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Abstract

Alcohol has been found to increase tobacco smoking in both dependent daily smokers (DDS) and nondependent nondaily smokers (NNS), yet little attention has been directed toward examining how different treatments/products modify drinking-related smoking behavior. This study examined the acute effects of snus (4mg of nicotine) on alcohol-related smoking responses in 18 DDS and 17 NNS. During each double-blind session, participants were randomly assigned to receive one of the following combinations: alcohol and snus, alcohol and placebo snus, placebo alcohol and snus, or placebo alcohol and placebo snus. Participants consumed their assigned beverage before absorbing their session's product, and after 30minutes participants could self-administer puffs of their preferred brand of cigarette over a 60-minute period using a progressive ratio task. Alcohol significantly increased tobacco craving (p<.001) and tended to decrease latency to start smoking (p=.021) but only among NNS. In contrast, snus tended to decrease the number of puffs earned and how hard DDS worked for puffs in both beverage conditions (ps≤.019) but it did not alter the smoking behavior of NNS. Craving was not significantly impacted by snus in either type of smoker. These findings raise the possibility that different processes mediate alcohol and cigarette co-use in NNS and DDS and suggest that snus may be effective in reducing alcohol-related cigarette use in DDS specifically.

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... Assessment of sex differences. Less than half of the studies (k = 16) Kahler et al., 2014;Kahler et al., 2012;King et al., 2009;Kirchner et al., 2007;McGrath et al., 2015;Oliver et al., 2013;Peloquin et al., 2013;Peloquin et al., 2014;Perkins et al., 2005;Sayette et al., 2005;Shiffman et al., 2013a;Shiffman et al., 2013b;Shiffman et al., 2015a;Shiffman et al., 2015b) assessed sex differences in tobacco-related cue reactivity. ...
... Differences based on tobacco dependency. 43% of studies (k = 16) Dunbar et al., 2014;Epstein et al., 2007;Field et al., 2005;Kirchner & Sayette, 2007;McGrath et al., 2015;McKee et al., 2006;Oliver et al., 2013;Peloquin et al., 2013;Rohsenow et al., 1997;Sayette et al., 2005;Shiffman et al., 2013a;Shiffman et al., 2013b;Shiffman et al., 2015a;Shiffman et al., 2015b) explored whether patterns of tobacco use affected tobacco cue reactivity after alcohol cue exposure. Of these, half (k = 8) reported null findings, seven reported significant findings, and one reported mixed findings. ...
... Dependent smokers were reported to smoke more (Rohsenow et al., 1997;Dunbar et al., 2014), smoke more quickly (McKee et al., 2006), and crave cigarettes more (Rohsenow et al., 1997) after alcohol cue exposure compared to non-dependent smokers. In contrast, one study reported that lighter smokers craved cigarettes more than heavier smokers after alcohol consumption (Oliver et al., 2013), and another reported that non-dependent smokers were quicker to start smoking and craved cigarettes more after alcohol consumption compared to placebo, an effect not seen in the dependent smokers of the sample (Peloquin et al., 2013). In another study, non-dependent smokers also scored higher on the SCQ-B after alcohol consumption compared to placebo, which was not seen in dependent smokers (Kirchner & Sayette, 2007). ...
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Aims: To examine the effect of alcohol cue exposure on tobacco-related cravings, self-administration and other measures of tobacco-related cue reactivity. Methods: We searched Medline, PsycINFO, Embase, CINAHL and Scopus from inception to May 2020 for articles reporting on a combination of cue reactivity (and/or cross-cue reactivity), alcohol use and tobacco consumption. A semi-quantitative analysis and study quality assessment were performed for the included articles. Results: A total of 37 articles met our inclusion criteria and were included in the systematic review. Most studies (60%) reported that alcohol cue exposure increased tobacco cravings, but only 18% of studies reported that alcohol cue exposure resulted in an increase in ad libitum smoking. There was also substantial heterogeneity between studies due to differences in methodology related to alcohol cue exposure, measures of tobacco cravings, as well as variable participant and study characteristics. Conclusions: Alcohol cue exposure can increase cravings for tobacco. This has important implications for individuals who use both substances but are trying to quit one or both.
... Attwood and colleagues (2012), Braun and colleagues (2012), Greenstein and colleagues (2010), colleagues (2012, 2014), McKee and colleagues (2006McKee and colleagues ( , 2008McKee and colleagues ( , 2010, Peloquin and colleagues (2013), colleagues (2000, 2005), Udo and colleagues (2013) Nicotine dependence • For daily but not nondaily smokers, alcohol increased responding specifically for nicotinized cigarettes . • Nondaily smokers, but not daily smokers, started smoking more quickly in the alcohol condition versus placebo (Peloquin et al., 2013). ...
... When examining self-reported positive and negative affect after drinking, 6 studies found no differences between nicotine and placebo (Acheson et al., 2006;Kouri et al., 2004;Peloquin et al., 2013;Penetar et al., 2009;Perkins et al., 1995Perkins et al., , 2000, but 1 study found that smoking and alcohol increased positive affect additively (Oliver et al., 2013). Nicotine also increased liking of alcoholic beverages. ...
... Regarding BAC, BAC following a priming oral dose of alcohol did not change due to nicotine transdermal patch or nasal spray pretreatments (Acheson et al., 2006;Kouri et al., 2004;McKee et al., 2008), nicotinized cigarettes smoked concurrently (Perkins et al., 2000), or nicotine via cigarette, snus, or nasal spray administered postdrink (Greenstein et al., 2010;Peloquin et al., 2013;Perkins et al., 2005). Some studies have found that after a fixed dose of alcohol, nicotine from nasal spray (Perkins et al., 1995) or cigarettes (Oliver et al., 2013;Rose et al., 2004) lowered BAC relative to placebo. ...
Article
Simultaneous use of cigarettes and alcohol is common and may be driven by nicotine increasing alcohol self-administration or vice versa. To better evaluate the causal nature of this relationship, we systematically reviewed human experimental laboratory studies that coadministered nicotine and alcohol with control conditions. Searches of PubMed/MEDLINE and PsycINFO databases and study bibliographies identified 30 studies that met our inclusion criteria. Research methodologies were critically reviewed. Effects of coadministration on drug self-administration and related factors such as craving, subjective response, motivation, and heart rate are reported. Results most strongly supported that alcohol increases nicotine and cigarette self-administration, whereas, depending on the context, nicotine increased, decreased, or had no effect on alcohol self-administration. Craving and subjective drug effects were also impacted by coadministration. Interaction effects of nicotine and alcohol on self-administration and subjective responses were reported infrequently. The effects may be moderated by a number of factors, including dose of administered drug and sex. Recommendations are made for future research, and clinical and policy implications of findings are discussed.
... For instance, epidemiological evidence suggests that compared with dependent smokers, NNS consume a greater proportion of their tobacco while drinking alcohol (Epstein, Sher, Young, & King, 2007;Harrison, Desai, & McKee, 2008;King, McNamara, Angstadt, & Phan, 2010;McKee, Harrison, & Shi, 2010;Shiffman et al., 2014). Experimental evidence suggests a similar pattern, with NNS appearing to be particularly sensitive to alcohol's effects on cigarettes craving (King, McNamara, Conrad, & Cao, 2009;Peloquin, Hecimovic, Sardinha, Stewart, Barrett, 2013) and smoking behavior (Barrett, Campbell, Roach, Stewart, & Darredeau, 2013;King et al., 2009;McKee et al., 2010). ...
... Brief Biphasic Alcohol Effects Scale. The Brief Biphasic Alcohol Effects Scale (B-BAES; Martin, Earleywine, Musty, Perrine, & Swift, 1993) is a six-item self-report measure used to assess the subjective stimulating effects of alcohol associated with rising BAC levels (factor1), and the subjective sedating effects associated with descending BAC levels (factor 2; e.g., Rueger, McNamara, & King, 2009), and has been previously shown to be sensitive to the effects of alcohol in NNS (Peloquin et al., 2013). ...
... ally, our experiment lacked a dependent smoker comparison group. Past research suggests that NNS may be more sensitive than dependent smokers to the effects of alcohol (e.g., Peloquin et al., 2013) and tobacco cues (e.g., Watson et al., 2010) on craving; however, we are unable to make inferences about such potential group differences in the present study given our sample. Last, it is possible that the experiment was underpowered to detect complex interaction effects, and a larger sample size may have revealed more subtle effects. ...
Article
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Non-daily smokers commonly smoke cigarettes following the consumption of alcohol, yet the reason(s) for this remains poorly understood. The present study examined the impact of alcohol consumption on responses in tobacco salient cues 49 male and 50 female non-daily smokers. After the administration of an alcohol, placebo, or control beverage, participants were exposed to series neutral video clips and tobacco smoking salient video clips, and their subjective states and heart rates were monitored. The timing of the exposure to the tobacco smoking clips was randomly determined to coincide with the timing of either the ascending limb or the descending limb of the blood alcohol concentration (BAC) curve of the alcohol beverage condition. The tobacco smoking clips were found to increase cigarette craving regardless of beverage condition or timing of exposure (p =.002). Alcohol consumption was associated with increased ratings of intoxication (p < .001), increased heart rate across participants (p <.001), and increased cigarette craving in female participants specifically (p = .017). Alcohol did not influence responses to the smoking videos. These results suggest that smoking salient cues and alcohol may impact cigarette craving in non-daily smokers through independent processes.
... The present results should be interpreted in light of the following methodological considerations. First, although previous within-subject investigations of alcohol interactions with nicotine/tobacco in humans, suggest that the present study was adequately powered to detect individual and interactive alcohol and nicotine/tobacco effects (e.g., Barrett et al., 2006;McKee et al., 2008;Peloquin et al., 2013;Rose et al., 2004), the extent to which this would extend to investigations involving a third addictive behavior such as gambling is not clear. Second, because the study utilized genuine VLT machines and the probability of wins and loses were outside of experimental control, gambling time and money limits were necessary to ensure a comparable experience between sessions. ...
