Spanish adaptation and validation of the Barratt Impulsiveness Scale for early adolescents (BIS-11-A) / Adaptación y validación española de la Escala de Impulsividad de Barratt en adolescentes tempranos (BIS-11-A)

Impulsivity has been associated with several psychiatric disorders such as substance abuse. The Barratt Impulsiveness Scale (BIS-11) is one of the most commonly administered self-reports for the assessment of impulsiveness in both research and clinical settings. There is a version for adolescents called BIS-11-A, which has not been yet properly adapted to Spanish population. The goal of this study is to offer an alternative and more adequate Spanish version of the BIS-1-A, as well as to assess its psychometric properties including factor structure, reliability and predictive validity regarding substance use (last month alcohol, tobacco and cannabis use, presence of last month intoxication, binge drinking and problem drinking). The BIS-11-A and items from the European School Survey Project on Alcohol and other Drugs (ESPAD) were applied to1,183 students (aged 12-14) at 16 Spanish secondary schools. The BIS-11-A showed a bidimensional factor structure, high reliability (Cronbach's alpha = .87) and good capacity for identifying substance use, binge drinking and problem drinking (sensitivity = 67.3-75%; specificity = 83.4-85.4%). The BIS-11-A Spanish version is a reliable and valid instrument for be used among early adolescents (AU)

La impulsividad ha sido relacionada con multitud de trastornos psiquiátricos como el abuso de sustancias. La Escala de Impulsividad de Barratt (BIS-11) es uno de los autoinformes más comúnmente administrados para la evaluación de la impulsividad tanto en el ámbito clínico como de investigación. Hay una versión para adolescentes llamada BIS-11-A, que aún no ha sido convenientemente adaptada a población española. El objetivo de este estudio es ofrecer una versión española alternativa y más adecuada del BIS-11-A, así como la evaluación de sus características psicométricas tales como estructura factorial, fiabilidad y validez predictiva sobre el uso de sustancias (uso en el último mes de alcohol, tabaco y cánnabis, presencia de borracheras en el último mes, consumo intensivo y problemático de alcohol). El BIS-11-A e ítems de la Encuesta Escolar Europea sobre Alcohol y otras Drogas (ESPAD) fueron aplicados a 1.183 estudiantes (edad 12-14 años) en 16 institutos españoles de Educación Secundaria. El BIS-11-A ha mostrado una estructura bidimensional, alta fiabilidad (alfa de Cronbach = 0,87) y buena capacidad para identificar el uso de sustancias, consumo intensivo y problemático de alcohol (sensibilidad = 67,3-75%; especificidad = 83,4-85,4%). La versión española del BIS-11-A es un instrumento fiable y válido para su uso con adolescentes tempranos (AU)

Interaction effect of contingency management and sex on delay-discounting changes among treatment-seeking smokers.

Despite the potential influence of sex on delay-discounting rates, there is no previous evidence with regard to the effect of this variable on the clinical interventions aimed at modifying delay-discounting rates. This study assessed the effect of sex on the association between the type of treatment received (either cognitive-behavioral treatment [CBT] alone or combined with contingency management [CM + CBT]) and delay-discounting changes at end of treatment and 6-month follow-up. This aim was addressed after controlling for the influence of baseline delay discounting. Treatment-seeking smokers (N = 116) were randomly assigned to either CM + CBT (n = 69) or CBT alone (n = 47). Participants completed delay-discounting assessments at intake, at end of treatment, and at 6-month follow-up. Results showed that there was a significant interaction effect of treatment type and sex, such that women who received CM decreased their discounting more than women who did not. However, this effect was not found among men. Participants who discounted most at intake showed the greatest delay-discounting decreases. Lastly, smoking abstinence did not affect changes in delay discounting. The current results suggest that CM intervention may have a differential effect on delay-discounting changes as a function of sex. This finding supports the relevance of considering the effect of individual variables when assessing changes in delay discounting due to clinical interventions.

Contingency management for cigarette smokers with depressive symptoms.

