Cue-induced cravings for cigarettes
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Corresponding author Stuart G. Ferguson, PhD School of Pharmacy, University of Tasmania, Private Bag 26, Hobart, Tasmania, 7001, Australia. E-mail: [email protected] Current Cardiovascular Risk Reports 2009, 3:385–390 Current Medicine Group LLC ISSN 1932-9520 Copyright © 2009 by Current Medicine Group LLC
Cigarette craving is usually thought of as being a product of abstinence from smoking. However, cigarette craving can also be evoked through exposure to situational cues that are associated with tobacco use. Such cue-induced cravings can be reliably produced in laboratory settings, and in observational field studies, they have been found to influence smoking behavior. It is the latter fi nding that is perhaps most clinically relevant, as research indicates that cue-induced cravings are a contributing factor in a substantial proportion of smoking lapses during quit attempts. In this review, we examine the literature regarding smoking cue-induced craving. Particular focus is given to recent discoveries and to studies that have evaluated the effectiveness of smoking cessation interventions on treating cue-induced cravings.
Introduction Among dependent smokers, cigarette craving is an almost universally reported symptom experienced during periods of abstinence. Craving has been defi ned in numerous ways [1], but the common thread with these defi nitions is that craving involves a strong, sometimes seemingly overwhelming desire to use a drug. Clinically, the experience of craving is important to understand and, if necessary, to treat, primarily because craving has been found to impede cessation. Research shows that craving can be a barrier to cessation at crucial stages in the quit process. Even before starting a quit attempt, craving (or more correctly, the fear of craving) can impede cessation, with clinical experience suggesting that smokers’ fear of experiencing craving is a reason for not attempting to quit. Furthermore, once a patient starts a quit effort, studies have found that the intensity of the craving experience can predict the outcome of the quit attempt [2–5]. These links between craving and cessation success, be it either a direct pathway or merely
a proxy for other fears and/or symptoms of withdrawal, elevate the study of craving from an esoteric pursuit to one of clinical significance. Among lay observers, cigarette craving is typically viewed as being the direct and simple result of nicotine abstinence. A typical physiologic model of craving would posit that smokers have become tolerant to the presence of nicotine, resulting in changes in the very physiology of the brain (eg, changes in the number and sensitivity of nicotinic receptors [6]) and, as a result of these changes, they crave nicotine when it is not available. Such a physiologic explanation of craving is supported by findings that link self-reported craving severity to blood nicotine levels (with craving increasing over time as blood nicotine levels fall [7]). However, researchers have also found that craving can be induced
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