... Fourth, alcohol was administered as a single, standardized, moderately intoxicating dose of vodka, followed by the administration of a single cigarette 20 min later and then and by an opportunity to gamble. A moderately intoxicating dose of was selected to maximize comparability with other protocols (e.g., Ellery et al., 2005;Peloquin et al., 2013), and the timing of tobacco administration was selected to correspond with observations that smokers typically initiate tobacco use when blood alcohol concentrations (BAC) are rising (e.g., McKee et al., 2006). Because the subjective and physiological effects of alcohol are known to vary during the ascending and descending limbs of the BAC curve (e.g., Brunelle et al., 2007), the present study was designed to ensure minimal variability in the alcohol effects when gambling responses were assessed. ...
Article
Rationale: Gamblers often use alcohol and/or tobacco when they gamble but little is known about the extent to which drinking or smoking affects gambling behavior. Objectives: This study examined the acute effects of alcohol and nicotine-containing tobacco administration on the subjective and behavioral responses to video-lottery terminal (VLT) gambling in 16 regular video-lottery terminal players (11 male) who were also regular consumers of alcohol and tobacco. Methods: During four double-blind, counterbalanced sessions, participants assessed the subjective effects of nicotine-containing tobacco or denicotinized tobacco following the administration of a moderately intoxicating dose of alcohol or a placebo beverage. They were then given $40 and provided with an opportunity to gamble using an authentic VLT. Results: Alcohol administration was associated with increased ratings of several subjective descriptors including “intoxicated”, “high”, “want alcohol”, “crave cigarette”, and “want to gamble” but did not affect subsequent gambling behavior. In contrast, relative to denicotinized tobacco, the administration of nicotine containing tobacco was associated with increased average wagers, but did not significantly alter subjective state. Conclusions: Findings suggest that both alcohol and nicotine-containing tobacco may acutely increase the propensity to gamble using VLTs, but they may do so through separate processes.
... The present results should be interpreted in light of the following methodological considerations. First, although previous within-subject investigations of alcohol interactions with nicotine/tobacco in humans, suggest that the present study was adequately powered to detect individual and interactive alcohol and nicotine/tobacco effects (e.g., Barrett et al., 2006;McKee et al., 2008;Peloquin et al., 2013;Rose et al., 2004), the extent to which this would extend to investigations involving a third addictive behavior such as gambling is not clear. Second, because the study utilized genuine VLT machines and the probability of wins and loses were outside of experimental control, gambling time and money limits were necessary to ensure a comparable experience between sessions. ...
... Fourth, alcohol was administered as a single, standardized, moderately intoxicating dose of vodka, followed by the administration of a single cigarette 20 min later and then and by an opportunity to gamble. A moderately intoxicating dose of was selected to maximize comparability with other protocols (e.g., Ellery et al., 2005;Peloquin et al., 2013), and the timing of tobacco administration was selected to correspond with observations that smokers typically initiate tobacco use when blood alcohol concentrations (BAC) are rising (e.g., McKee et al., 2006). Because the subjective and physiological effects of alcohol are known to vary during the ascending and descending limbs of the BAC curve (e.g., Brunelle et al., 2007), the present study was designed to ensure minimal variability in the alcohol effects when gambling responses were assessed. ...
Article
Rationale: Gamblers often use alcohol and/or tobacco when they gamble but little is known about the extent to which drinking or smoking affects gambling behavior. Objectives: This study examined the acute effects of alcohol and nicotine-containing tobacco administration on the subjective and behavioral responses to video-lottery terminal (VLT) gambling in 16 regular video-lottery terminal players (11 male) who were also regular consumers of alcohol and tobacco. Methods: During four double-blind, counterbalanced sessions, participants assessed the subjective effects of nicotine-containing tobacco or denicotinized tobacco following the administration of a moderately intoxicating dose of alcohol or a placebo beverage. They were then given $40 and provided with an opportunity to gamble using an authentic VLT. Results: Alcohol administration was associated with increased ratings of several subjective descriptors including “intoxicated”, “high”, “want alcohol”, “crave cigarette”, and “want to gamble” but did not affect subsequent gambling behavior. In contrast, relative to denicotinized tobacco, the administration of nicotine containing tobacco was associated with increased average wagers, but did not significantly alter subjective state. Conclusions: Findings suggest that both alcohol and nicotine-containing tobacco may acutely increase the propensity to gamble using VLTs, but they may do so through separate processes.
... First, although previous within-subject investigations of alcohol interactions with nicotine/tobacco in humans, suggest that the present study was adequately powered to detect individual and interactive alcohol and nicotine/tobacco effects (e.g. Barrett et al. 2006;McKee et al. 2008;Peloquin et al. 2013;Rose et al. 2004), it is not clear the extent to which this would extend to investigations involving a third addictive behavior such as gambling. Second, because the study utilized genuine VLT machines and the probability of wins and loses were outside of experimental control, gambling time and money limits were necessary to ensure a comparable experience between sessions. ...
... Fourth, alcohol was administered as a single, standardized, moderately intoxicating dose of vodka, followed by the administration of a single cigarette 20 minutes later and then and by an opportunity to gamble. A moderately intoxicating dose of was selected to maximize comparability with other protocols (e.g.Ellery et al. 2005;Peloquin et al. 2013), and the timing of tobacco administration was selected to correspond with observations that smokers typically initiate tobacco use when blood alcohol concentrations (BAC) are rising (e.g. McKee el at. ...
Article
Rationale: Gamblers often use alcohol and/or tobacco when they gamble but little is known about the extent to which drinking or smoking affects gambling behavior. Objectives: This study examined the acute effects of alcohol and nicotine-containing tobacco administration on the subjective and behavioral responses to video-lottery terminal (VLT) gambling in 16 regular video-lottery terminal players (11 male) who were also regular consumers of alcohol and tobacco. Methods: During four double-blind, counterbalanced sessions, participants assessed the subjective effects of nicotine-containing tobacco or denicotinized tobacco following the administration of a moderately intoxicating dose of alcohol or a placebo beverage. They were then given $40 and provided with an opportunity to gamble using an authentic VLT. Results: Alcohol administration was associated with increased ratings of several subjective descriptors including "intoxicated", "high", "want alcohol", "crave cigarette", and "want to gamble" but did not affect subsequent gambling behavior. In contrast, relative to denicotinized tobacco, the administration of nicotine containing tobacco was associated with increased average wagers, but did not significantly alter subjective state. Conclusions: Findings suggest that both alcohol and nicotine-containing tobacco may acutely increase the propensity to gamble using VLTs, but they may do so through separate processes.
... In a sample of 16 adult gamblers who regularly consumed alcohol and nicotine, Barrett and colleagues [92] found that, although alcohol produced higher levels of both stimulation and sedation relative to placebo, the addition of nicotine did not result in a significant change for either effect. Similar results were indicated in a study by Peloquin et al. [93] which compared nicotine dependent (n = 18) and non-dependent (n = 17) smokers. Stimulation and sedation scores measured with the B-BAES were compared across four conditions based on beverage (alcohol vs. placebo) and nicotine product (snus vs. placebo) using a within-subject design. ...
Article
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Purpose of Review The Biphasic Alcohol Effects Scale (BAES) is widely used to assess stimulant and sedative alcohol effects. This paper reviews (a) recent measurement developments, (b) behavioral and physiological correlates, and (c) the role of the BAES in refining theories of SR and pharmacological interventions. Recent Findings An abbreviated scale (B-BAES) and a comprehensive measures of alcohol effects (SEAS) demonstrate strong psychometric properties and use of the BAES has helped refine the Differentiator Model of SR. Importantly, both BAES stimulation and sedation robustly predict risk for later alcohol problems, and the BAES has demonstrated utility in examining mechanisms of pharmacotherapy effects. Summary The BAES is the most widely used measure of SR and has informed both theory and practice. Recent findings point to important future directions including the need to (a) examine developmental influences, (b) refine our understanding of FH effects, and (c) consider expansion to capture novel aspects of SR.
... Dokazano je, da alkohol poveča željo po kajenju in nasprotno. Zasvojene osebe si z uporabo alkohola in nikotina nižajo negativne odtegnitvene simptome od obeh zasvojenosti, ampak mehanizem, prek katerega alkohol in nikotin pri zasvojenem uporabniku medsebojno zvišujeta uporabo, je sestavljen iz več komponent in še ni popolnoma raziskan (30,31). ...
Article
Full-text available
Izvleček Izhodišča. Zasvojenost od alkohola je zelo pogosta in kompleksna bolezen. Zasvojeni od alkohola imajo veliko tveganje za pojav sopojavne psihiatrične motnje. Metode. V prvi tovrstni slovenski raziskavi smo preverili prisotnost in izraženost simptomatike najpogostejših sopojavnih duševnih motenj pri zasvojenih od alkohola. Vključili smo tri skupine moških: 101 preiskovanca, hospitaliziranega zaradi zdravljenja akutne zasvojenosti od alkohola, 100 abstinentnih preiskovancev in 97 zdravih kontrol iz skupine prostovoljnih krvodajalcev. Za oceno simptomatike smo uporabili vprašalnike AUDIT, Yale-Brownovo lestvico obsesivnosti in kompulzivnosti ter lestvico obsesivno-kompulzivnega pitja, Zungovo lestvico depresivnosti in anksioznosti, Kratko lestvico socialne fobije in Buss-Durkeejevo lestvico sovražnosti. Rezultati. V skupini preiskovancev z akutno zasvojenostjo so bili pomembno bolj izražene obsesivna (p < 0,001) in kompulzivna simptomatika (p < 0,001) ter obsesivno-kompulzivna simptomatika, vezana na pitje alkoholnih pijač (p < 0,001), kot v preostalih dveh skupinah. Pri preiskovancih z akutno zasvojenostjo so bile v primerjavi z abstinenti in zdravimi kontrolami statistično pomembno bolj izražene anksioznost (p < 0,001), depresivnost (p < 0,001) in agresivnost (p < 0,001). Zaključki. Obsesivno-kompulzivna simptomatika, anksioznost, depresivnost in agresivnost so lahko sopojavno vezane na zasvojenost od alkohola. Med zdravljenjem zasvojenosti od alkohola je zato treba pozornost usmeriti tudi na te simptome, saj tako lahko bistveno izboljšamo izid zdravljenja zasvojenosti od alkohola in zmanjšamo tveganje za relaps.
