
(by using the substance) or merely goads to using (Stewart et al., 1984). Less investigated
are the ways in which anticipation of drug use (separate from actual consumption) by
continuing users not currently trying to quit, might contribute to the perpetuation of a drug
Author Manuscript
habit. We tested two key contextual factors (perceived opportunity to smoke soon1 and
current motivation to quit) thought to affect smoking anticipation. Specifically, we assessed
how these two factors affect smokers’ experience of smoking-related (viewing images of
smoking cues, holding a cigarette) and smoking-unrelated (listening to a comedy clip)
stimuli.
Perceived Smoking Opportunity

The idea that drug availability influences the nature of craving is not new (Baker et al., 1987;
Childress, McLellan, & O’Brien, 1986). Consistent with this premise, Juliano and Brandon
(1998) and Droungas, Ehrman, Childress, and O’Brien (1995) found that smokers reported
stronger urges when they expected than when they did not expect to smoke. In a review,
Author Manuscript
Wertz and Sayette (2001a) observed a strong effect of perceived drug use opportunity, with
those expecting to use reporting much stronger urges. Several subsequent studies across a
range of measurement domains generally have reinforced the proposition that expecting to
smoke soon increases urge ratings (e.g., Carter & Tiffany, 2001; Dols, van den Hout, Kindt,
& Willems, 2002; Field & Duka, 2001; Thewissen, van den Hout, Havermans, & Jansen,
2005; Thewissen, van der Meijden, Havermans, van den Hout, & Jansen, 2008) and
improves affect as assessed by self-report (Carter & Tiffany, 2001), electrophysiology
(Zinser, Fiore, Davidson, & Baker, 1999), and affect-related facial expressions (Sayette &
Hufford, 1995; Sayette, Wertz, Martin, Perrott, & Hobel, 2003). These data suggest that
many cravings can be rewarding (pleasurable) anticipatory experiences, and that our usual
‘set’ that craving must be a frustrating moment of torment derives only from what we know
about relapse, not ad lib smoking. Further, expecting to smoke soon also appears to affect
Author Manuscript
the manner in which cues are processed. Research indicates, for example, that expecting to
smoke soon heightens attentional bias toward smoking stimuli (Wertz & Sayette, 2001b),
and alters neural responding to both smoking cues and to nonsmoking reward (Wilson,
Sayette, Delgado, & Fiez, 2005; 2008).
1Because smokers sometimes can have cigarettes available but still not perceive an opportunity to smoke – e.g., orthodox Jews on the
Sabbath may have cigarettes available yet “know” that they will not smoke (Dar, Stronguin, Marouani, Krupsky, & Frenk, 2005), we
instead use the term perceived smoking opportunity herein to refer to the perception that the cigarette is able to be smoked (see Wertz
& Sayette, 2001a).
Motivation to Seek Treatment

Author Manuscript
Research indicates that individuals motivated to seek treatment experience different levels
and types of cue-elicited cravings than do “continuing” drug users. In abstinence seeking
situations, individuals do not intend to use the substance because they are motivated to quit.
In abstinence avoidance situations, continuing smokers are not trying to quit, but their
typical drug use routine is interrupted (e.g., no more cigarettes) and the aim is to regain
access to and use the drug (Tiffany, 1990). During drug cue exposure, studies testing
continuing users observed urges almost twice the level of those found when testing
participants in treatment (see Wertz & Sayette, 2001a). Data from brain imaging studies also
reveal different patterns of neural activation following cue exposure among these two types
of users (see Wilson, Sayette, & Fiez, 2004).
Anticipation of Imminent Use

Author Manuscript
The forgoing suggests that a particular combination of perceived smoking opportunity and
(weak) motivation to seek treatment may elicit a type of craving associated with what
Bradford, Curtin, and Piper (2015) refer to as anticipation of imminent use. We argue that
this situation may arise when abstinent-avoidant (continuing) smokers who have not recently
smoked (and thus are not already satisfied) are faced with the prospect of smoking very
soon. That is, the experience of anticipation itself may become satisfying. Baker, Brandon,
and Chassin (2004a) go further, suggesting that “there is more ‘reward’ in the anticipation of
smoking than in smoking per se” (p. 477). Consistent with this position is the observation in
monkeys that more dopamine is released during anticipation than during actual food
consumption (Schultz & Romo, 1990; see also Volkow et al., 2006). In humans, a recent
neuroimaging study examined responses among smokers varying in their motivation to quit
and their perceived opportunity to smoke soon using the same four types of groups as in the
Author Manuscript
present study (Wilson et al., 2012). Across multiple brain regions, connectivity analyses
pointed to distinct activation patterns among continuing smokers anticipating imminent use,
such that “greater engagement of the rostral prefrontal cortex was associated with greater
activation of areas of the brain implicated in reward-related processing and craving…,
perhaps reflecting the use of cognitive control to support positive anticipatory processing”
(Wilson et al., 2012, p. 208). When smoking is imminent, continuing smokers may be most
comfortable with, and most willing to “indulge” their cravings (Sayette, 2004). From an
economic perspective, Loewenstein (1987) describes savoring as the “positive utility derived
from anticipation of future consumption” (p. 667). Children who hoard their stash of
Halloween candy, for example, may prefer savoring their candy to actual consumption.
Accordingly, if smokers learn (perhaps unconsciously) to deliberately expose themselves to
drug-related cues when actively using, then upon quitting some may inadvertently persist in
Author Manuscript
exposing themselves to smoking cues that had triggered these positive anticipatory states
(Baker, Japuntich, Hogle, McCarthy, & Curtin, 2006; Sayette, in press).
The prospect that anticipation of imminent use may offer key insights regarding smoking
motivation is highlighted in a recent study. Bradford et al. (2015) observed that anticipation
of imminent use among smokers not currently trying to quit served to relieve the stress
associated with receipt of an electric shock. As these authors emphasize, preconsumptive
experiences linked to anticipation of imminent use can function to reinforce smoking. They
Author Manuscript
encourage future research to better “dissect the cognitive-attentional and affective processes
that lead up to a relapse (i.e., anticipation)…” (p. 133). Consistent with this aim, in the
present study, we tested the impact of anticipation of imminent use on the degree to which
smokers choose to engage smoking cues.
Present Study
Most lab-based drug cue reactivity studies involve participants who do not expect to use the
drug during the experiment (see Bradford et al., 2015). Outside the lab, however, responses
to drug cues occur in conjunction with a variety of expectations regarding drug use.
Understanding of the etiological importance of cue reactivity must account for these
different expectations. This study used novel stimuli and recruited both continuing and
treatment-motivated smokers to evaluate the impact of perceived smoking opportunity on
Author Manuscript
smoking anticipation experiences, and in particular on the manner in which smokers