Despite depressive symptoms being very common among smokers from the general population, few studies have examined the effects of depressive symptoms on smoking treatment outcomes, and even less research has been carried out in the context of contingency management (CM). The authors conducted a secondary analysis to assess the interrelation between treatment condition, depressive symptoms and treatment outcomes among treatment-seeking smokers. The sample was made up of 147 treatment-seeking smokers who were randomly allocated 2 treatment conditions: cognitive behavioral treatment (CBT; n = 74), or CBT + CM (n = 73). CBT was applied in 1-hr group-based sessions over 6 weeks. The CM protocol was voucher-based with maximum earnings of €300 (US$339). Depressive symptoms were assessed using the Beck Depression Inventory-II. Smoking abstinence was verified though cotinine and carbon monoxide. Several analyses were conducted to explore the effect of treatment condition and baseline depressive symptoms on treatment outcomes, as well as the effect of treatment condition and smoking status on depressive symptoms. The CBT + CM condition was more effective than CBT, independent of depressive symptoms. The presence of depressive symptoms decreased the number of days of continuous smoking abstinence. Participants with a greater number of days of continuous smoking abstinence had fewer depressive symptoms than those with fewer days of continuous smoking abstinence. Findings suggest that health care providers should consider encouraging their patients with depressive symptoms to seek smoking cessation services that include both smoking cessation protocols and behavioral activation for mood management, thus maximizing both smoking and depressive outcomes.

Contingency management for substance use disorders in Spain: Implications for research and practice.

OBJECTIVE: We provide a narrative review of published studies evaluating voucher-based contingency management (CM) treatment for cocaine, nicotine and cannabis use disorders in Spain and discuss the concerns and future challenges. METHOD: Published studies between 2008 and 2015 that evaluated the impact of incentives for SUD in Spain and included an appropriate control or comparison condition were identified and reviewed. RESULTS: Adding voucher-based CM to standard treatments obtained better treatment retention and cocaine abstinence than standard care alone. CM also improved psychosocial functioning. Economic status or depressive symptoms did not affect the results of CM treatment for cocaine dependence. The addition of a CM protocol to cognitive behavioral treatment (CBT) also improved treatment effectiveness for smoking cessation. Available data on the effect of CM on cannabis use disorders (CUD) with young people did not allow confirmation of its superiority to date. CONCLUSION: The research conducted to date in Spain confirms and expands the findings of studies conducted in the US supporting the effectiveness of CM in the context of community settings with cocaine- and nicotine-dependents. However, CM has not yet been readily adopted into general clinical practice in Spain or the rest of Europe. The limited effectiveness of CM for CUD is likely due to the scarcity of data and may change with more studies, taking into account recent research on this topic in the US. Continued efforts are warranted to further develop and disseminate incentive-based treatments for SUD across clinical settings and populations in Spain.

Individual variables related to craving reduction in cue exposure treatment.

INTRODUCTION: Although extensive research has demonstrated that cigarette craving can be effectively attenuated, very few studies have explored associations between individual variables and craving reduction. This study explored whether individual characteristics predict craving decreases during virtual reality cue exposure treatment (VR-CET). METHOD: Participants were 41 treatment-seeking smokers (73% women) with a mean age of 39.4 (SD=13.2), who had been smoking 15.0 (SD=7.1) cigarettes per day for 20.0 (SD=10.7) years. Their mean score on the Fagerström Test of Nicotine Dependence (FTND) was 4.8 (SD=2.3). Participants completed five cue exposure sessions using virtual reality for smoking cessation over a five-week period. The percentage of reduction in craving was calculated by comparing self-reported craving after the first and last exposure sessions. Sociodemographic characteristics (gender, age, years of education and marital status), tobacco-related [duration of daily smoking, cigarettes per day, FTND and Nicotine Dependence Syndrome Scale (NDSS)] and psychological characteristics [depressive symptoms (Beck's Depression Inventory-Second Edition, BDI-II), impulsiveness (delay discounting) and anxiety (State-Trait Anxiety Inventory, STAI)] were examined as possible predictors for craving reductions. RESULTS: Multiple regression revealed that greater decreases in craving were associated with younger age (ß=-.30, p=.043), cigarettes smoked per day (ß=.30, p=.042), higher values on delay discounting (ß=.34, p=.020) and higher BDI-II scores (ß=.30, p=.035). CONCLUSION: These findings suggest that smokers with certain individual characteristics may benefit most from interventions aimed at reducing craving through VR-CET.