... In a cross-sectional epidemiological study [39] among Singapore residents, a positive association of alcohol abuse with nicotine dependence was significant with OR = 3.1. Another study revealed that alcohol significantly increased tobacco craving and tended to decrease the latency to start smoking [40]. ...
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Objective: To survey cigarette behaviors and nicotine dependence among Chinese MA users, explore risk factors for high nicotine dependence, and analyze the relationship between nicotine dependence and MA-related euphoria and sexual impulse. Methods: A cross-sectional study, applying a self-designed questionnaire with the Fagerström Test for Nicotine Dependence (FTND) and Visual Analog Scale (VAS), was performed among 391 MA users in Beijing and Guangdong, China. Results: Most MA users were smokers, including 159 having high dependence on nicotine (HD users, FTND > 5) and 197 low or medium dependent (LMD users, FTND ≤ 5). Men or married users were more likely to be highly dependent than women or unmarried users. Higher MA dose and ever-use of ketamine or alcohol were associated with higher likelihood of high nicotine dependence. HD users reported significantly higher euphoria and stronger sexual impulse after using MA, indicated by higher VAS scores. Conclusions: Potential risk factors for high nicotine dependence among MA users may include male gender, being married, higher MA dosage, and ever-use of ketamine or alcohol, which should be taken into consideration in individualized health promotion on smoking cessation. Severe nicotine dependence was associated with stronger MA-related euphoria and sexual impulse and it should be confirmed by further studies.
... It is possible that these early responses may reflect neuronal changes that, over time, may become responsible for later higher-order cognitions that lead to alcohol and its rewards becoming prioritized in the cognitive system (Cox et al. 2006; Klinger and Cox 2004). It is important to note however, that given the comorbidity between alcohol consumption and that of other drugs (Cooney et al. 2003; Peloquin et al. 2013), the effects observed in dependent drinkers in this study may reflect neuronal changes that have occurred as a function of interactions between multiple drugs. Additionally, the current findings extend our previous behavioral work demonstrating that escape drinkers showed a greater attentional bias to alcohol-related cues than nonescape drinkers (Forestell et al. 2012). ...
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Previous work has indicated that implicit attentional biases to alcohol-related cues are indicative of susceptibility to alcohol dependence and escape drinking, or drinking to avoid dysphoric mood or emotions. The goal of the current study was to examine whether alcohol dependence and escape drinking were associated with early neural attentional biases to alcohol cues. Electroencephalography data were recorded from 54 college students who reported that they regularly drank alcohol, while they viewed alcohol and control pictures that contained human content (active) or no human content (inactive). Those who were alcohol dependent showed more neural attentional bias to the active alcohol-related stimuli than to the matched control stimuli early in processing, as indicated by N1 amplitude. Escape drinkers showed greater neural attention to the active alcohol cues than non-escape drinkers, as measured by larger N2 amplitudes. While alcohol dependence is associated with enhanced automatic attentional biases early in processing, escape drinking is associated with more controlled attentional biases to active alcohol cues during a relatively later stage in processing. These findings reveal important information about the time-course of attentional processing in problem drinkers and have important implications for addiction models and treatment.
Article
Background: Alcohol consumption promotes lapses to smoking among smokers trying to quit, perhaps particularly among smokers with lower dependence. We assessed how the role of alcohol in lapses varies over time. Methods: This is a secondary analysis of ecological momentary assessment data collected from 159 daily smokers (mean age = 43.90 (SD = 10.41), 56.60% female) who drink alcohol. During the 4 weeks following initial cessation (quit >24 h), a logistic time-varying effect model (TVEM) modeled momentary assessments of lapses and temptations to smoke compared to randomly-selected moments as a function of concurrently-assessed recent alcohol use (past 15 min). Time was examined continuously. Results: Recent alcohol use was associated with smoking lapses, particularly for less nicotine dependent individuals, and the association varied across time. For individuals who did not smoke within 5 min of waking, alcohol use became a significant predictor of lapse on Day 1 post-quit, increased in strength until Day 7, then decreased such that alcohol use was no longer associated with lapse by Day 25. For this subgroup, the associations between alcohol use and temptations were relatively stable and significant from Day 1 to 22 post-quit. Results were similar when dependence was assessed by the Nicotine Dependence Symptom Scale. Conclusions: The association between drinking and smoking lapse and temptations varies over time, peaking early in smoking abstinence and declining thereafter. This could reflect progressive relapse of most vulnerable individuals or habituation to alcohol as a smoking cue. Interventions to prevent alcohol-related lapses are essential early in the quit period.
Article
Background: Alcohol use disorders and tobacco use contribute significant risk to the global burden of disease, and each are major public health concerns. Together, alcohol and tobacco use are highly comorbid and have multiplicative health risks when used concurrently, underscoring the importance of examining alcohol-tobacco interactions in the human laboratory. Objective: The aims of this review were to summarize the state of research examining alcohol-tobacco interactions in the human laboratory. Methods: We reviewed human laboratory evidence for alcohol and tobacco/nicotine interactions, including 1) craving in drinkers and smokers exposed to smoking or drinking cues, 2) fixed-dosing of alcohol or nicotine in smokers and drinkers, and 3) smoking and alcohol influences on self-administration behaviors. The interactive effects of tobacco/nicotine with other drugs of abuse are also briefly discussed. Results: Overall, results identified that alcohol and tobacco have reciprocal influences on potentiating craving, subjective responses to fixed-dose alcohol or nicotine administration, and self-administration. The literature identified that alcohol increases craving to smoke, decreases time to initiate smoking, and increases smoking self-administration. Similarly, tobacco and nicotine increase alcohol craving, decrease subjective effects of alcohol, and increase alcohol consumption. Conclusion: Future studies should continue to focus on alcohol and tobacco/nicotine interactions in individuals with a wide scope of drinking and smoking histories, different states of alcohol and nicotine deprivation, and influences of either drug on craving, subjective responses, and consumption over the course of the blood alcohol curve. This work could have important implications for the impact of alcohol-tobacco interactions on guiding clinical practice, as well as in the changing landscape of addiction.
Article
Rationale There is presently no approved single treatment for dual alcohol and nicotine dependencies. Objective This pilot study investigated baclofen effects in alcoholic smokers. Methods This was a preliminary double-blind placebo-controlled randomized clinical study with 30 alcoholic smokers randomized to baclofen at 80 mg/day or placebo. A subgroup (n = 18) participated in an alcohol cue-reactivity experiment. Results Baclofen, compared with placebo, significantly decreased the percent days of abstinence from alcohol-tobacco co-use (p = 0.004). Alcohol dependence severity moderated baclofen effects, with the higher severity group having the greater baclofen response (p < 0.001). Although the percent days of alcohol-tobacco co-use declined in both groups, this decline was greater after placebo than baclofen (p < 0.001). Secondary analyses on alcohol or tobacco use alone suggested that the increase in percent days of co-abstinence was driven by the medication differences on heavy drinking days and on percent days smoking. In the cue-reactivity substudy, baclofen slightly decreased alcohol urge (p = 0.058) and significantly reduced salivation (p = 0.001), but these effects were not related to cue type. Conclusions This study provides preliminary evidence suggesting a possible role of baclofen in the treatment of alcoholic smokers. However, the mixed results and the small sample require larger confirmatory studies.
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People who drink alcohol are more likely to smoke, and experiments have shown that alcohol can increase cigarette smoking. However, it is not clear why alcohol consumption should increase smoking. To address this issue the current experiment looked at the effects of alcohol on a range of behavioural and subjective measures intended to assess the reward value of smoking. These included a preference test carried out after subjects had smoked cigarettes of one colour after consuming alcohol, and cigarettes of another colour after consuming non-alcoholic drinks. In the preference test, subjects were offered the choice of smoking the alcoholic or non-alcoholic drink-paired cigarette. It was hypothesised that if alcohol increased the reward value of smoking, subjects would choose to smoke the alcohol-paired cigarette. Consumption of alcohol increased the length of time people spent smoking, increased the number of puffs taken on each cigarette, and increased the amount of tobacco burnt. There were also strong subjective effects, with subjects looking forward more to smoking after alcohol and reporting greater smoking satisfaction after alcohol. However, subjects did not show a preference for the cigarettes they had smoked after alcohol.
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We examine and refine the Fagerström Tolerance Questionnaire (FTQ; Fagerström, 1978). The relation between each FTQ item and biochemical measures of heaviness of smoking was examined in 254 smokers. We found that the nicotine rating item and the inhalation item were unrelated to any of our biochemical measures and these two items were primary contributors to psychometric deficiencies in the FTQ. We also found that a revised scoring of time to the first cigarette of the day (TTF) and number of cigarettes smoked per day (CPD) improved the scale. We present a revision of the FTQ: the Fagerström Test for Nicotine Dependence (FTND).
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Obstructed labour is still a major cause of maternal and perinatal morbidity and mortality in Uganda, where many women give birth at home alone or assisted by non-skilled birth attendants. Little is known of how the community view obstructed labour, and what actions they take in cases where this complication occurs. The objective of the study was to explore community members' understanding of and actions taken in cases of obstructed labour in south-western Uganda. Grounded theory (GT) was used to analyse data from 20 focus group discussions (FGDs), 10 with women and 10 with men, which were conducted in eight rural and two urban communities. A conceptual model based on the community members' understanding of obstructed labour and actions taken in response is presented as a pathway initiated by women's desire to 'protecting own integrity' (core category). The pathway consisted of six other categories closely linked to the core category, namely: (1) 'taking control of own birth process'; (2) 'reaching the limit--failing to give birth' (individual level); (3) 'exhausting traditional options'; (4) 'partner taking charge'; (5) 'facing challenging referral conditions' (community level); and finally (6) 'enduring a non-responsive healthcare system' (healthcare system level). There is a need to understand and acknowledge women's reluctance to involve others during childbirth. However, the healthcare system should provide acceptable care and a functional referral system closer to the community, thus supporting the community's ability to seek timely care as a response to obstructed labour. Easy access to mobile phones may improve referral systems. Upgrading of infrastructure in the region requires a multi-sectoral approach. Testing of the conceptual model through a quantitative questionnaire is recommended.