experience both smoking and nonsmoking stimuli.
Although we believe research manipulating treatment seeking status and perceived smoking
opportunity is vital, it is unsurprising that systematic investigations rarely are conducted. It
can be difficult to recruit smokers who wish to quit when advertising for smokers more
generally. In some instances smokers initially claim an interest in quitting that does not
translate into specific actions to do so. This change of heart may reflect genuine ambivalence
about quitting or perhaps a desire to gain entrance into a paid experiment by reporting what
participants hope will be the right response. Alternatively, because motivation to quit is not a
static phenomenon, interest in quitting may shift from the time of initial assessment to actual
participation in the experiment. Regardless of the explanation, in the present study we
Author Manuscript
sought to remedy this concern by recruiting motivated to quit participants by having them
initially visit a quit-smoking clinic.
We also believe that it is challenging to create optimal circumstances to experience

anticipation of imminent use in the lab. On one hand, there must be some base level of desire
to smoke. If participants are told to smoke at the start of, or just before entering, the
experiment, for example, there may be little desire or anticipation to smoke another cigarette
during the experiment (see Wilson & Sayette, 2015). On the other hand, if there is too much
withdrawal due to an extended period of abstinence, then even modest delays prior to
consumption can be experienced unpleasantly (Sayette et al., 2003). While we believe that in
the natural environment these two conditions are often met, it is trickier to execute them in
the lab using standardized approaches to smoking abstinence. Following interviews with 21
smokers of varying ages and levels of dependence, we opted to use a 5-hr abstinence period,
Author Manuscript
a duration less than what is used in nearly all studies requiring nicotine deprivation, but still
we hoped long enough to lead smokers to want to smoke.
Finally, calibrating the delay phase in the laboratory is difficult. It must be long enough to
permit savoring but not too long that frustration ensues. For instance, in past work we found
that delaying smoking for even short durations turned affect-related facial responses from
predominantly positive to predominantly negative (Sayette et al., 2003).
In sum, continuing smokers and those seeking treatment at a local smoking clinic
Author Manuscript
participated in a smoking cue exposure study following 5-hr of smoking abstinence.

Smokers were randomly assigned to smoking opportunity condition (i.e., told they either
would or would not be permitted to smoke during the experiment). They were assessed using
traditional self-report affect and urge measures during an in vivo smoking cue exposure task
and also completed two tasks designed to evaluate the attractiveness of smoking and
nonsmoking stimuli. (Because it is impractical to randomly assign smokers to treatment-
seeking status, efforts were undertaken to try to keep the groups to approximately the same
age and gender composition, and when necessary to adjust statistically for such group
differences in status.) We hypothesized that participants who expected to smoke would
generally find smoking and nonsmoking stimuli to be more pleasant than would those not
expecting to smoke and that this observation would be particularly true for continuing
smokers who expected to smoke. Thus, we predicted a treatment motivation by smoking
Author Manuscript
instruction interaction. Regardless of the presence of an interaction, however, we predicted,

in accord with the findings from Wilson et al. (2012), that continuing smokers expecting to
smoke soon would be more likely than each of the other three groups to find the
experimental stimuli rewarding.
Methods
Design
Our main goal was to examine the impact of (a) treatment-seeking status (status) and (b) the
perceived opportunity to smoke soon (opportunity) on smokers across four response
domains. We recruited participants for the motivated to seek treatment (MST) condition who
had first visited a quit smoking clinic offered by a University of Pittsburgh-affiliated
hospital. Smokers (responding to newspaper advertisements) were considered to be currently
Author Manuscript
not interested (CNI) in quitting if they reported not being interested in seeking treatment or
cutting down on their cigarette use within the next 30 days (see also Geier, Sweitzer,
Denlinger, Sparacino, & Donny, 2014). Importantly, as noted above, while MST smokers did
intend to quit smoking soon, they had not yet begun to reduce cigarette use. Thus, they were
seriously interested in quitting but in most cases not yet ready to make an active attempt.
This study used a factorial design, with MST and CNI smokers, all of whom were required
to abstain from smoking for 5-hr prior to entering the laboratory, being randomly assigned to
receive instructions indicating that they either would (Yes) or would not (No) have the
opportunity to smoke during the experiment. Thus, there were four groups of participants:
MST-Yes (N= 53); MST-No (N= 54); CNI-Yes (N= 60); and CNI-No (N= 60).
Participants
Author Manuscript
Participants consisted of 227 smokers (117 female, 110 male) aged 30–70. (To reduce
potential age differences between the two types of smokers, we excluded participants under
30 years old, who tended to be uninterested in quitting.) All participants were required (and
reported) smoking ≥ 10 cigarettes per day for at least 12 continuous months. To assess
exclusionary criteria, participants completed an initial telephone interview and attended a
screening session. Participants were excluded if they reported a medical condition that
contraindicated nicotine or if they were illiterate. Informed consent was obtained from all
participants. Based on self-reported assessment, the final sample was 45% African-
Author Manuscript
American, 46.5% Caucasian, 7% multiracial, 1%, Asian, and 0.5% American Indian.
Procedure
Telephone screening—Smokers who responded to ads or who had been informed about
our study after visiting a smoking clinic underwent a phone interview to exclude those not
meeting selection criteria. Smokers who met selection criteria were asked to attend a 30-min
screening session to determine whether they would qualify for a 2-hr experimental session.
Smokers were told that they would be paid $5.00 at the screening session if they were
determined to be ineligible or $60.00 at the experimental session if they were determined to
be eligible.
Screening session—The 30-min screening session was held at either our laboratory or
Author Manuscript
the smoking clinic. At this session, participants were required to show photo identification,
to provide a baseline CO reading, and to complete a brief interview regarding their current
medical status and medication usage. Participants were ruled eligible if they were aged 30–
70, their CO reading was >10 ppm, and their current medical status and medication usage
did not indicate that smoking a cigarette would be especially harmful to them. Ineligible
participants were paid $5.00 and permitted to leave. Eligible participants were provided with
instructions for the experimental session. Specifically, they were told to bring a pack of their
preferred brand of cigarettes and to abstain from smoking for 5 hours prior to the
experimental session. They also were told that breath samples would be collected to ensure
that they had abstained from smoking for 5-hr.
Experimental session—Table 1 presents a timeline of the procedures. Sessions were

begun between 10:00 a.m. and 2:00 p.m. To check compliance with smoking abstinence
Author Manuscript
instructions, participants reported the last time they smoked and provided a CO reading.
Participants had to have a CO that did not exceed 20 ppm. [This value is higher than in some
of our past studies (e.g., Sayette & Hufford, 1994; Sayette et al., 2001; Sayette,
Loewenstein, Griffin, & Black, 2008), which reflects an abbreviated abstinence duration
requirement.] Participants presented their pack of cigarettes and lighter to the experimenter
and completed an assessment of current mood and desire to smoke. Using a scale with 1 =
strongly disagree and 7 = strongly agree, current mood was measured using two items (I am
happy, joyful, or pleased; I am depressed, angry, worried, or frustrated) (Carter & Tiffany,
2001), and desire to smoke was measured by one item (I would like to smoke a cigarette).
Composite baseline mood reflected the difference between the negative and positive item.
These three items were embedded within a 6-item current experiences scale that also
included three filler items designed to make the focus on mood and smoking desire less
Author Manuscript
salient.
Depending on opportunity condition, participants next randomly received one of two sets of
instructions regarding the opportunity to smoke during the study. Participants in the Yes
condition were told:
“People often want to know whether they will be able to smoke during this
experiment, and YES, during that break you would be welcome to smoke a
cigarette. If you choose to have a cigarette during this smoke break, you’ll be able
Author Manuscript
to do so in this room, as it has been approved for that purpose and has an air-
clearing machine and special ventilation in the ceiling. Please note that this break is
scheduled into the study, regardless of whether you choose to smoke, and does not
affect how long you will be here.”
Participants in the No condition were told:
“People often want to know whether they’ll be able to smoke during this
experiment and unfortunately the answer is no. Do you think you’ll be okay with
not smoking during the 2 ½ hours in which you’re here? [All indicated they would
be okay not smoking while in the experiment.] Participants received one of two
consent forms corresponding to their condition, stipulating that they either would
(Yes) or would not (No) be allowed to smoke during the experimental session. We
previously used this approach to reinforce instruction manipulations (e.g., Sayette
Author Manuscript
et al., 2003). Equivalent numbers of MST and CNI smokers were assigned to each
condition.
Post-smoking opportunity instruction: After the opportunity manipulation, participants