The association of both self-reported and behavioral impulsivity with the annual prevalence of substance use among early adolescents.

BACKGROUND: In relation to substance use, Spanish adolescents aged 12 to 14 can be largely classified in four groups, from highest to lowest prevalence: (a) No substance use, (b) Only alcohol use, (c) Alcohol and tobacco use, and (d) Alcohol, tobacco and cannabis use. The aim of the present study is to analyze the possible relationship between impulsivity and the substance-use group to which the young person belongs METHODS: One thousand three hundred and forty-eight adolescents aged 12 to 14 in northern and eastern Spain reported their drug use, completed impulsivity self-reports (BIS-11-A and ImpSS) and performed behavioral tasks (Stroop Test and Delay Discounting). RESULTS: Results from both measurement approaches were related to early drug use. An increasing impulsivity trend is found across groups from less to more substance involvement, except in the case of Delay Discounting, which is sensitive only for those with more substance-involved. CONCLUSIONS: Impulsivity is a key factor for early drug use, especially as regards more substance-involved. This should be taken into account in designing prevention programs or as a key variable for interventions aimed at delaying the onset of substance use.

Interaction of depressive symptoms and smoking abstinence on delay discounting rates.

Delay discounting and depressive symptomatology have strong connections with smoking. However, few studies have examined interactions across delay discounting, depressive symptoms, and smoking status. The primary goal of this secondary analysis was to assess the interrelations across these 3 variables among treatment-seeking smokers. Delay discounting and depressive symptoms were assessed in 95 smokers enrolled in a clinical trial for smoking cessation at intake and 6-month follow-up. Participants with and without depressive symptoms did not differ in their discounting rates neither at intake nor at 6-month follow-up. However, delay discounting was significantly lower among abstainers at 6-month follow-up, and changes in discounting associated with smoking status were more pronounced among participants with depressive symptoms. These results clarify the relationship between delay discounting and depressive symptoms among current and former smokers and suggest that the association between smoking abstinence and lower delay discounting is significantly greater among individuals with depressive symptoms versus those who do not have depressive symptomatology.

Spanish adaptation and validation of the Barratt Impulsiveness Scale for early adolescents (BIS-11-A).

Impulsivity has been associated with several psychiatric disorders such as substance abuse. The Barratt Impulsiveness Scale (BIS-11) is one of the most commonly administered self-reports for the assessment of impulsiveness in both research and clinical settings. There is a version for adolescents called BIS-11-A, which has not been yet properly adapted to Spanish population. The goal of this study is to offer an alternative and more adequate Spanish version of the BIS-1-A, as well as to assess its psychometric properties including factor structure, reliability and predictive validity regarding substance use (last month alcohol, tobacco and cannabis use, presence of last month intoxication, binge drinking and problem drinking). The BIS-11-A and items from the European School Survey Project on Alcohol and other Drugs (ESPAD) were applied to1,183 students (aged 12-14) at 16 Spanish secondary schools. The BIS-11-A showed a bidimensional factor structure, high reliability (Cronbach's alpha = .87) and good capacity for identifying substance use, binge drinking and problem drinking (sensitivity = 67.3-75%; specificity = 83.4-85.4%). The BIS-11-A Spanish version is a reliable and valid instrument for be used among early adolescents.