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When the first version (the Tolerance Questionnaire, Fagerstrom, 1978) of the Fagerstrom Test for Nicotine Dependence (FTND; Heatherton, Kozlowski, Frecker, & Fagerstrom, 1991) was developed, tobacco smoking was not regarded as an addiction. Nevertheless, evidence that this might be the case was beginning to appear, and some researchers became increasingly interested in investigating the importance of nicotine in the smoking habit and educating the public about it. The research led to a profound change in the understanding of cigarette smoking, and in 1988, the U.S. Surgeon General, in the remarkable book Nicotine Addiction, established once and “forever” the importance of nicotine in tobacco smoking (U.S. Department of Health and Human Services [U.S. DHHS], 1988). However, as the role of nicotine was established, researchers lost sight of the possibility that other determinants might also be important. More recently, it has been found that, although nicotine is the most important addictive component of tobacco smoke, it is probably not the only substance involved in the development of tobacco dependence. In light of what is now known about what determines cigarette smoking, it seems timely to propose a renaming of the FTND to the Fagerstrom Test for Cigarette Dependence (FTCD). The background for this is discussed in this commentary.
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Snus is a low-nitrosamine smokeless product that appears to be safer than other smokeless products. Evidence indicates that snus has been used as an effective smoking cessation aid in Scandinavia. No randomized controlled trial has directly tested the efficacy of snus for smoking cessation. This randomized, double-blind, placebo-controlled multicentre trial tested the efficacy of snus for smoking cessation. Of the 250 subjects, 125 were randomized to active or placebo snus sachets. Subjects were followed up through 28 weeks after randomization. In total, 5 clinical visits and 8 telephone contacts were scheduled. Primary outcome measure was biologically verified continuous smoking abstinence from Week 6 through 28. The continuous abstinence rate during Weeks 6-28 in the snus and placebo groups was 4.0% and 1.6% (odds ratio [OR]: 2.5, 95% CI: 0.4-27), respectively. The point prevalence abstinence rate at 6 weeks was 18.4% in the snus group versus 8.8% in the placebo group (OR: 2.3, 95% CI: 1.1-5.0, p = .03). At Week 28, the difference in favor of the snus group was not statistically significant (12.8% vs. 7.2%, OR: 1.9, 95% CI: 0.8-4.4). Snus was generally well tolerated. Treatment-related adverse events that were more common in the snus group were generally mild and included nausea, dyspepsia, gingivitis, hiccups, and dizziness. Although the cessation rates generally were low and, at 28 weeks, did not differ between active and placebo, early quit rates suggested that snus was superior and with similar effect sizes to those with nicotine replacement. These results suggest that snus needs to be further researched as a smoking cessation treatment.
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In Sweden, the smoking prevalence has declined. In 2007, it was among the lowest in the industrialized world. A steady increase in the use of Swedish oral moist snuff, snus, has occurred in parallel. This development is neither solicited by authorities nor the medical establishment, but rather has occurred along with increased awareness of the dangers of smoking, and has been promoted by product development and marketing of snus. To evaluate time trends in patterns of tobacco use in northern Sweden during 1990-2007. Cross-sectional (99,381 subjects) and longitudinal (26,867 subjects) data from the Västerbotten Intervention Programme (VIP) 1990-2007 were analyzed. All adults in Västerbotten County are invited to a VIP health examination at ages 40, 50, and 60 years, and until 1995 also 30 years. Smoking and use of snus were evaluated by gender, age and educational groups. Intermittent smoking was categorized as smoking. From the period 1990-1995 to the period 2002-2007, smoking prevalence decreased from 26 to 16% among men and from 27 to 18% among women. The differences in prevalence increased between educational groups. The decline in smoking was less and the increase of snus use was greater among those with basic education. The use of snus among basic-educated 40-year-olds reached 35% among men and 14% among women during 2002-2007. Dual smoking and snus use increased among men and women with basic education. Smoking without snus use was more prevalent among women. Gender differences in total smoking prevalence (smoking only plus dual use) were small in all age groups, but increased among those with basic education reaching 7.3% during 2002-2007, with women being more frequent smokers. Smoking prevalences were similar among never, former and current snus users. Among the 30,000 former smokers, 38% of men and 64% of women had never used snus. Longitudinal data showed a decline in total tobacco use from baseline until follow-up and this was mainly due to a smoking cessation rate of<1% a year. Snus use was started by 6.2% of the 30-year-old women (age at baseline), and this contributed to a stable prevalence of total tobacco use in this group. Seventy percent of baseline snus users still used snus at follow-up. Among smokers, 55% continued smoking, 12% of men and 7% of women switched to snus. Among those with dual tobacco use at baseline, a third of men and a fourth of women remained dual users 10 years later. There are increasing differences in tobacco use between educational groups. Higher smoking and snus use prevalence are found among those with basic education, and this is most pronounced in the younger group of this middle-aged population. In spite of a higher prevalence of smoking without snus use among women, total smoking prevalence is similar in men and women due to a higher prevalence of dual tobacco use, i.e. snus and cigarettes, among men. The increase in snus use is being paralleled by a slight increase in dual use and the smoking prevalence does not seem to be influenced by snus. This should be the subject of further studies and also have implications for tobacco control policies.
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Swedish-style snus (SS) has been proposed as a smoking cessation aid.1 2 In Norway, SS use has been reported to be a common self-selected smoking cessation strategy,3 and it has been argued that the relatively low rates of smoking in Sweden may be in part attributable to SS use.1 4 However, because SS is not risk-free and its use may be associated with the development of dependence, its use for smoking cessation remains a subject of controversy.5 We recently reported that acute SS administration (8 mg of nicotine) significantly reduced craving relative to a nicotine/tobacco-free snus as well as to a 2 mg nicotine lozenge (NL).6 However, differences in …
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Some smokeless tobacco products, such as Swedish snus, are today considered to be associated with substantially fewer health hazards than cigarettes. This risk differential has contributed to the scientific debate about the possibilities of harm reduction within the tobacco area. Although current manufacturing methods for snus build on those that were introduced more than a century ago, the low levels of unwanted substances in modern Swedish snus are largely due to improvements in production techniques and selection of raw materials in combination with several programs for quality assurance and quality control. These measures have been successively introduced during the past 30-40 years. In the late 1990s they formed the basis for a voluntary quality standard for Swedish snus named GothiaTek®. In recent years the standard has been accepted by the members of the trade organization European Smokeless Tobacco Council (ESTOC) so it has now evolved into an industrial standard for all smokeless tobacco products in Europe. The initial impetus for the mentioned changes of the production was quality problems related to microbial activity and formation of ammonia and nitrite in the finished products. Other contributing factors were that snus came under the jurisdiction of the Swedish Food Act in 1971, and concerns that emerged in the 1960s and 1970s about health effects of tobacco, and the significance of agrochemical residues and other potential toxicants in food stuffs. This paper summarizes the historical development of the manufacture of Swedish snus, describes the chemical composition of modern snus, and gives the background and rationale for the GothiaTek® standard, including the selection of constituents for which the standard sets limits. The paper also discusses the potential future of this voluntary standard in relation to current discussions about tobacco harm reduction and regulatory science in tobacco control.
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Alcohol and tobacco use covary at multiple levels of analysis, and co-use of the 2 substances may have profound health consequences. To characterize the motivationally relevant processes contributing to co-use, the current study used ecological momentary assessment (EMA) to examine the subjective consequences of naturally occurring simultaneous use of alcohol and tobacco. Current smokers who reported frequently drinking alcohol (N=259) used electronic diaries to monitor their daily experiences for 21 days. Participants responded to prompted assessments and also initiated recordings when they smoked a cigarette or completed the first drink in a drinking episode. Momentary reports of smoking and alcohol consumption were associated with one another, and these effects remained after adjustment for occasion- and person-level covariates. When participants consumed alcohol, they reported increased pleasure and decreased punishment from the last cigarette. Smoking was associated with small increases in pleasure from the last drink. Ratings of buzzed and dizzy were synergistically affected by co-use of alcohol and tobacco. Co-use was also followed by higher levels of craving for both alcohol and tobacco. Results point to the importance of reward and incentive processes in ongoing drug use and suggest that alcohol intensifies real-time reports of the motivational consequences of smoking more strongly than smoking affects corresponding appraisals of alcohol effects.
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Socio-demographic and lifestyle characteristics of snus users have not been systematically described. Such knowledge is pivotal for tobacco control efforts and for the assessment of health effects of snus use. A cross-sectional study was conducted, based on the Stockholm Public Health Survey, including a population-based sample of 34,707 men and women aged 18-84 years. We examined how socio-demographic, lifestyle and health-related characteristics were associated with the prevalence of current daily snus use, smoking and dual tobacco use. Logistic regression was used to calculate odds ratios of prevalence (ORs) and 95% confidence intervals (CIs). Low educational level (OR = 1.60, CI = 1.41-1.81 and OR = 1.49, CI = 1.17-1.89, for men and women respectively), as well as occupational class and low income were associated with snus use. Some unfavourable lifestyle characteristics, including risky alcohol consumption (males: OR = 1.81, CI = 1.63-2.02; females: OR = 1.79, CI = 1.45-2.20), binge drinking and low consumption of fruit and vegetables were also associated with snus use. In contrast, physical inactivity and overweight/obesity were not, nor was perceived health. The prevalence of smoking followed steeper gradients for social as well as lifestyle characteristics. Overweight and obese men were however less often smokers. Perceived poor general health and psychological distress were highly related to smoking. Social disadvantage, as well as unhealthy lifestyle and self-reported poor health were strongly associated with dual use. There were limited differences between men and women. The social, lifestyle and health profiles of exclusive snus users in Stockholm County are less favourable than those of non-users of tobacco, but more advantageous than those of exclusive smokers. This knowledge should guide tobacco control measures as well as the interpretation of health risks linked to snus use.