(1) completed measures of urge and affect; (2) viewed the smoking/alcohol images; (3)
listened to a 5-min clip of a comedy routine; and (4) underwent an in vivo smoking cue
exposure during which urge and affect were again recorded.
Post-instruction urge and affect: Following opportunity instruction, participants reported

urge to smoke (post-opportunity urge) using a rating scale ranging from 0 (labeled “no urge
to smoke at all”) to 100 (labeled “the most intense urge to smoke that you have ever felt.”
(Juliano & Brandon, 1998; Sayette et al., 2001). Participants then indicated their current
Author Manuscript
affect state using the Positive and Negative Affect Schedule (PANAS: Watson, Clark, &
Tellegen, 1988).
Smoking image reward task: Participants rated a series of images presented on a computer
monitor that included nine alcohol and nine cigarette ads (interspersed) purportedly to be
used in a future study. (Images were located on the internet and selected for inclusion based
on ratings obtained in a pilot study in our laboratory.) We chose to use alcohol images as our
comparison stimuli as we felt it would provide an especially stringent test of our hypothesis
that anticipating smoking a cigarette would make proximal smoking cues an especially
alluring stimulus, even when compared to other consummatory substances that are often
used by smokers. Second, the name of the laboratory includes both alcohol and smoking and
consequently we believed it added plausibility to our cover story that we would want
Author Manuscript
participants to evaluate these images for future research projects. Participants viewed each
image for as long as they wished before hitting the space bar to advance to the next image,
and rated each image using a 1–9 scale, where 1 = not at all pleasant and 9 = extremely
pleasant. To test the reactions to cigarette images (relative to alcohol images), we assessed:
1) the rating assigned to each image (Pleasantness) and 2) the amount of time participants
chose to view each image (Time2).
Comedy clip: Participants next listened to a 5-min comedy clip, which was designed to
Author Manuscript
serve as our non-smoking rewarding stimulus, taken from a stand-up act performed by
comedian Jerry Seinfeld. None of the jokes included sexual or aggressive content. Following
the clip, participants rated the routine using two 0–10 scales with 0 = to not at all and 10 =
extremely to indicate how entertaining and how funny they found the comedy clip to be.
In vivo cue exposure: Following the comedy routine and a 2-min rest period, participants
completed an in vivo smoking cue exposure manipulation that has been used previously in
our lab (e.g., Sayette & Hufford, 1994; Sayette et al., 2001; Sayette & Parrott, 1999). A
covered tray was placed on a desk in the experimental room in front of the participant.
Participants were told not to touch the tray. Once the experimenter had returned to an
adjacent room, participants were instructed over an intercom to remove the cover from the
tray, revealing the cigarette pack they had brought to the session along with a lighter and
ashtray. (Participants’ own cigarettes served as the smoking cue to increase magnitude of
Author Manuscript
reactivity.) They were instructed to remove a cigarette and light it without putting it in their
mouths. Participants next were told to put down the lighter, hold the cigarette comfortably,
and look at it without placing it in their mouths. After 15-sec participants again rated their
urge to smoke (in vivo urge) and completed a PANAS rating (in vivo PANAS). Seven
seconds later, participants extinguished their cigarette in the ashtray.
Post-experimental questionnaires and debriefing: Following in vivo cue exposure,

participants completed three questionnaire packets. The first included a form assessing
demographic variables as well as several other questionnaires3. The second packet included
a modified version of the smoking history assessment developed by Shiffman and colleagues
(Shiffman, Paty, Kassel, Gnys, & Zettler-Segal, 1994), as well as the Nicotine Dependence
Syndrome Scale (Shiffman, Waters, & Hickox, 2004), revised Fagerström Test for Nicotine
Author Manuscript
Dependence (Heatherton, Kozlowski, Frecker, & Fagerstrom, 1991), and Smoking-Specific

Felt Attitudinal Ambivalence Scale (Lipkus, Green, Feaganes, & Sedikides, 2001). The third
packet included the Contemplation Ladder (Biener & Abrams, 1991) and a form asking
participants about the study’s purpose. Once participants completed all three packets, they
were debriefed, paid $60.00, and permitted to leave.
Results
Preliminary Analyses
Table 2 presents participant characteristics by group. Groups were equivalent on ethnic and
racial composition, years of schooling (M= 13.2), gender distribution (51.5% female),
Author Manuscript
2This measure was adapted from work linking image viewing time and attraction (Field, Mogg, & Bradley, 2004; Lykins, Meana, &
Strauss, 2008). Because we worried that too much delay due to repeated assessment of emotion items might undermine our fragile
anticipation of imminent use phenomenon (Sayette et al., 2003), we assessed only image pleasantness, assuming a “not at all pleasant”
rating would approximate an unpleasant reaction.
3We included the following questionnaires: the Snaith-Hamilton Pleasure Scale (Snaith, Hamilton, Morley, Humayan, Hargreaves, &
Trigwell, 1995), Affective Intensity Measure (Larsen & Diener, 1987), Balanced Inventory of Desirable Responding-6 (Paulhus,
1991), NEO Five-Factor Inventory (Costa & McRae, 2003), Barratt Impulsiveness Scale (Patton, Stanford, Barratt, 1995), and Mindful
Attention Awareness Scale (Brown & Ryan, 2003). Because they were unrelated to our outcomes and to conserve space we do not
address them further in this report.
number of cigarettes/day, and baseline mood. Groups did not differ on CO readings at study
Author Manuscript
outset.
Participants randomly assigned to the Yes and No smoking opportunity conditions did not
vary on age, FTND, motivation to quit (using the contemplation ladder) or wanting to smoke
a cigarette. As expected, MST participants reported significantly higher scores on the
contemplation ladder (M= 8.52) than did CNI’s (M=5.63), F (1, 206) = 67.76, p <.0001. At
the outset of the experimental session, MST’s reported lower scores for wanting to smoke a
cigarette (M=5.35) than did CNI participants (M=6.28), F (1, 222) = 17.19, p <.0001. MST
smokers also were slightly older (M= 50.5 years) than were CNI smokers (M= 48.3 years), F
(1, 221) = 4.02, p <.05. MST participants reported lower FTND values (M= 4.6) than did
CNI participants (M= 5.3), F (1, 219) = 5.94, p <.02. Except when otherwise noted, our
general approach was to covary for age, FTND, and baseline mood (which could affect the
DVs of interest).
Author Manuscript
Post-Smoking Access Instruction