La impulsividad ha sido relacionada con multitud de trastornos psiquiátricos como el abuso de sustancias. La Escala de Impulsividad de Barratt (BIS-11) es uno de los autoinformes más comúnmente administrados para la evaluación de la impulsividad tanto en el ámbito clínico como de investigación. Hay una versión para adolescentes llamada BIS-11-A, que aún no ha sido convenientemente adaptada a población española. El objetivo de este estudio es ofrecer una versión española alternativa y más adecuada del BIS-11-A, así como la evaluación de sus características psicométricas tales como estructura factorial, fiabilidad y validez predictiva sobre el uso de sustancias (uso en el último mes de alcohol, tabaco y cánnabis, presencia de borracheras en el último mes, consumo intensivo y problemático de alcohol). El BIS-11-A e ítems de la Encuesta Escolar Europea sobre Alcohol y otras Drogas (ESPAD) fueron aplicados a 1.183 estudiantes (edad 12-14 años) en 16 institutos españoles de Educación Secundaria. El BIS-11-A ha mostrado una estructura bidimensional, alta fiabilidad (alfa de Cronbach = 0,87) y buena capacidad para identificar el uso de sustancias, consumo intensivo y problemático de alcohol (sensibilidad = 67,3-75%; especificidad = 83,4-85,4%). La versión española del BIS-11-A es un instrumento fiable y válido para su uso con adolescentes tempranos.

Probability and predictors of the cannabis gateway effect: a national study.

BACKGROUND: While several studies have shown a high association between cannabis use and use of other illicit drugs, the predictors of progression from cannabis to other illicit drugs remain largely unknown. This study aims to estimate the cumulative probability of progression to illicit drug use among individuals with lifetime history of cannabis use, and to identify predictors of progression from cannabis use to other illicit drugs use. METHODS: Analyses were conducted on the sub-sample of participants in Wave 1 of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) who started cannabis use before using any other drug (n=6624). Estimated projections of the cumulative probability of progression from cannabis use to use of any other illegal drug use in the general population were obtained by the standard actuarial method. Univariate and multivariable survival analyses with time-varying covariates were implemented to identify predictors of progression to any drug use. RESULTS: Lifetime cumulative probability estimates indicated that 44.7% of individuals with lifetime cannabis use progressed to other illicit drug use at some time in their lives. Several sociodemographic characteristics, internalizing and externalizing psychiatric disorders and indicators of substance use severity predicted progression from cannabis use to other illicit drugs use. CONCLUSION: A large proportion of individuals who use cannabis go on to use other illegal drugs. The increased risk of progression from cannabis use to other illicit drugs use among individuals with mental disorders underscores the importance of considering the benefits and adverse effects of changes in cannabis regulations and of developing prevention and treatment strategies directed at curtailing cannabis use in these populations.

Toward a comprehensive developmental model of smoking initiation and nicotine dependence.

BACKGROUND: This study aims to identify predictors of smoking initiation and nicotine dependence (ND) to develop a comprehensive risk-factor model based on Kendler's development model for major depression. METHODS: Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), Wave 2 (n=34,653). Risk factors were divided into five developmental tiers according to Kendler's model (childhood, early adolescence, late adolescence, adulthood, past-year). Hierarchical logistic regression models were built to predict the risk of smoking initiation and the risk of ND, given initiation. The continuation ratio (CR) was tested by ordinal logistic regression to examine whether the impact of the predictors was the same on smoking initiation or ND. RESULTS: The final models highlighted the importance of different tiers for each outcome. The CR identified substantial differences in the predictors of smoking initiation versus ND. Childhood tier appears to be more determinant for smoking initiation while the effect of more distal tiers (i.e. childhood and early adolescence) was tempered by more proximal ones (i.e. late adolescence, adulthood and past-year) in ND, with few sex differences. CONCLUSIONS: The differential effect of some predictors on each outcome shows the complexity of pathways from smoking initiation to ND. While some risk factors may be shared, others impact only at one stage or have even an inverse effect. An adaptation of Kendler's developmental model for major depression showed high predictive power for smoking initiation and ND.

Effects of systematic cue exposure through virtual reality on cigarette craving.