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Given there are few experimental studies comparing the effects of snus and medicinal products for quitting smoking, self-reports from smokers who have used different methods for quitting smoking can be informative. Fourteen thousand seven hundred and forty-four Norwegian men aged between 20 and 50 years were selected at random from a national representative web panel and sent a questionnaire by E-mail. Of the 7,170 (48.6%) who responded, there were 1,775 former and 1,808 current smokers. They were asked about the method they used and the outcome of their last attempt to quit smoking. In a regression model in which education, number of previous attempts to quit smoking, perception of risk, and age were controlled for, the odds ratio (OR) for reporting total abstinence at the time of the survey was significantly higher for those who had used varenicline (OR = 4.95, p < .006) and snus (OR = 2.68, p < .001) compared with those who had used nicotine chewing gum (reference OR = 1). For smokers who reported that they had tried to quit with the help of snus, 62.4% reported that they still used snus at the time of the survey either daily (43.8%) or occasionally (18.6%). The proportion who still used medicinal nicotine products at the time of the survey was 9.5%. Compared with medicinal nicotine products, snus and varenicline increased the probability of quitting smoking completely, but snus seemed to maintain nicotine dependence.
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In the study, the authors examined the effects of smoking deprivation, anticipation of smoking, and actual smoking on the craving to smoke. Flight attendants who were light to heavy smokers rated their craving to smoke at predetermined time points during a 2-way short flight (each leg 3-5.5 hr) and a 1-way long flight (8-13 hr). In both short and long flights, craving increased gradually and peaked as landing approached. Craving levels at the end of the 1st leg of the short flights were equal to those at the end of the long flight and were much higher than those at the parallel time point in the long flight. In the short flight, craving levels at the beginning of the 2nd leg dropped relative to the end of the 1st leg, both for participants who smoked during the intermission and for those who did not, though the drop was steeper for the former. The results provide additional evidence for the role of psychological factors in determining the craving to smoke in a naturalistic setting.
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Alcohol has been shown to increase smoking urges and smoking behavior. However, alcohol's effects on specific components of smoking behavior for nicotine versus non-nicotine factors and potential sex differences in this response have not been investigated. Forty-two young male and female non-dependent, heavy social drinking smokers participated in two double-blind laboratory sessions. They were randomized to either an alcohol (0.8 g/kg; n = 29) or placebo (n = 13) beverage pre-administration group. After beverage consumption, they were assessed for smoking urges and then given the opportunity to smoke cigarettes which were either all nicotinized (0.6 mg/cigarette) or denicotinized (< or =0.05 mg/cigarette) over a 3-h period; smoking behavior was quantified by a smoking topography device. Subjects took standardized puffs of the session's cigarette both before and after beverage administration to provide a reference when making future smoking choices. Alcohol, compared with placebo beverage, increased both men's and women's smoking urge, as well as subjective ratings of smoking reference puffs for either nicotinized or denicotinized cigarettes. In terms of smoking choice behavior, regardless of cigarette type, alcohol (>placebo) increased men's smoking behavior, including puff count, volume, and duration. In contrast, for women, smoking topography measures did not differ between alcohol and placebo conditions. In summary regardless of nicotine content, in men, alcohol increased smoking urge and behavior, whereas in women, alcohol increased smoking urge but did not increase smoking behavior. These results indicate that the mechanisms underlying co-use of alcohol and tobacco in women may be more complex than in men.
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To assess whether people who use smokeless tobacco products are at increased risk of myocardial infarction and stroke. Meta-analysis of observational studies from Sweden and the United States. Electronic databases and reference lists. Quantitative estimates of the association between use of smokeless tobacco products and risk of myocardial infarction and stroke among never smokers. Both authors independently abstracted risk estimates and study characteristics. Summary relative risks were estimated on the basis of random effects models. 11 studies, mainly in men, were included. Eight risk estimates were available for fatal myocardial infarction: the relative risk for ever use of smokeless tobacco products was 1.13 (95% confidence 1.06 to 1.21) and the excess risk was restricted to current users. The relative risk of fatal stroke, on the basis of five risk estimates, was 1.40 (1.28 to 1.54). The studies from both the United States and Sweden showed an increased risk of death from myocardial infarction and stroke. The inclusion of non-fatal myocardial infarction and non-fatal stroke lowered the summary risk estimates. Data on dose-response were limited but did not suggest a strong relation between risk of dying from either disease and frequency or duration of use of smokeless tobacco products. An association was detected between use of smokeless tobacco products and risk of fatal myocardial infarction and stroke, which does not seem to be explained by chance.
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Few prospective studies of smoking initiation have investigated a wide range of time-varying and invariant predictor variables at the individual and contextual levels concurrently. In this study (1999-2005), 877 Canadian students (mean age = 12.7 years) who had never smoked at baseline completed self-report questionnaires on cigarette smoking and 32 predictor variables in 20 survey cycles during secondary school. Height and weight were measured in survey cycles 1, 12, and 19. School administrators completed questionnaires on school tobacco control policies/activities, and trained observers collected data on access to tobacco products in commercial establishments near schools. Younger age, single-parent family status, smoking by parents, siblings, friends, and school staff, stress, impulsivity, lower self-esteem, feeling a need to smoke, not doing well at school, susceptibility to tobacco advertising, alcohol use, use of other tobacco products, and attending a smoking-tolerant school were independent determinants of smoking initiation. Independent determinants of daily smoking onset among initiators of nondaily smoking included smoking by siblings and friends, feeling a need to smoke, susceptibility to tobacco advertising, use of other tobacco products, and self-perceived mental and physical addiction. Adolescent tobacco control programs should address multiple individual and contextual-level risk factors. Strategies that address nicotine dependence symptoms are also needed for adolescents who have already initiated smoking.
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We examine and refine the Fagerström Tolerance Questionnaire (FTQ: Fagerström, 1978). The relation between each FTQ item and biochemical measures of heaviness of smoking was examined in 254 smokers. We found that the nicotine rating item and the inhalation item were unrelated to any of our biochemical measures and these two items were primary contributors to psychometric deficiencies in the FTQ. We also found that a revised scoring of time to the first cigarette of the day (TTF) and number of cigarettes smoked per day (CPD) improved the scale. We present a revision of the FTQ: the Fagerström Test for Nicotine Dependence (FTND).
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This study tested whether alcohol consumption reduces anxiety and panic associated with a panic-challenge procedure. Subjects with panic disorder were randomly assigned to consume either a moderate dose of alcohol or a nonalcoholic placebo. All subjects were told that they were drinking alcohol to control beverage expectancies. Following the beverage administration, subjects underwent a panic challenge (35% carbon dioxide) and a series of anxiety symptom assessments. Subjects who consumed alcohol reported significantly less state anxiety both before and after the challenge. In response to the challenge, subjects who consumed alcohol experienced significantly fewer panic attacks when applying liberal panic criteria; however, this effect only approached significance when applying conservative panic criteria. These findings suggest that alcohol acts acutely to reduce both panic and the anxiety surrounding panic, and they lend support to the view that drinking behavior among those with panic disorder is reinforced by this effect. We suggest that this process may contribute to the high rate at which alcohol-use disorders co-occur with panic disorder.
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The hypothesis that smokeless tobacco-related sensory and behavioral cues can act as conditioned stimuli was tested in a counterbalanced double-blind experimental design. The nicotine content of snuff smokeless tobacco (ST) was manipulated for 24 male ST users by mixing ST with an ST substitute. Affect was manipulated through imagery scripts, stress was induced by a mental arithmetic task, and physiological measures and self-reported affect, stress, and urge for ST were collected. Urge for ST was consistently reduced regardless of the nicotine content in the ST conditions. Urge was increased by the stress manipulation and by negative affect when compared with positive affect. Urge for ST was positively correlated with stress and negative affect but was not correlated with positive affect. Physiological arousal was not related to urge. Results generally parallel studies of smoking and suggest that ST substitute products may aid ST cessation.
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A brief, 10-item version of the Questionnaire of Smoking Urges (QSU; Tiffany & Drobes, British Journal of Addiction 86:1467-1476, 1991) was administered to 221 active cigarette smokers in a laboratory setting (Study 1) and to 112 smokers enrolled in a comprehensive smoking cessation program (Study 2). In the laboratory setting, craving to smoke was evaluated in response to neutral and smoking-related stimuli. In the clinical setting, craving was assessed prior to cessation and again during treatment. Factor analyses revealed that a two-factor solution best described the item structure of the QSU-Brief across conditions. Factor 1 items reflected a strong desire and intention to smoke, with smoking perceived as rewarding for active smokers. Factor 2 items represented an anticipation of relief from negative affect with an urgent desire to smoke. The findings were consistent with the expressions of craving found in the 32-item version of the QSU (Tiffany & Drobes, 1991). Regression analyses demonstrated stronger baseline mood intensity and self-reported tendency to smoke to achieve pleasurable effects and to experience the desire to smoke when cigarettes are unavailable were predictive of general levels of craving report in active smokers in the laboratory and clinical setting. The findings supported a multidimensional conceptualization of craving to smoke and demonstrated the utility of a brief multidimensional measure of craving.
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To review the evidence on the effects of moist smokeless tobacco (snus) on smoking and ill health in Sweden. Narrative review of published papers and other data sources (for example, conference abstracts and internet based information) on snus use, use of other tobacco products, and changes in health status in Sweden. Snus is manufactured and stored in a manner that causes it to deliver lower concentrations of some harmful chemicals than other tobacco products, although it can deliver high doses of nicotine. It is dependence forming, but does not appear to cause cancer or respiratory diseases. It may cause a slight increase in cardiovascular risks and is likely to be harmful to the unborn fetus, although these risks are lower than those caused by smoking. There has been a larger drop in male daily smoking (from 40% in 1976 to 15% in 2002) than female daily smoking (34% in 1976 to 20% in 2002) in Sweden, with a substantial proportion (around 30%) of male ex-smokers using snus when quitting smoking. Over the same time period, rates of lung cancer and myocardial infarction have dropped significantly faster among Swedish men than women and remain at low levels as compared with other developed countries with a long history of tobacco use. Snus availability in Sweden appears to have contributed to the unusually low rates of smoking among Swedish men by helping them transfer to a notably less harmful form of nicotine dependence.