Post-instruction urge and affect
Urge to smoke: A 2 (status) × 2 (opportunity) ANCOVA with age, FTND, baseline mood,
and baseline desire to smoke as covariates, revealed a main effect of status, F (1, 211) =
8.67, p <.004 (d=.40). Specifically, urge to smoke scores were significantly higher for CNI’s
(M= 65.38, SD = 23.50) than for MST’s (M=55.97, SD = 23.64). No other effects were
significant.
Affect: Scores on the positive and negative subscales of the PANAS – covarying for age,
FTND, and baseline mood – did not vary significantly across conditions (p’s >.15).
Author Manuscript
Smoking image reward task—We examined two variables related to the experience of
viewing smoking cues: pleasantness of the smoking images relative to the alcohol images
and time spent viewing the smoking relative to the alcohol images. [In each case the
smoking image values were responses to smoking images subtracting values for the alcohol
images.]
Pleasantness: A 2 (status) × 2 (opportunity) ANCOVA with age, FTND, and baseline mood
as covariates, revealed a main effect of status, F (1, 214) = 4.33, p <.04 (d=.28), and a
marginal effect for opportunity, F (1, 214) = 2.97, p <.09. Pairwise least square means tests
revealed that as expected, the CNI-Yes smokers enjoyed viewing cigarette images
significantly more than did each of the other three conditions (all p’s <. 04), all d’s ranging
from .39 to .51).4 (See Figure 1.)
Author Manuscript
Time: We next examined the amount of time that participants chose to view each slide. No
main effects emerged, but there was a marginally significant interaction, such that the two
4Although common in the literature, using covariance analyses in a quasi-experimental design is suboptimal. We are unaware,
however, of a straight-forward solution beyond our selection of similar gender compositions and an age range that we hoped would
constrain potential preexisting differences between the CNI and MST groups (e.g., to prevent having a disproportionate number of
young continuing smokers). Note also that all of these significant contrasts remain when covariates are removed from the analysis.
groups that might have a conflict between their quitting motivation status and their perceived
Author Manuscript
opportunity to smoke (MST-Yes and the CNI-No smokers) tended to spend relatively less
time viewing the smoking slides compared to the nonconflict groups (MST-No and the CNI-
Yes smokers) F (1, 214) = 3.10, p <.08.
Taken together, the CNI-Yes smokers found viewing smoking images to be significantly
more pleasant than did smokers in the other three conditions and (along with the other
nonconflict group) tended to look at the smoking images for relatively longer periods of
time.
Comedy clip—In addition to testing the impact of condition on responses to smoking cues,
we investigated whether anticipating smoking would enhance the experience of generally
pleasant stimuli unrelated to smoking. Unfortunately, only 57% of participants reported that
they would recommend the comedy clip to a friend, a value which did not differ by
Author Manuscript
condition. It may be that the clip was not sufficiently enjoyable to many of our participants.
The two comedy measures (entertaining, funny) were highly correlated, r (227) =.91, p <.
0001. We therefore created a composite ‘enjoy’ variable and conducted a 2 (status) × 2
(opportunity) ANCOVA with age, FTND, and baseline mood as covariates, and enjoy as the
dependent variable. There was a main effect for age, such that older participants liked the
clip more than did younger participants, F (1, 214) = 4.95, p <.03. Although in the direction
of an effect for opportunity, such that the CNI-Yes participants liked the clip more than did
those in the other three groups], no effects reached significance (p’s > .12).
In vivo smoking cue exposure

Urge—During exposure to the lit cigarette, we computed a 2 (status) × 2 (opportunity)
Author Manuscript
ANCOVA with age, FTND, baseline mood, and baseline desire to smoke as covariates, and
in vivo urge to smoke as the dependent variable. As expected, baseline desire to smoke was a
significant covariate, F (1, 213) = 34.34, p <.0001. There also was a main effect of status, F
(1, 213) = 3.95, p <.05 (d=.27), such that even after adjusting for baseline levels of desire,
CNI participants reported greater urge to smoke (M= 73.82, SD = 28.82) than did MST (M=
66.01. SD = 28.84) participants.
Affect—We computed a 2 (status) × 2 (opportunity) ANCOVA with age, FTND, and

baseline mood as covariates, and the in vivo PANAS as the dependent variable. (This
measure was introduced ¼ of the way through data collection and thus was completed by
165 participants.) For the negative subscale, as expected, baseline mood was a significant
covariate, F (1, 153) = 4.76, p <.04. There also was a main effect of opportunity, F (1, 153) =
Author Manuscript
5.82, p <.02 (d=.33), such that even after adjusting for baseline mood, Yes participants
reported a less negative mood (M = 13.93, SD = 7.41) than did No (M = 16.40, SD = 7.83)
participants. For the positive subscale, though the CNI-Yes group reported the highest mean
value among the four groups, none of the differences reached significance (p’s > .07).
Discussion
Author Manuscript
Craving is often discussed in the clinical literature and among laypersons as if it is a unitary
phenomenon. Yet cravings may manifest quite differently depending on the context in which
they arise (Sayette, in press). While most discussion of cigarette craving focuses on
frustrating experiences of those trying to quit that precede relapse (Tiffany 1992), there also
are important conceptual and clinical reasons to examine cravings associated with the
anticipation of imminent smoking in continuing smokers. The present study employed a
diverse set of measures to examine two contextual variables (current interest in quitting and
perceived opportunity to smoke soon) thought to affect the degree to which imminent
smoking is anticipated.
We were particularly interested in determining whether continuing smokers anticipating the