INTRODUCTION: Cigarette cravings have been associated with less successful attempts to quit smoking and a greater likelihood of relapse after smoking cessation. Background craving refers to a relatively steady and continuous experience of craving, while cue-induced craving refers to phases of intense craving triggered by cues associated with smoking. Cue exposure treatment (CET) involves repeated exposure to stimuli associated with substance use in order to reduce craving responses. However, mixed results have been found regarding the effect of CET on both types of craving. The aim of this study was to assess the effect of systematic virtual reality cue exposure treatment (VR-CET) on background and cue-induced cravings. METHODS: Participants were 48 treatment-seeking smokers. The VR-CET consisted of prolonged exposure sessions to several interactive virtual environments. The VR-CET was applied once a week over 5 weeks. An individualized hierarchy of exposure was drawn up for each patient starting from the easiest virtual environment. Background and cue-induced cravings were recorded in each session. RESULTS: Cue-induced craving decreased over each session as a result of prolonged exposure. VR-CET also reduced cue-induced and background cravings across the 5 sessions, showing a cumulative effect across the exposure sessions. CONCLUSIONS: Our results evidenced the utility of VR-CET in reducing both types of cigarette craving. A combination of CET through VR with psychological treatments may improve current treatments for smoking cessation.

Predictors of quit attempts and successful quit attempts among individuals with alcohol use disorders in a nationally representative sample.

BACKGROUND: This study sought to identify predictors of attempting to quit and of successfully quitting alcohol abuse or dependence in the general population. METHODS: Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). RESULTS: Approximately 10% of individuals with alcohol abuse and 18% of those with dependence attempted to quit over the three year follow-up period. Of those who tried, 38% of individuals with abuse and 30% of those with dependence successfully quit. Among individuals with alcohol abuse or dependence, being single, younger than 40 years old, having low income, a co-occurring psychiatric disorder and greater number of dependence symptoms increased the likelihood of attempting to quit. Among individuals with alcohol abuse, male gender and low educational attainment further increased the odds of quit attempts. However, greater severity of alcohol use disorder, having a co-occurring drug use disorder and greater number of psychiatric disorders decreased the odds of success among individuals with alcohol abuse, while female gender, being married and older than 40 years old increased the odds of success. Among individuals with alcohol dependence, having nicotine dependence, greater number of psychiatric disorders and personality disorders decreased the odds of success. CONCLUSIONS: Predictors of attempts to quit are different and sometimes opposite from those leading to successful quitting probably indicating that some factors that increase motivation may decrease ability to quit. These findings may help in the development of more targeted and effective interventions for alcohol use disorders.

Contingency management for smoking cessation among treatment-seeking patients in a community setting.

BACKGROUND: Contingency management (CM) is an efficacious intervention for reducing cigarette smoking. However, CM is rarely adopted as a smoking cessation treatment in the community. This study analyzed the effectiveness of a CM procedure in combination with a cognitive-behavioral treatment (CBT) for smoking cessation among treatment-seeking patients from the general population. METHODS: A total of 92 patients were randomly assigned to one of two treatment conditions: CBT (N=49) or CBT+CM (N=43). The CM procedure included a voucher program through which nicotine abstinence was reinforced on a schedule of escalating magnitude of reinforcement with a reset contingency. Self-reported smoking status was confirmed with both carbon monoxide (CO) level in expired air and cotinine levels in urine. RESULTS: Of the patients who received CBT+CM 97.7%, completed 6 weeks of treatment, versus 81.6% of those who received CBT (p=.03). At the post-treatment assessment, 95.3% of the patients assigned to the CBT+CM condition achieved abstinence in comparison to the 59.2% in the CBT group (p=.000). At the one-month follow-up, 72.1% of the patients who received CBT+CM maintained smoking abstinence, versus 34.7% in the CBT group (p=.001). At the six-month follow-up, 51.2% of the patients who received CBT+CM maintained smoking abstinence in comparison to the 28.6% in the CBT group (p=.04). CONCLUSIONS: Results from this randomized clinical trial showed that adding CM to a CBT is effective, and is feasible as an intervention approach with treatment-seeking patients in a community setting.

Decreased delay discounting in former cigarette smokers at one year after treatment.