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This study examined the effects of acute doses of ethanol on smoking in cigarette smokers. Subjects were moderate-to-heavy smokers (20-30 cigarettes/day) who drank alcohol regularly (4-10 drinks/week). Using a within-subjects design, the dose of ethanol ingested was varied and the number of cigarettes smoked and the temporal pattern of smoking were evaluated. At the beginning of the session, subjects ingested placebo, 0.2, 0.4, or 0.8 g/kg ethanol and were then allowed to smoke freely for 3 h. Subjective mood measures, physiological measures and psychomotor performance were examined at hourly intervals. Subjects smoked more cigarettes during the first hour post-beverage after consuming 0.4 or 0.8 g/kg ethanol than after consuming placebo or 0.2 g/kg ethanol. During the second and third hours of smoking, no differences were observed between the conditions. Changes in the carbon monoxide content of subjects' breath as a function of dose were not significant, but were in the expected direction based on the number of cigarettes smoked under the different conditions. We conclude that alcohol increases cigarette consumption in non-alcohol-abusing smokers, but that this effect is short-lived and occurs only during the ascending limb of the blood alcohol curve.
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Background: This study tested whether alcohol consumption reduces anxiety and panic associated with a panic-challenge procedure.Methods: Subjects with panic disorder were randomly assigned to consume either a moderate dose of alcohol or a nonalcoholic placebo. All subjects were told that they were drinking alcohol to control beverage expectancies. Following the beverage administration, subjects underwent a panic challenge (35% carbon dioxide) and a series of anxiety symptom assessments.Results: Subjects who consumed alcohol reported significantly less state anxiety both before and after the challenge. In response to the challenge, subjects who consumed alcohol experienced significantly fewer panic attacks when applying liberal panic criteria; however, this effect only approached significance when applying conservative panic criteria.Conclusions: These findings suggest that alcohol acts acutely to reduce both panic and the anxiety surrounding panic, and they lend support to the view that drinking behavior among those with panic disorder is reinforced by this effect. We suggest that this process may contribute to the high rate at which alcohol-use disorders co-occur with panic disorder.
Article
The use of snus is increasing in Norway. In this study we examined differences between adolescents who were exclusive snus users, and adolescent non-users, smokers and dual users of snus and cigarettes on a number of psychosocial factors, categorized as risk variables and protective variables associated with involvement in health compromising behavior. We applied separate logistic regression models, where exclusive snus users (n=740) were compared with non-users (n=904), smokers (n=219), and dual users (n=367). Compared to non-users, the group of exclusive snus users was associated with variables traditionally predicting health risk behavior, such as smoking friends (OR=1.74, SD 1.27-2.38) and truancy (OR=2.12, SD 1.65-2.78). Compared to smokers, exclusive snus users were related to variables traditionally associated with protection against involvement in health risk behavior, e.g. higher academic orientation (OR=1.66, SD 1.12-2.45). Associations with protective factors were also observed when exclusive snus users were compared with dual users. While the group of exclusive snus users was associated with a pattern of psychosocial risk compared to non-users, they showed a more conventional pattern when compared to smokers and dual users. The group of exclusive snus users may be described on a continuum varying from psychosocial risk factors to protective factors of risk involvement depending on the group of comparison.
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Background: Alcohol consumption has been linked to increased tobacco use and craving in both dependent and nondaily smokers, yet the extent to which these relationships depend on interactions involving nicotine remains unclear. This study examined the acute effects of alcohol on the subjective and behavioral responses to nicotine-containing tobacco and denicotinized tobacco in 17 (10 male) dependent daily smokers (DDS) and 23 (11 male) nondependent nondaily smokers (NNS). Methods: During 4 randomized double-blind sessions, participants assessed the effects of nicotine-containing tobacco or denicotinized tobacco following the administration of a moderately intoxicating dose of alcohol (mean blood alcohol concentration = 0.076 g/dl) or a placebo beverage. They could then self-administer additional puffs of the same type of cigarette sampled over a 60-minute period using a progressive ratio task. Results: In NNS, alcohol significantly increased the self-administration of both nicotine-containing and denicotinized cigarettes, and no differences in self-administration were observed between the 2 types of tobacco within either beverage condition. In contrast, in DDS, alcohol was associated with decreased denicotinized tobacco self-administration relative to the placebo beverage condition as well as with increased self-administration of nicotine-containing tobacco relative to denicotinized tobacco. DDS also exhibited relatively elevated craving following the administration of a nicotine-containing cigarette in the alcohol beverage condition. Conclusions: Findings suggest that nicotine may be critical to the drinking-smoking relationship in DDS, but that nonnicotine smoking factors may be more important in NNS.
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Background: Previous research suggests that high levels of anxiety sensitivity (AS; fear of anxiety symptoms) may constitute a risk factor for alcohol abuse. The present study evaluated the hypothesis that high AS levels may increase risk for alcohol abuse by promoting a heightened sober reactivity to theoretically relevant stressors and heightened sensitivity to alcohol's emotional reactivity dampening effects, which would negatively reinforce drinking in this population. Methods: One hundred and two undergraduate participants (51 high AS, 51 low AS) with no history of panic disorder were assigned to either a placebo, low‐dose alcohol, or high‐dose alcohol beverage condition (17 high AS, 17 low AS per beverage condition). After beverage consumption and absorption, participants underwent a 3 min voluntary hyperventilation challenge. Results and Conclusions: High‐AS/placebo participants displayed greater affective and cognitive reactivity to the challenge than low‐AS/placebo participants, which indicated increased fear and negative thoughts (e.g., “losing control”) during hyperventilation among sober high AS individuals. Dose‐dependent alcohol dampening of affective and cognitive reactivity to hyperventilation was observed only among high‐AS participants, which suggested that high‐AS individuals may be particularly sensitive to alcohol‐induced reductions in their degree of fear and negative thinking in response to the experience of physical arousal sensations. In contrast, dose‐dependent alcohol dampening of self‐reported somatic reactivity was observed among both high‐ and low‐AS participants. We discuss implications of these results for understanding risk for alcohol abuse in high‐AS individuals, as well as directions for future research.
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Both nicotine and various non-nicotine smoking factors are believed to contribute to tobacco addiction but their relative roles remain incompletely understood. This study aimed to help clarify these roles by examining acute interactions between nicotine and denicotinized tobacco (DT). During two randomized blinded sessions, the effects of a quick-release 4 mg nicotine lozenge (NL) versus placebo lozenge (PL) on the subjective and behavioural responses to DT were examined in 27 (14 men) dependent, daily smokers. Participants were administered NL or PL for 30 min before receiving one initial DT cigarette. Participants could then earn additional DT cigarette puffs over the following 60 min. Subjective state was assessed using the Questionnaire of Smoking Urges-Brief and visual analogue scales at baseline, postlozenge and postinitial DT cigarette. Relative to PL, NL was associated with increased alertness as well as with reduced levels of DT self-administration (P<0.01). The administration of a single DT cigarette was followed by a reduction in craving under both lozenge conditions (P<0.001), an effect that was significantly greater in women (P<0.01). Moreover, DT administration was associated with increased ratings of 'pleasant', 'satisfied', 'stimulated' and 'relaxed', as well as with decreased ratings of 'anxious' (P's<0.01), independent of lozenge condition. The findings suggest that both nicotine and non-nicotine smoking factors may make important contributions towards the addictive properties of tobacco.
Article
Snus, a smokeless tobacco product, was introduced in the United States in 2006. Because it is available in a variety of flavors and is relatively easy to conceal, snus might be particularly attractive to adolescents. Yet, no studies have examined snus use in U.S. adolescents. This brief report examined (a) differences between adolescent snus users and non-snus users on a variety of demographic, behavioral, and intrapersonal factors and (b) prevalence of snus use among current users of various other tobacco products versus nontobacco users. Participants were 8,472 6th- to 12th-grade students who voluntarily completed the 87-item Texas Youth Tobacco Survey during class time. Overall, 7.1% of students reported ever trying snus; of these, 77% were male, 68% were in high school, and 46% were White. Mixed-effects regression models indicated that the prevalence of cigarette, chew, cigar, and alcohol use was higher among snus users than among non-snus users. Compared with non-snus users, snus users performed more poorly in school and perceived snus, cigarettes, chew, and cigars to be less dangerous. Finally, current users of cigarettes, chew, and cigars had a higher prevalence of snus use than did their peers who did not use the respective products. Among U.S. adolescents, snus use may be part of a constellation of health compromising behaviors. Additional research is needed to determine who is using snus and identify the determinants and consequences of snus use, all of which can inform interventions and policies aimed at decreasing tobacco use among youth.
Article
Nicotine is absorbed in substantial quantities from smokeless tobacco and could contribute to the adverse consequences of smokeless tobacco use. Chronic systemic exposure to nicotine could contribute to accelerated coronary artery disease, acute cardiac ischemic events, and hypertension. Systemic absorption of sodium and mutagenic chemicals from smokeless tobacco could aggravate hypertension or cardiac failure, or contribute to cancer, respectively. Information concerning the potential hazards of nicotine and other systemically absorbed toxins may be incorporated into educational programs to discourage the use of smokeless tobacco.
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Snus availability has been claimed to have contributed to the low rates of smoking among Swedish men and made possible the transfer to a less harmful form of nicotine dependence. Fourteen cigarette smokers were randomly assigned to 2 types of 1 g Swedish portion snus and 4 mg nicotine polacrilex (NP) chewing gum in open-label, single-dose crossover study. Nicotine delivery and pharmacokinetics were estimated, and self-reports of subjective effects were obtained using Visual Analogue Scales (VASs). Extracted dose from the NP gum averaged 2.56 mg compared with 2.12 and 2.18 mg, respectively, for Swedish portion snus. This resulted in a slightly larger area under the curve (AUC) for the NP chewing gum. The rise of the nicotine plasma concentration was faster for Swedish snus. Median T(max) was shorter, 30 min for snus compared with 45 min for the NP gum. The lower C(max) of NP gum compared with the snus products in spite of larger AUC may be explained by slower absorption from the chewing gum. The faster absorption of nicotine from Swedish portion snus was mirrored in a higher VAS score for "head rush." Craving/urges to smoke decreased similarly for all treatments. Salivation and throat burn were rated higher for the 4 mg NP gum compared with both types of snus. Swedish snus produced higher maximum blood nicotine concentration in shorter time and with a quicker onset of "head rush" compared with 4 mg NP chewing gum in spite of a smaller extracted dose. The quicker onset of "head rush" and supposedly higher satisfaction from snus may partly explain the widespread use of snus for stopping smoking in Sweden.