opportunity to smoke very soon would be most likely to find smoking stimuli (separate from
Author Manuscript
the act of smoking itself) to be attractive and enjoyable to observe. Results provide some
initial support for this hypothesis. Smokers who were not trying to quit and who were
informed they would be able to smoke imminently in our study seemed to find the smoking
images relative to alcohol images5 to be more pleasant than did the other groups of smokers.
They also tended to report more positive affect following a traditional in vivo smoking cue
exposure manipulation. In tandem with recent findings indicating that anticipation of
imminent use dampened response to a stressor (Bradford et al., 2015), the present data
suggest that certain preconsumptive factors (such as anticipation) can, independent of actual
consumption, improve emotional experiences and enhance the attractiveness of the smoking
cues that trigger cravings.
These data offer support for incentive motivation theory, which emphasizes the drive to
Author Manuscript
consume a drug. The present data also suggest, however, that under certain conditions the
cues themselves become attractive. One might imagine that CNI-Yes smokers would be
eager to race through the smoking image task knowing that the sooner they complete the
tasks the sooner they can smoke. From this perspective, the smoking images are merely an
obstacle interfering with smoking. Yet the data suggest that these smokers were not in a
hurry to do so, and instead seemed to find the smoking images and the in vivo cue exposure
pleasant to view (see also Wilson et al., 2012). In some cases drug users may wish to delay
actual use in order to prolong pleasure associated with anticipation of imminent use [i.e.,
relish the moment (Kavanagh, Andrade, & May, 2005)]. These findings reinforce prior
animal research suggesting that in certain situations, drug cues themselves may become
desirable (e.g., Flagel et al., 2011; Palmatier et al., 2007). Moreover, such cues may be more
likely to assume rewarding properties in certain animals (sign trackers) than in others (goal-
Author Manuscript
trackers) (Yager & Robinson, 2015), suggesting a potential individual difference variable to
be evaluated in future studies with humans.
The present findings also suggest that a smoker’s motivation to seek treatment is a factor
that influences craving intensity. Both following the smoking opportunity instruction and
during a subsequent in vivo smoking cue exposure manipulation there was a main effect of
5In hindsight it would have been useful to have assessed participants for alcohol misuse.
motivation to seek treatment status, such that urge to smoke was greater for CNI than for
Author Manuscript
MST smokers. This finding, which emerges from a sample that contrasted both types of
smokers within one study is in accord with the conclusions from a review of prior studies
that tended to use either continuing or treatment-seeking participants, but not both (Wertz &
Sayette, 2001a).
We had expected that status and opportunity also would combine to affect the degree to
which a comedy clip was experienced as enjoyable. While there were some effects in the
expected direction, none reached significance. Thus, we failed to support the hypothesis that
being in a pleasant anticipatory state would lead to enhanced reward associated with other
nonsmoking stimuli. Because nearly half the participants did not seem especially amused by
the comedy clip (reporting that they would not recommend it to a friend) we wonder if a
more engaging clip might have offered a better test.
Author Manuscript
Caveats and Implications

We believe that the present study, which included one of the larger samples of nicotine-
deprived smokers found in the smoking cue reactivity literature, offers a reasonable, if not
overwhelming, level of evidence to suggest that smokers not interested in quitting and who
anticipate smoking very soon will find smoking cues attractive. We hope that our findings
are viewed as providing preliminary support for the idea that responses to smoking cues
sometimes can have pleasant features, and that our CNI-Yes group tended to manifest
distinct response patterns from the other groups of smokers. More importantly, we hope that
these findings will stimulate additional research, especially when one considers that they
emerged despite the challenges associated with capturing this pleasant anticipatory
experience in the laboratory.
Author Manuscript
First, as noted above, it is difficult to specify an optimal duration of smoking abstinence in

order to test smokers in the lab who are nicotine-deprived enough that they wish to smoke,
but are not so deprived that any extra delay (to complete the measures) is going to be
experienced negatively. We aimed to model in our study the type of anticipatory experience
a diner might enjoy while awaiting the arrival of their favorite dish at a wonderful restaurant,
including stealing glances at a diner at a nearby table who is already enjoying the same
selection. That pleasant experience disappears if s/he has just eaten a large meal before
entering the restaurant, or conversely, if s/he has gone too long without eating, such that any
further delay before the prized dish is served becomes unpleasant. We conducted pilot
testing prior to selecting a 5-hr abstinence duration and found it to be preferred to an
individually tailored abstinence approach (it is hard to determine in advance the ideal
abstinence interval length for each person). Indeed, mean urge to smoke levels – which were
Author Manuscript
above the scale midpoint but lower than in many prior smoking studies with longer
abstinence requirements (see Wertz & Sayette, 2001a) suggest that we were at least close to
the right abstinence interval. Nevertheless, surely there were smokers in our study who
would have been more likely to have experienced a pleasant anticipatory craving experience
if the delay interval had been either longer or shorter. Moreover, it appears that a 24-hr
smoking abstinence period did not prevent the emergence of a viable smoking anticipation
state (Bradford et al., 2015), so clearly more investigation of this issue is indicated.
Second, it can be challenging to recruit smokers who wish to quit smoking very soon.
Author Manuscript
Motivation to quit is better viewed as a dimensional than a dichotomous construct that can
shift over time. Based on our prior struggles to recruit MST smokers, in this study we
recruited these participants after they had attended a smoking cessation clinic to discuss
quitting. But even in this setting the vast majority of the smokers ultimately never reached
quit day before breaking off contact with the clinic. Thus, the MST smokers in the present
study may have been less motivated to quit than we would have hoped. Accordingly, the
observed differences between MST and CNI participants, though clearly significant based
on contemplation ladder scores, nevertheless might have led to an underrepresentation of the
true magnitude of the effect of treatment motivation on craving.
Finally, it is tricky to manipulate perceived smoking opportunity in the lab. Ideally an

experiment could capture the pleasant anticipation experience described in the restaurant
scene above and then administer a battery of tests during that experience without shattering
Author Manuscript
this pleasant, though fragile, moment altogether. We observed just how difficult it is to
assess pleasant anticipatory cravings in a prior study (using a longer abstinence requirement
than in the present study) in which even slightly varying the delay interval before smoking
(from 15-sec to 60-sec) altered the affective experience (Sayette et al., 2003, experiment 2).
In sum, we believe pleasant anticipatory cravings are common to continuing smokers in the
real-world while they savor the moments prior to a regularly scheduled smoke break.
Nevertheless, the constraints of a laboratory setting create challenges to unobtrusively
capturing them. We believe that this study, as well as our prior neuroimaging study (Wilson
et al., 2012) and the study by Bradford et al. (2015), suggests that such imminent
anticipatory states can be elicited and observed in a controlled setting, however, and
moreover, that the study of this form of drug anticipation merits further inquiry. These few
Author Manuscript
studies by themselves do not establish directly that anticipation of imminent smoking is

