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National Research Forum on Nicotine Addiction - smoke spacer

Addicted to Nicotine
A National Research Forum

Section V: Psychobiology of Nicotine Addiction
Neil E. Grunberg, Ph.D., Chair


BEHAVIORAL-COGNITIVE EFFECTS OF SMOKING

Stephen J. Heishman, Ph.D.
Intramural Research Program
National Institute on Drug Abuse

Introduction

It is well established that nicotine can function as a reinforcer to maintain self-administration behavior in humans and animals. In addition, tobacco use by humans is influenced by many factors, including the effects of smoking on performance, stress, and body weight. The relationship between these three factors and nicotine addiction will be the focus of this presentation.

EFFECTS OF SMOKING ON PERFORMANCE

What We Know

  • Nicotine deprivation can impair attention and cognition and smoking or nicotine can reverse withdrawal-induced deficits. Performance impairment has been observed within 4 hours of tobacco deprivation. Many studies describing nicotine's "enhancement" of attention and cognition only demonstrated that nicotine reversed withdrawal effects.
  • Nicotine enhances finger tapping, attention, and under certain conditions, memory. It is well established that nicotine enhances tapping rate and motor responding in tests of focused attention. Recent evidence indicates that nicotine also enhances sustained attention and recognition memory. However, no studies have reported enhancement of sensory abilities, selective attention, learning, and other cognitive abilities.
  • Degraded attention and cognition following a period of nicotine deprivation can be a strong motivating factor to smoke to reverse such deficits, thus maintaining nicotine addiction. Nicotine's true enhancement of performance is of secondary importance in the maintenance of addiction because of the modest and limited effects.

What We Need To Know More About

  • The full range of conditions under which nicotine affects behavior must be determined. For example, attentional processes have been studied extensively, whereas few studies have examined nicotine's effect on learning. Few studies have attempted to control or manipulate environmental, psychological, and biological variables that influence nicotine's behavioral effects.
  • Dose-response relationships are not known for most of nicotine's performance effects. A small minority of studies have administered placebo and multiple doses of nicotine, and even fewer have reported nicotine plasma concentrations in order to understand the relationship between plasma levels and performance.
  • Does limited performance enhancement play a role in smoking initiation? It is unlikely that enhanced attention and cognition play a major role in adolescents' decisions to begin smoking, but no studies have been conducted.

EFFECTS OF SMOKING ON STRESS

What We Know

  • Stress results in increased smoking, but there is little evidence that smoking reduces stress. If nicotine reduces stress, then smokers should be less stressed than nonsmokers, and smokers should experience increased stress when they quit. However, surveys indicate that smokers are more stressed than nonsmokers, and studies show that individuals report feeling less stress after quitting smoking. It is possible that smoking exacerbates stress via negative moods experienced during acute nicotine deprivation between cigarettes.
  • Nicotine deprivation increases stress and negative mood states, and smoking or nicotine can reverse these changes. Nicotine withdrawal is characterized by feelings of stress, anger, and irritability. These mood changes can develop during the 30- to 45-minute interval between cigarettes in regular smokers. Smoking can rapidly reverse such negative moods.
  • Nicotine addiction is maintained by reversal of deprivation-induced stress and negative mood observed between cigarettes or during more prolonged periods of abstinence. There is no clear evidence that smokers experience true stress reduction compared with nonsmokers.

What We Need To Know More About

  • Does smoking produce true stress reduction or simply withdrawal relief? Currently, the most compelling explanation is that smoking modulates perceived stress and negative mood states through reversal of withdrawal effects, rather than genuine reductions in stress. However, there may be conditions under which smoking enhances mood and reduces stress in the absence of nicotine deprivation.
  • The mechanisms by which stress functions to maintain addictive smoking behavior are not well understood. Numerous psychological and biological changes occur during stress, and some of these perturbations in normal functioning may mediate smoking behavior. For example, the biochemical changes caused by stress and nicotine may play a role in smoking initiation, cessation, or relapse.
  • What interventions are effective in reducing stress experienced during smoking cessation? During acute nicotine withdrawal (first week after cessation), people experience increased stress and anxiety. However, by 2 weeks, negative mood states have returned to baseline and continue to decline with time. Little research has focused on ways to reduce the increased stress during early withdrawal. Such interventions could enhance smoking cessation efforts.

EFFECTS OF SMOKING ON BODY WEIGHT

What We Know

  • There is an inverse relationship between smoking and body weight; smokers weigh on average 6 to 9 pounds less than nonsmokers. The weight gain reliably observed after smoking cessation also averages 6 to 9 pounds, and smoking relapse returns weight to levels seen before cessation. Individuals who smoke heavily gain the most weight after cessation.
  • Changes in eating and energy expenditure are responsible for the body weight changes seen during smoking cessation and relapse. There is evidence that eating increases during the first few weeks of cessation. Smoking causes acute increases in metabolic rate that are repeated with each cigarette; however, chronic changes in metabolic rate are not associated with increased physical activity, nor does cessation result in decreased activity.
  • Nicotine decreases food intake and increases energy expenditure in animals, indicating that the changes in body weight seen during smoking cessation and relapse are due to nicotine.
  • Concerns over weight gain, rather than weight gain itself, contribute to continued smoking and appear to deter quit attempts, especially in women. There is no direct evidence that preventing weight gain after smoking cessation will increase cessation rates.

What We Need To Know More About

  • What interventions are effective in dealing with concerns about weight gain to enhance smoking cessation efforts? Because no effective interventions have been developed to counter the weight gain after cessation, research should focus on the perception of weight gain and helping ex-smokers deal with the small increase in weight relative to the substantial health benefits achieved from quitting smoking.
  • The importance of body weight concern appears to vary across age and gender. For example, white adolescent females report smoking for weight control, whereas black adolescent females do not. It may be that younger women have greater concern about weight control than older women. These age and gender associations have obvious treatment implications.
  • The psychological and biological mechanisms underlying the effects of smoking on body weight are not well known. A better understanding may lead to effective weight control interventions for smoking cessation programs.

Recommended Reading

Attention and Cognition

Heishman, S.J. What aspects of human performance are truly enhanced by nicotine? Addiction 93:317-320, 1998.

Heishman, S.J.; Taylor, R.C.; and Henningfield, J.E. Nicotine and smoking: A review of effects on human performance. Exp Clin Psychopharmacol 2:345-395, 1994.

Sherwood, N. Effects of nicotine on human psychomotor performance. Human Psychopharmacol Clin Exp 8:155-184, 1993.

Stress

Pomerleau, O.F., and Pomerleau, C.S. Research on stress and smoking: Progress and problems. Br J Addict 86:599-603, 1991.

Parrott, A.C. Nesbitt's paradox resolved? Stress and arousal modulation during cigarette smoking. Addiction 93:27-39, 1998.

Body Weight

French, S.A., and Jeffery, R.W. Weight concerns and smoking: A literature review. Ann Behav Med 17:234-244, 1995.

Grunberg, N.E. The inverse relationship between tobacco use and body weight. In: Kozlowski, L.T., et al., eds. Research Advances in Alcohol and Drug Problems, Vol. 10. New York: Plenum Press, 1990. pp. 273-315.

Perkins, K.A. Weight gain following smoking cessation. J Consult Clin Psychol 61:768-777, 1993.


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