Article
Swedish-style snus (SS) has recently garnered controversy for its proposed use as a smoking cessation aid and/or harm reduction tool. However, to date, little work has been done to evaluate the extent to which SS affects cigarette cravings and smoking behavior under double-blind controlled conditions. During four double-blind placebo-controlled randomized sessions, 15 smokers (8 male) administered SS, placebo (nicotine/tobacco-free) snus (PS), a nicotine-containing lozenge (NL), or a placebo lozenge (PL) for 30 min and assessed their effects using Visual Analogue Scales and the Brief Questionnaire of Smoking Urges. They could then self-administer their usual brand of cigarettes using a progressive ratio task over the next 60 min. Following the completion of their final session, 11 participants (6 male) ranked each of the products used in the study in terms of their preferences. Relative to the other products, SS was associated with a decreased intention to smoke as well as a delayed onset of cigarette smoking in men but not women. However, SS administration was also associated with increased feelings of frustration and irritability relative to NL and SS was ranked as being the least preferred product used in the study. Findings suggest that SS is effective in acutely suppressing craving and smoking in at least some smokers, but that its acceptability may be limited. Copyright
Article
A large proportion of smokers consolidate their smoking patterns during young adulthood, and it is possible that the high rates of drinking found in this age group may facilitate the transition from nondaily to daily cigarette use. The primary aim of this study was to examine how alcohol alters the subjective effects of smoking in heavy-drinking young adults (age 21-25) who are still at an experimental stage of smoking but show recent increases in their smoking behavior. Using a within-subject design, we examined whether alcohol or the expectation of receiving alcohol increased either subjective responses to smoking or the amount smoked. Subjects participated in three sessions, in which they received alcohol (0.08 g/dL targeted blood alcohol level), a taste-masked placebo presented as alcohol, or a mixer beverage not presented as alcohol. Measures included positive and negative subjective reactivity (e.g., satisfaction, nausea, craving relief, and enjoyment of airway sensations) associated with smoking a single cigarette and subsequent ad lib smoking behavior. Both conditions in which the subjects expected to receive alcohol increased positive effects of smoking (satisfaction, calm, and taste), compared to the mixer beverage. Alcohol, compared to the placebo and mixer beverages, decreased negative effects (nausea) associated with smoking a cigarette and increased subsequent smoking. This initial study has implications for understanding how alcohol and the expectation of alcohol improves the experience of smoking in nondaily smokers who are still at an experimental stage of smoking.
Article
Although frequent heavy drinking has been associated with decreased odds of quitting smoking, the extent to which smoking cessation is associated with decreased alcohol consumption is less clear. The present study examined over a 2-year period whether individuals who quit smoking for at least 6 months, compared to those making a quit attempt but continuing to smoke and to those not making any attempt to quit smoking, showed greater reductions in drinking frequency, average weekly quantity of alcohol consumption, and frequency of heavy drinking. Data were drawn from the International Tobacco Control Four Country Survey, a prospective cohort study of smokers in Australia, Canada, the UK, and the US. A total of 3614 participants provided alcohol data at one study wave and were re-interviewed 2 years later regarding smoking and alcohol use. Consistent with prior studies, individuals who drank heavily (4+/5+ drinks for women and men, respectively) more than once a week had especially low rates of quitting smoking. There was little evidence, however, that those who achieved sustained smoking cessation made greater reductions in drinking compared to those who continued to smoke. These results were consistent across countries and sexes and did not differ significantly by heaviness of smoking. Results indicate that quitting smoking, in and of itself, does not lead to meaningful changes in alcohol use. Therefore, interventions and policies directed towards increasing smoking cessation are unlikely to affect rates of hazardous drinking unless they include specific elements that address alcohol consumption.
Article
Novel approaches to nicotine replacement therapy (NRT) are needed to improve the modest long-term quit rate of 10%. Snus (Swedish tobacco) and Zonnic (oral nicotine sachet) rapidly deliver nicotine via buccal absorption and have potential as NRTs. As a prelude to formal evaluation of either product as a smoking cessation therapy, it is necessary to determine their acceptability and the willingness of smokers to use them in populations with no history of access to oral tobacco products. An open-label crossover study of ad libitum snus, Zonnic, and nicotine gum among 63 smokers for 2 weeks each, and smoking reduction if the subjects did not feel the desire to smoke. Diary cards recorded use of products and cigarettes; formal and ad hoc scales measured urges to smoke, withdrawal symptoms, and the sensory quality of the products. Subjects preferred snus and Zonnic over gum. Snus and Zonnic were superior to gum in reducing urges to smoke and caused fewer side effects. All three products suppressed withdrawal symptoms. Subjects reduced their smoking by Ms of 33%, 37%, and 42% during the gum, snus, and Zonnic fortnights, respectively. Most subjects reported a strong desire to use Zonnic or snus to quit smoking. Subjects preferred snus and Zonnic, which both had significantly fewer gastrointestinal side effects than gum and resulted in greater reductions in smoking. Snus and Zonnic are effective in suppressing desires to smoke and reducing smoking, and further studies are warranted to investigate their effect on long-term quit rates.
Article
The utility of one of the most widely used subjective alcohol assessment tools, the Biphasic Alcohol Effects Scale (BAES) has been somewhat limited based on lack of psychometric studies in large and diverse samples, a range of alcohol doses, the length of the measure, and the original instructional set which precluded baseline measurement and disclosed to subjects that they received alcohol. The current study investigated the factor structure of the BAES with a modified instructional set at pre-drink baseline and after consumption of various doses of alcohol, in a sample of 190 men and women, heavy and light social drinkers. This study tested the psychometric properties of a brief version of the BAES (Brief-BAES or B-BAES). Results demonstrated robust support of the stimulant and sedative constructs across all conditions, and demonstrated strong psychometric support for the 6-item B-BAES. This is the first comprehensive study to expand the utility of the BAES by instructional set, baseline measurement, at various alcohol doses, and by drinking history and sex. In addition, the introduction of the B-BAES may further increase the utility of this scale, particularly in paradigms with repeated measurement or time constraints.
Article
Nicotine sustains tobacco addiction, a major cause of disability and premature death. Nicotine binds to nicotinic cholinergic receptors, facilitating neurotransmitter release and thereby mediating the complex actions of nicotine in tobacco users. Dopamine, glutamate, and gamma aminobutyric acid release are particularly important in the development of nicotine dependence, and corticotropin-releasing factor appears to contribute to nicotine withdrawal. Nicotine dependence is highly heritable. Genetic studies indicate roles for nicotinic receptor subtypes, as well as genes involved in neuroplasticity and learning, in development of dependence. Nicotine is primarily metabolized by CYP 2A6, and variability in rate of metabolism contributes to vulnerability to tobacco dependence, response to smoking cessation treatment, and lung cancer risk. Tobacco addiction is much more common in persons with mental illness and substance abuse disorders, representing a high proportion of current smokers. Pharmacotherapeutic approaches to tobacco addiction include nicotine replacement, bupropion, and varenicline, the latter a selective nicotine receptor partial agonist.
Article
Different prevalences of cigarette smoking and use of snus between University students and non-students, may supply us with information about the diffusion stage of the epidemic. User characteristics and involvement in other risk behaviour influences their status as diffusion agents. 1 655 students at the University of Oslo responded to a postal questionnaire about their tobacco, alcohol and drug use, gambling habits, physical activity and incidence of anxiety and depression. Data on tobacco habits of similarly aged youth outside University were obtained from Statistics Norway. The response rate was 57 %. The proportion of daily smokers was significantly lower among students (men [10 %], women [9.6 %]), than among non-students (men [27 %], women [28 %]). The proportion of snuff users (daily + occasionally) for women was almost three times higher among students (12 %) than non-students (3.8 %). For men the results were different (28 % snuff users among students and 33 % among non-students). The quit-rate for smoking among students was higher for daily (46 %) and former users (61 %) of snus, than among students who had not used snus (34 %). Cigarette smoking increased with drug abuse, alcohol consumption, physical inactiveness, reduced mental health, and absence of parity. Use of snus was a typical male phenomenon, and increased with alcohol consumption and drug abuse. The diffusion of the snus epidemic seems to be in an early stage for women, while for men it may already have reached a level of maturity. The high proportion of previous smokers among snus users, indicates that snus may affect the prevalence and frequency of smoking in a population. Groups with a low social impact seem to have a higher prevalence of smokers, both in general and among students, while the opposite is the case for snus users.
Article
The Michigan Alcoholism Screening Test and a shortened 13-item version can reliably be used as self-administered questionnaires.
Article
Visual analogue scales (VAS) have been used in the social and behavioral sciences to measure a variety of subjective phenomena. The VAS method has potential utility for the measurement of a variety of clinical phenomena of interest to nurse investigators. In this review a description of the various forms of the VAS and an historical overview of their development are presented. In addition, conceptual, psychometric, and statistical aspects of the VAS are considered. Finally, strengths and limitations of the VAS method are addressed.
Article
Using reports of relapse crises collected through a relapse prevention hotline, this paper develops a taxonomy of relapse situations. Cluster analysis resulted in four clusters. Social situations are characterized by social drinking and exposure to smoking. Relaxation situations are marked by relaxation, usually after a meal. Work situations take place during work when the exsmoker is feeling anxious. Upset situations occur when the exsmoker is feeling anxious or depressed while home alone. These situations were significantly discriminated by their scores on the McKennel Smoking Motivation Scales, suggesting a connection between smoking patterns and relapse. Behavioral coping was less likely and relapse more likely in social and upset situations. The frequency of coping accounted for the higher relapse rates in Upset, but not in social situations. Relapse was nearly inevitable among people who failed to cope behaviorally in social situations, suggesting that they are especially tempting.
Article
1 The value of a portable breathlyser (Alcometer AE-M2) in the assessment of gastric emptying after alcohol ingestion was investigated by comparing breath and venous blood alcohol concentrations with simultaneous scintigraphic measurements of gastric emptying rate. 2 Alcohol absorption, as determined by the area under the venous blood alcohol concentration-time curve during the first 30 min, correlated with gastric emptying during the same period, implying dependence of the rate of alcohol absorption on gastric emptying rate. 3 There was no correlation between breath and venous alcohol concentrations during the first 15 min after alcohol ingestion, but a significant correlation was observed thereafter. 4 Breath alcohol measurements may be sufficient to detect gross alterations in gastric emptying but measurements of venous blood alcohol are likely to be more reliable.