rewarding, however, and future research is needed to evaluate the impact of this state on
positive and negative moods across a variety of contexts. Our findings also raise questions
regarding a potential conceptual distinction between the pleasantness of smoking cues and
the pleasantness of anticipatory craving, per se. It would be valuable to show that
anticipation of imminent use is actually reinforcing, in that smokers would be willing to
work (or pay) to receive such moments of anticipation. In addition to experimental
investigations, complementary research using ecological momentary assessment (Shiffman
& Kirchner 2009) would seem to be especially valuable for capturing the individualized
routines leading to pleasant anticipatory cravings.
There is a chasm between how cravings are regularly experienced by smokers in the natural
Author Manuscript
environment and how they are studied in the laboratory. If cravings in the continuing user
offer regularly scheduled anticipatory experiences that also may be accompanied by pleasant
reactions to drug cues (as found in the present study), then it follows that quitting a drug
necessarily leads to the abrupt loss of these moments, and their loss may help explain the
increase in negative affect following cessation (Baker et al., 2004b; 2006).
If replicated, this research (along with Bradford et al., 2015 and Wilson et al., 2012), may
offer a new research direction that considers the anhedonic effects of quitting due to the loss
of these rewarding anticipatory cued experiences (Leventhal, Waters, Kahler, Ray, Sussman,
Author Manuscript
2009). Moreover, the present data suggest the potential efficacy of cognitive-behavioral or
mindfulness training interventions aimed at managing the loss of these anticipatory states
(independent of actual drug ingestion experiences) after quitting. Treatment often focuses on
the times of day that shift from drug use to nondrug use upon quitting. Less attention is paid
to the period just prior to drug use, which ostensibly (and pharmacologically) remain
unchanged. Indeed, what may have been a pleasant or less stressful period linked to
anticipating the next smoke break or time at the bar now may turn somber or more anxious,
with nothing to look forward to or to eagerly anticipate. This affective downshift may be all
the more threatening due to smokers’ lack of insight regarding their cravings (Sayette et al.,
2008).
Conceptually, focus on anticipation of imminent use also raises questions about how these
anticipatory states develop over the course of addiction. Robinson and Berridge (1993) posit
Author Manuscript
that drug wanting sensitizes with repeated use, while drug liking does not. It is unclear if
pleasant anticipation states become sensitized, like wanting, or instead become muted over
time, like the hedonic experience of the drug. Research that also recruits light smokers who
have just begun smoking would provide optimal conditions to evaluate potential differences
in sensitivity to anticipation of imminent use. Moreover, research would be useful to
evaluate interventions that focus on the loss of these anticipatory experiences after quitting
and to develop strategies not just to add replacement rewards into their lives, but to ensure
these new rewards create pleasant anticipation states (e.g., have PDAs signal 30-min prior to
meeting friends). Clearly continued research on the impact of contextual factors such as
motivation to quit and perceived smoking opportunity will lead to a more nuanced
understanding of drug cue reactivity and craving.
Author Manuscript
Acknowledgments
This research was supported by NIH (National Cancer Institute) grant R01 CA159463-12 to Michael Sayette. We
thank George Loewenstein for his helpful comments throughout the study, Betty Marconi for her help with
recruitment, and Michael Laurent, Mike Sayers and the students and staff at the Alcohol and Smoking Research
Laboratory for assistance collecting data.
References
Baker TB, Brandon TH, Chassin L. Motivational influences on cigarette smoking. Annual Review of
Psychology. 2004a; 55:463–491.
Baker TB, Japuntich SJ, Hogle JM, McCarthy DE, Curtin JJ. Pharmacologic and behavioral
withdrawal from addictive drugs. Current Directions in Psychological Science. 2006; 15(5):232–
236.
Baker TB, Piper ME, McCarthy DE, Majeskie MR, Fiore MC. Addiction motivation reformulated: An
Author Manuscript
affective processing model of negative reinforcement. Psychological Review. 2004b; 111:33–51.

[PubMed: 14756584]
Baker, TB.; Morse, E.; Sherman. The motivation to use drugs: A psychobiological analysis of urges.
In: Rivers, C., editor. The Nebraska Symposium on Motivation: Alcohol use and abuse. Lincoln:
University of Nebraska Press; 1987. p. 257-323.
Biener L, Abrams DB. The contemplation ladder: Validation of a measure of readiness to consider
smoking cessation. Health Psychology. 1991; 10(5):360–365. [PubMed: 1935872]
Bindra D. A motivational view of learning, performance, and behavior modification. Psychological
Review. 1974; 81:199–213. [PubMed: 4424766]
Carter BL, Tiffany ST. The cue-availability paradigm: The effects of cigarette availability on cue
reactivity in smokers. Experimental and Clinical Psychopharmacology. 2001; 9:183–190. [PubMed:
Author Manuscript
11518094]
Childress AR, McLellan AT, O’Brien CP. Conditioned responses in a methadone population. Journal
of Substance Abuse Treatment. 1986; 3:173–179. [PubMed: 3806730]
Conklin CA, Tiffany ST. Applying extinction research and theory to cue exposure addiction
treatments. Addiction. 2002; 97:155–167. [PubMed: 11860387]
Dar R, Stronguin F, Marouani R, Krupsky M, Frenk H. Craving to smoke in orthodox jewish smokers
who abstain on the sabbath: A comparison to a baseline and a forced abstinence workday.
Psychopharmacology. 2005; 183(3):294–299. [PubMed: 16237578]
Brown K, Ryan R. The benefits of being present: Mindfulness and its role in psychological well-
Being. Journal of Personality and Social Psychology. 2003; 84:822–848. [PubMed: 12703651]
Costa, PT.; McRae, RR. Revised NEO-Personality Inventory and NEO-Five Factor Inventory. Lutz, Fl,
editor. Psychological Assessment Resources; 2003.
Dols M, van den Hout M, Kindt M, Willems B. The urge to smoke depends on the expectation of
smoking. Addiction. 2002; 97(1):87–93. [PubMed: 11895274]
Author Manuscript
Droungas A, Ehrman R, Childress AR, O’Brien CP. Effect of smoking cues and cigarette availability
on craving and smoking behavior. Addictive Behaviors. 1995; 20:657–673. [PubMed: 8712062]
Field M, Duka T. Smoking expectancy mediates the conditioned responses to arbitrary smoking cues.
Behavioural Pharmacology. 2001; 12:183–194. [PubMed: 11485055]
Field M, Mogg K, Bradley BP. Eye movements to smoking-related cues: effects of nicotine
deprivation. Psychopharmacology. 2004; 173:116–123. [PubMed: 14663552]
Flagel SB, Clark JJ, Robinson TE, Mayo L, Czuj A, Willuhn I, et al. A selective role for dopamine in
stimulus-reward learning. Nature. 2011; 469:53–59. [PubMed: 21150898]
Geier CF, Sweitzer MM, Denlinger R, Sparacino G, Donny EC. Abstinent adult daily smokers show
reduced anticipatory but elevated saccade-related brain responses during a rewarded antisaccade
task. Psychiatry Research: Neuroimaging. 2014; 223(2):140–147. [PubMed: 24914005]
Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO. The Fagerstrom test for nicotine
dependence: a revision of the Fagerstrom Tolerance Questionnaire. British Journal of Addiction.
1991; 86(9):1119–1127. [PubMed: 1932883]
Author Manuscript
Heckman BW, Kovacs MA, Marquinez NS, Meltzer LR, Tsambarlis ME, et al. Effects of mood
manipulations on cigarette craving: A meta-analysis. Addiction. 2013; 108:2068–2078. [PubMed:
23795674]
Jellinek EM. The “craving” for alcohol. Quarterly Journal of Studies on Alcohol. 1955; 16:35–38.
[PubMed: 14372010]
Juliano LM, Brandon TH. Reactivity to perceived smoking availability and environmental cues:
Evidence with urge and reaction time. Experimental and Clinical Psychopharmacology. 1998;
6:45–53. [PubMed: 9526145]
Kavanagh DJ, Andrade J, May J. Imaginary Relish and Exquisite Torture: The Elaborated Intrusion
Theory of Desire. Psychological Review. 2005; 112:446–467. [PubMed: 15783293]
Larsen R, Diener E. Affect intensity as an individual difference characteristic: A review. Journal of
Research in Personality. 1987; 21:1–39.
Leventhal AM, Waters AJ, Kahler CW, Ray LA, Sussman S. Relations between anhedonia and
smoking motivation. Nicotine & Tobacco Research. 2009; 11(9):1047–1054. [PubMed: 19571250]
Author Manuscript
Lipkus IM, Green JD, Feaganes JR, Sedikides C. The relationship between attitudinal ambivalence and
desire to quit smoking among college smokers. Journal of Applied Social Psychology. 2001; 31(1):
113–133.
Loewenstein G. Anticipation and the valuation of delayed consumption. The Economic Journal. 1987;
97:666–684.
Lykins A, Meana M, Strauss G. Sex differences in visual attention to erotic and non-erotic stimuli.
Archives of Sexual Behavior. 2008; 37:219–228. [PubMed: 17668312]
Monti PM, Rohsenow DJ, Rubonis AV, Niaura RS, Sirota AS, Colby SM, Goddard P, Abrams DB. Cue
exposure with coping skills treatment for male alcoholics: A preliminary investigation. Journal of
Author Manuscript
Consulting and Clinical Psychology. 1993; 61:1011–1019. [PubMed: 7906700]