Article
Alcohol produces stimulant and sedative effects, and both types of effect are thought to influence drinking practices. This article describes the development and preliminary validation of the Biphasic Alcohol Effects Scale (BAES), a self-report, unipolar adjective rating scale designed to measure both stimulant and sedative effects of alcohol. An initial pool of 12 stimulant and 12 sedative items was derived from previous alcohol effect measures, and from descriptors of intoxication generated by subjects during interviews conducted on both the ascending and descending limbs of the blood alcohol curve. This item pool was administered to a sample of sober college students twice, with a 2-week inter-test interval. Items that were difficult to comprehend, or that had high ratings or low test-retest reliability, were eliminated, resulting in a seven-item stimulant subscale and a seven-item sedative subscale. These subscales showed high internal consistency in a sober state, which was not improved by additional item deletion. The data from this study also provided a basis for revising the instructions for the BAES. The new 14-item instrument was then given to 30 male and 12 female nonalcoholics on the ascending and descending limbs of the blood alcohol curve, after the administration of either 0.75 ml/kg alcohol (males) or 0.65 ml/kg alcohol (females). Internal consistency was high for both BAES subscales on both limbs of the blood alcohol curve (Cronbach's alpha = 0.85 to 0.94), and was not improved by additional item deletion. Factor analyses conducted on both limbs of the blood alcohol curve supported the proposed factor structure of the BAES.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
This research investigated the effect of alcohol consumption on smokers' general levels of craving for cigarettes and their reactivity to smoking-related cues. Cue reactivity was evaluated across multiple trials of exposure to both imaginal and in vivo presentations of smoking and non-smoking stimuli. On imagery trials, subjects imagined either smoking and non-smoking scenarios; during in vivo trials subjects watched an experimenter either smoke a cigarette or drink water. Measures included self-reported craving to smoke and selected somatovisceral responses. Subjects (n = 60) completed two sessions, the first examined cue reactivity in the absence of alcohol. In Session 2 subjects were told they were consuming alcohol; half received placebo and the other half were given ethanol (0.75 ml/kg). Following beverage consumption, subjects were exposed to the cue manipulation. In both sessions, exposure to smoking stimuli enhanced craving in each presentation mode and increased skin conductance levels in the in vivo mode. Alcohol intoxication produced a generalized increase in craving but did not selectively enhance craving or physiological reactivity to smoking stimuli. The results are discussed in terms of models of craving and processes through which alcohol may influence craving to smoke.
Article
To assess the effects of a smoking cessation program for recovering alcoholics on use of alcohol, tobacco and illicit drugs after discharge from residential treatment. A randomized community intervention trial design was employed in which 12 residential drug treatment centers in Iowa, Kansas and Nebraska were matched and then randomly assigned to the intervention or control condition. Approximately 50 adult residents (inpatients) from each site were followed for 12 months after treatment discharge. Participating residents in the six intervention centers received a 4-part, individually tailored, smoking cessation program while those in the six control sites received usual care. Both moderate and heavy drinking rates were reduced in the intervention group. Intervention site participants were significantly more likely than controls to report alcohol abstinence at both the 6-month (OR = 1.59, 95%CI: 1.09-2.35) and 12-month assessment (OR = 1.84, 95%CI: 1.28-2.92). Illicit drug use rates were comparable. Effect of the intervention on tobacco quit rates was not statistically significant. Counseling alcoholics in treatment to quit smoking does not jeopardize the alcohol recovery process. However, low-intensity tobacco interventions are unlikely to yield high tobacco quit rates.
Article
Previous research suggests that high levels of anxiety sensitivity (AS; fear of anxiety symptoms) may constitute a risk factor for alcohol abuse. The present study evaluated the hypothesis that high AS levels may increase risk for alcohol abuse by promoting a heightened sober reactivity to theoretically relevant stressors and heightened sensitivity to alcohol's emotional reactivity dampening effects, which would negatively reinforce drinking in this population. One hundred and two undergraduate participants (51 high AS, 51 low AS) with no history of panic disorder were assigned to either a placebo, low-dose alcohol, or high-dose alcohol beverage condition (17 high AS, 17 low AS per beverage condition). After beverage consumption and absorption, participants underwent a 3 min voluntary hyperventilation challenge. High-AS/placebo participants displayed greater affective and cognitive reactivity to the challenge than low-AS/placebo participants, which indicated increased fear and negative thoughts (e.g., "losing control") during hyperventilation among sober high AS individuals. Dose-dependent alcohol dampening of affective and cognitive reactivity to hyperventilation was observed only among high-AS participants, which suggested that high-AS individuals may be particularly sensitive to alcohol-induced reductions in their degree of fear and negative thinking in response to the experience of physical arousal sensations. In contrast, dose-dependent alcohol dampening of self-reported somatic reactivity was observed among both high- and low-AS participants. We discuss implications of these results for understanding risk for alcohol abuse in high-AS individuals, as well as directions for future research.
Article
People who drink alcohol are more likely to smoke, and experiments have shown that alcohol can increase cigarette smoking. However, it is not clear why alcohol consumption should increase smoking. To address this issue the current experiment looked at the effects of alcohol on a range of behavioural and subjective measures intended to assess the reward value of smoking. These included a preference test carried out after subjects had smoked cigarettes of one colour after consuming alcohol, and cigarettes of another colour after consuming non-alcoholic drinks. In the preference test, subjects were offered the choice of smoking the alcoholic or non-alcoholic drink-paired cigarette. It was hypothesised that if alcohol increased the reward value of smoking, subjects would choose to smoke the alcohol-paired cigarette. Consumption of alcohol increased the length of time people spent smoking, increased the number of puffs taken on each cigarette, and increased the amount of tobacco burnt. There were also strong subjective effects, with subjects looking forward more to smoking after alcohol and reporting greater smoking satisfaction after alcohol. However, subjects did not show a preference for the cigarettes they had smoked after alcohol.
Article
This study examined the effects of acute doses of ethanol on smoking in cigarette smokers. Subjects were moderate to-heavy smokers (20-30 cigarettes/day) who drank alcohol regularly (4-10 drinks/week). Using a within-subjects design, the dose of ethanol ingested was varied and the number of cigarettes smoked and the temporal pattern of smoking were evaluated. At the beginning of the session, subjects ingested placebo, 0.2, 0.4, or 0.8g/kg ethanol and were then allowed to smoke freely for 3h. Subjective mood measures, physiological measures and psychomotor performance were examined at hourly intervals. Subjects smoked more cigarettes during the first hour post-beverage after consuming 0.4 or 0.8g/kg ethanol than after consuming placebo or 0.2g/kg ethanol. During the second and third hours of smoking, no differences were observed between the conditions. Changes in the carbon monoxide content of subjects' breath as a function of dose were not significant, but were in the expected direction based on the number of cigarettes smoked under the different conditions. We conclude that alcohol increases cigarette consumption in non-alcohol-abusing smokers, but that this effect is short-lived and occurs only during the ascending limb of the blood alcohol curve.
Article
The most recent epidemiologic review of the cancer risks associated with smokeless tobacco use appeared in 1986, when 10 studies were available. This review describes 21 published studies, 20 of which are of the case-control type. We characterize each study according to the specific anatomic sites and according to the type of smokeless tobacco products for which it provides relative risks of cancer. The use of moist snuff and chewing tobacco imposes minimal risks for cancers of the oral cavity and other upper respiratory sites, with relative risks ranging from 0.6 to 1.7. The use of dry snuff imposes higher risks, ranging from 4 to 13, and the risks from smokeless tobacco, unspecified as to type, are intermediate, from 1.5 to 2.8. The strengths and limitations of the studies and implications for future research are discussed.
Article
The very low smoking prevalence in Sweden has received considerable attention. Sweden was the only country in Europe to reach the World Health Organizations' goal of less than 20% daily smoking prevalence among adults by year 2000. Only 17% of Swedish men smoke. Some have argued that this has been achieved because Swedes use another form of tobacco instead. Sweden has a high level of use of a moist snuff product called 'snus'. Nineteen per cent of adult men and 1% of women are daily users and the trend is increasing. Epidemiological studies have failed to find evidence that snus causes cancers, including oral cancer. Its adverse effects on the cardiovascular system are debated, but are certainly less than those of smoking. Recent studies among former smokers indicate that many men have quit smoking using snus. Forty-seven per cent of current snus users are former smokers and 28% of ex-smoking used snus at their last attempt to stop smoking. The association between high snus consumption and low smoking prevalence has been debated and challenged. It has been argued that snus may be a gateway to cigarette smoking. Recent data has found that among those starting tobacco use in the form of snus, 20% later go on to smoking while the same risk for those not starting with snus is 43%. On balance, there is reason to believe that having snus available to the Swedish population has been of benefit to public health. Repealing the ban on snus in the rest of the European Union might also have some positive effect, depending on the marketing.
Article
To assess to what extent snus has been used as an aid to stop smoking among Swedish smokers. A random telephone retrospective survey of Swedish smokers and ex-smokers. Survey conducted in November-December 2000. A national sample of 1000 former and 985 current daily smokers aged 25-55 years. Smoking status, date and method of quitting by self-report. Thirty-three per cent of former smokers and 27% of current smokers had ever used snus. The difference was larger among men (55% versus 45%, P = 0.003). Current smokers who made use of snus smoked on average fewer cigarettes per day than non-users of snus. The mean duration of abstinence among former smokers was not influenced by snus use. Conditionally on age, education and use of nicotine replacement therapy there was an increased probability of being a former rather than a current smoker with ever use (OR 1.72, 95% CI = 1.30-2.28) or current use (OR 1.81, 95% CI = 1.31-2.53) of snus. Having used snus at the latest quit attempt increased the probability of being abstinent by about 50% (OR 1.54, 95% CI = 1.09-2.20). Our study suggests that by using snus, Swedish male smokers may increase their overall chances of abstinence. However, 71% of the men in this sample who quit smoking did so without using snus and the duration of abstinence was not affected by snus use. This suggests that snus is not a necessary component of smoking cessation at the population level. Snus use was very rare among women.