Niaura RS, Rohsenow DJ, Binkoff JA, Monti PM, Pedraza M, Abrams DB. Relevance of cue reactivity
to understanding alcohol and smoking relapse. Journal of Abnormal Psychology. 1988; 97:133–
152. [PubMed: 3290304]
O’Brien CP, Childress AR, McLellan T, Ehrman R. Integrating systematic cue exposure with standard
treatment in recovering drug dependent patients. Addictive Behaviors. 1990; 15:355–365.
[PubMed: 2248109]
Palmatier M, Liu X, Matteson G, Donny E, Caggiula A, Sved A. Conditioned reinforcement in rats
established with self-administered nicotine and enhanced by noncontingent nicotine.
Psychopharmacology. 2007; 195:235–243. [PubMed: 17676401]
Patton JH, Stanford MS, Barratt ES. Factor structure of the Barratt Impulsiveness Scale. Journal of
Clinical Psychology. 1995; 51:768–774. [PubMed: 8778124]
Paulhus, DL. Measurement and control of response bias. In: Robinson, J.; Shaver, P.; Wrightsman, L.,
editors. Measures of personality and social psychological attitudes. Vol. xiv. San Diego, CA, US:
Author Manuscript
Academic Press; 1991. p. 17-59.p. 753

Robinson TE, Berridge KC. The neural basis of drug craving: An incentive-sensitization theory of
addiction. Brain Research Reviews. 1993; 18:247–291. [PubMed: 8401595]
Sayette, MA. Self-Regulatory Failure and Addiction. In: Baumeister, RF.; Vohs, KD., editors.
Handbook of Self-Regulation: Research, Theory, and Applications. New York: Guilford Press;
2004. p. 447-465.
Sayette MA. The Role of Craving in Substance Use Disorders: Theoretical and Methodological Issues.
Annual Review of Clinical Psychology. in press
Sayette MA, Hufford MR. Effects of cue exposure and deprivation on cognitive resources in smokers.
Journal of Abnormal Psychology. 1994; 103:812–818. [PubMed: 7822584]
Sayette MA, Hufford MR. Urge and affect: A facial coding analysis of smokers. Experimental and
Clinical Psychopharmacology. 1995; 3:417–423.
Sayette MA, Loewenstein G, Griffin KM, Black J. Exploring the cold-to-hot empathy gap in smokers.
Psychological Science. 2008; 19:926–932. [PubMed: 18947359]
Author Manuscript
Sayette MA, Martin CS, Hull JG, Wertz JM, Perrott MA. The effects of nicotine deprivation on
craving response covariation in smokers. Journal of Abnormal Psychology. 2003; 112:110–118.
[PubMed: 12653419]
Sayette MA, Martin CS, Wertz JM, Shiffman S, Perrott MA. A Multidimensional analysis of cue-
elicited craving in heavy smokers and tobacco chippers. Addiction. 2001; 96:1419–1432.
[PubMed: 11571061]
Sayette MA, Wertz JM, Martin CS, Cohn JF, Perrott MA, Hobel J. Effects of smoking opportunity on
cue-elicited urge: A facial coding analysis. Experimental and Clinical Psychopharmacology. 2003;
11:218–227. [PubMed: 12940501]
Sayette MA, Parrott DJ. Effects of olfactory stimuli on urge reduction in smokers. Experimental and
Clinical Psychopharmacology. 1999; 7:151–159. [PubMed: 10340155]
Schultz W, Romo R. Dopamine neurons of the monkey midbrain. Journal of Neurophysiology. 1990;
63:607–624. [PubMed: 2329364]
Shiffman S, Kirchner TR. Cigarette-by-cigarette satisfaction during ad libitum smoking. Journal of
Abnormal Psychology. 2009; 118:348–359. [PubMed: 19413409]
Author Manuscript
Shiffman S, Paty JA, Kassel JD, Gnys M, Zettler-Segal M. Smoking behavior and smoking history of
tobacco chippers. Experimental and Clinical Psychopharmacology. 1994; 2(2):126–142.
Shiffman S, Waters AJ, Hickox M. The Nicotine Dependence Syndrome Scale: a multidimensional
measure of nicotine dependence. Nicotine & Tobacco Research. 2004; 6:327–348. [PubMed:
15203807]
Siegel, S. Classical conditioning, drug tolerance, and drug dependence. In: Israel, Y.; Glaser, F.;
Kalant, H.; Popham, R.; Schmidt, W.; Smart, R., editors. Research advances in alcohol and drug
problems. Vol. 7. New York: Plenum Press; 1983. p. 207-246.
Snaith RP, Hamilton M, Morley S, Humayan A, Hargreaves D, Trigwell P. A scale for the assessment
of hedonic tone: The Snaith-Hamilton Pleasure Scale. British Journal of Psychiatry. 2005; 167:99–
Author Manuscript
103. [PubMed: 7551619]

Solomon R, Corbitt J. An opponent process theory of motivation: II. Cigarette addiction. Journal of
Abnormal Psychology. 1973; 81:158–171. [PubMed: 4697797]
Stewart J, de Wit H, Eikelboom R. Role of unconditioned and conditioned drug effects in self-
administration of opiates and stimulants. Psychological Review. 1984; 91:251–268. [PubMed:
6571424]
Thewissen R, van den Hout M, Havermans RC, Jansen A. Context-dependency of cue-elicited urge to
smoke. Addiction. 2005; 100(3):387–396. [PubMed: 15733252]
Thewissen R, van der Meijden VAF, Havermans RC, van den Hout M, Jansen A. From the office to the
pub: The role of Tiffany, S.T. (1990). A cognitive model of drug urges and drug-use behavior: Role
of automatic and nonautomatic processes. Psychological Review. 2008; 97:147–168.
Tiffany ST, Wray JM. The clinical significance of drug craving. Annals of the New York Academy of
Sciences. 2012; 1248:1–17. [PubMed: 22172057]
Tiffany ST. A cognitive model of drug urges and drug-use behavior: Role of automatic and
Author Manuscript
nonautomatic processes. Psychological Review. 1990; 97(2):147–168. [PubMed: 2186423]

Tiffany ST. A critique of contemporary urge and craving research: Methodological, psychometric, and
theoretical issues. Advances in Behaviour Research and Therapy. 1992; 14:123–139.
Volkow ND, Wang G, Telang F, Fowler J, Logan J, Childress A, Jayne M, Ma Y, Wong C. Cocaine
cues and dopamine in dorsal striatum: Mechanism of craving in cocaine addiction. Journal of
Neuroscience. 2006; 26:6583–6588. [PubMed: 16775146]
Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and
negative affect: the PANAS scales. Journal of Personality and Social Psychology. 1988; 54:1063–
1070. [PubMed: 3397865]
Wertz JM, Sayette MA. A review of the effects of perceived drug use opportunity on self-reported
urge. Experimental and Clinical Psychopharmacology. 2001a; 9:3–13. [PubMed: 11519632]
Wertz JM, Sayette MA. Effects of smoking opportunity on attentional bias in smokers. Psychology of
Addictive Behaviors. 2001b; 15:268–271. [PubMed: 11563808]
Wikler A. Recent progress in research on the neurophysiological basis of morphine addiction.
Author Manuscript
American Journal of Psychiatry. 1948; 105:329–338. [PubMed: 18890902]

Wikler A. Dynamics of drug dependence: Implications of a conditioning theory for research and
treatment. Archives of General Psychiatry. 1973; 28:611–616. [PubMed: 4700675]
Wilson SJ, Sayette MA. Neuroimaging craving: Urge intensity matters. Addiction. 2015; 110:195–203.
[PubMed: 25073979]
Wilson SJ, Sayette MA, Fiez JA. Prefrontal responses to drug cues: A Neurocognitive analysis. Nature
Neuroscience. 2004; 7:211–214. [PubMed: 15001989]
Wilson SJ, Sayette MA, Fiez JA. Quitting-unmotivated and quitting-motivated cigarette smokers
exhibit different patterns of cue-elicited brain activation when anticipating an opportunity to
smoke. Journal of Abnormal Psychology. 2012; 121(1):198–211. [PubMed: 21859165]
Wilson SJ, Sayette MA, Delgado MR, Fiez JA. Instructed smoking expectancy modulates cue-elicited
neural activity: A preliminary study. Nicotine and Tobacco Research. 2005; 7:637–645. [PubMed:
16085533]
Wilson SJ, Sayette MA, Delgado MR, Fiez JA. Effect of smoking opportunity on responses to
monetary gain and loss in the caudate nucleus. Journal of Abnormal Psychology. 2008; 117:428–
Author Manuscript
434. [PubMed: 18489219]

Wilson SJ, Sayette MA, Fiez JA. Quitting-unmotivated and quitting-motivated cigarette smokers
exhibit different patterns of cue-elicited brain activation when anticipating an opportunity to
smoke. Journal of Abnormal Psychology. 2012; 121:198–211. [PubMed: 21859165]
Yager LM, &Robinson TE. Individual variation in the motivational properties of a nicotine cue: sign-
trackers vs. goal trackers. Psychopharmacology. 2015; 232:3149–3160. [PubMed: 25980485]
Zinser MC, Fiore MC, Davidson RJ, Baker TB. Manipulating smoking motivation: Impact on an
electrophysiological index of approach motivation. Journal of Abnormal Psychology. 1999;
108:240–254. [PubMed: 10369034]
Author Manuscript
Author Manuscript
Figure 1. Mean (SEM) pleasantness rating of smoking images

Ratings of smoking images are relative to ratings of alcohol images [i.e., pleasantness =
Author Manuscript
(mean of alcohol ratings) – (mean of smoking ratings)]. “Higher” bars indicate a relative
preference for smoking images. Means are adjusted for differences in age, FTND, and
baseline mood (though all significant differences remain when analyses are conducted
without covariates). Note: CNI-Yes group is significantly higher than each of the other three
groups (p’s <.05)
Author Manuscript
Table 1
Timeline of experimental procedures

Author Manuscript
Time Task
0 – 14 Baseline CO reading and mood assessment
15 – 17 Smoking opportunity instruction
18 – 19 Measures of urge and affect
20 – 24 Smoking image reward task
25 – 30 Comedy clip
31 – 34 In vivo smoking cue exposure
35 – 39 Break or smoke break
40 – 99 Post-experimental questionnaires and debriefing
Author Manuscript
Author Manuscript
Author Manuscript
Author Manuscript Author Manuscript Author Manuscript Author Manuscript
Table 2
Participant characteristics by treatment-seeking status
Years of Cigarettes/ % African

n Age % Caucasian % Hispanic
Education Day American
CNI 120 48.31 (8.05) 13.15 (2.50) 16.20 (5.73) 50.8 41.7 4.2
Sayette and Dimoff
MST 107 50.50 (8.29) 13.18 (2.90) 15.39 (8.43) 38.3 51.4 4.7
CNI = smokers currently not interested in quitting
MST = smokers motivated to seek treatment
Page 20

Nihms765787 PDF

Hochgeladen von

Dokumentinformationen

Originaltitel

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

Nihms765787 PDF

Hochgeladen von

Copyright:

Verfügbare Formate

HHS Public Access

Published in final edited form as:

In search of anticipatory cigarette cravings: The impact of

Perceived Smoking Opportunity

Motivation to Seek Treatment

Anticipation of Imminent Use

smoking anticipation experiences, and in particular on the manner in which smokers

We also believe that it is challenging to create optimal circumstances to experience

participated in a smoking cue exposure study following 5-hr of smoking abstinence.

instruction interaction. Regardless of the presence of an interaction, however, we predicted,

Experimental session—Table 1 presents a timeline of the procedures. Sessions were

Post-smoking opportunity instruction: After the opportunity manipulation, participants

Post-instruction urge and affect: Following opportunity instruction, participants reported

Post-experimental questionnaires and debriefing: Following in vivo cue exposure,

Dependence (Heatherton, Kozlowski, Frecker, & Fagerstrom, 1991), and Smoking-Specific

Post-Smoking Access Instruction

In vivo smoking cue exposure

Affect—We computed a 2 (status) × 2 (opportunity) ANCOVA with age, FTND, and

We were particularly interested in determining whether continuing smokers anticipating the

Caveats and Implications

First, as noted above, it is difficult to specify an optimal duration of smoking abstinence in

Finally, it is tricky to manipulate perceived smoking opportunity in the lab. Ideally an

studies by themselves do not establish directly that anticipation of imminent smoking is

affective processing model of negative reinforcement. Psychological Review. 2004b; 111:33–51.

Consulting and Clinical Psychology. 1993; 61:1011–1019. [PubMed: 7906700]

Academic Press; 1991. p. 17-59.p. 753

103. [PubMed: 7551619]

nonautomatic processes. Psychological Review. 1990; 97(2):147–168. [PubMed: 2186423]

American Journal of Psychiatry. 1948; 105:329–338. [PubMed: 18890902]

434. [PubMed: 18489219]

Figure 1. Mean (SEM) pleasantness rating of smoking images

Timeline of experimental procedures

Participant characteristics by treatment-seeking status

Years of Cigarettes/ % African

CNI = smokers currently not interested in quitting

MST = smokers motivated to seek treatment

Das könnte Ihnen auch gefallen