Current cigarette smokers exhibit greater delay discounting relative to ex-smokers. However, few studies have assessed longitudinal changes in delay discounting and cigarette smoking. The purpose of this study was to assess changes in delay discounting of hypothetical monetary rewards and smoking among treatment-seeking smokers (N=80) at baseline, after 6 weeks of behavioral treatment, and at 12-month follow-up. Results showed no changes in delay discounting in either smokers or abstainers at the end-of-treatment. In contrast, at 12-month follow-up, significant decreases in delay discounting were observed in abstainers while delay discounting remained the same for smokers. To our knowledge, this is the first study to observe significant decreases in delay discounting following prolonged smoking abstinence. Such findings provide evidence that delay discounting may have more state-like characteristics than previously believed.

Self-change among Spanish speakers with alcohol and drug use disorders in Spain and the United States.

OBJECTIVE: Few cross-cultural studies have investigated the self-change process with substance abusers. This study examined commonalities and differences related to the self-change process with Spanish speaking self-changers in Spain and the United States (U.S.) who reported recovering from an alcohol or drug problem on their own (i.e., without formal help or treatment) for ≥1 year. METHOD: Advertisements were primarily used to recruit participants. There were 56 participants in the final sample (Spain, n=29; US; n=27). Participants provided demographic and substance use history information and completed the Drug Use History Questionnaire, Reasons for Change Scale, the Life Events Checklist, and a checklist for maintenance factors after recovery. RESULTS: Significantly more self-changers from the U.S. met DSM IV-TR criteria for alcohol dependence, reported significantly more life events in the year prior to recovery and significantly more maintenance/support events in the year after their recovery than their counterparts in Spain. The majority of participants' recoveries involved abstinence. Some alcohol abusers, however, report successfully engaging in low-risk drinking with no consequences(50% Spain; 22% U.S.), and some drug abusers in Spain (23%) reported a few days per year of very little drug use. CONCLUSIONS: The two groups of Spanish speakers represented very different cultures, and those from the U.S. came from several countries in the Southern hemisphere. The results of this study suggest that even though people speak the same language that does not mitigate against cultural differences. Additional studies of the process of self change with larger participant samples are needed to better inform the development and provision of interventions for Spanish speakers with alcohol and drug use disorders across different cultures and countries.

Contingency management improves outcomes in cocaine-dependent outpatients with depressive symptoms.

Despite depressive symptoms being very common among patients seeking treatment for cocaine dependence, few studies have examined the effects of depressive symptoms on cocaine outpatient treatment outcomes, and there is even less research in the context of Contingency Management (CM). The purpose of this study was to assess the main and interactive effects of co-occurring depressive symptoms on CM outcomes. Cocaine-dependent individuals (N = 108) were randomized to Community Reinforcement Approach (CRA) or CRA plus CM in two outpatient community clinical settings. Participants were categorized according to depression symptoms, self-reported by means of the BDI at treatment entry. Outcome measures included treatment retention and documented cocaine abstinence over a 6-month treatment period. Depressive symptoms were more commonly found in females and in unemployed participants, and were associated with more drug-related, social, and psychiatric problems at treatment entry. Individuals with baseline depressive symptoms had poorer treatment outcomes than patients without depressive symptoms. The addition of CM to CRA made the program more effective than with CRA alone, regardless of depressive symptoms. CM was associated with better abstinence treatment outcomes, while the interaction between unemployment and depressive symptoms was associated with negative retention treatment outcomes. This study supports the efficacy of CM for cocaine-dependent outpatients with and without depressive symptoms, and highlights its importance for improving treatment for unemployed and depressed cocaine-dependent individuals.

A systematic assessment of delay discounting in relation to cocaine and nicotine dependence.

Delay discounting is a measure of impulsivity describing how a reinforcer loses value as the delay to its receipt increases. Greater delay discounting is reliably observed among those with different substance use disorders (SUDs) compared to the general population. Nevertheless, the relation between delay discounting and the type and number of substances used remains unclear. The aim of this study was to compare delay discounting across four groups of participants: cocaine- and nicotine-dependent participants, cocaine-dependent only participants, nicotine-dependent only participants, and non-dependent controls. One hundred and seven participants completed a computerized delay discounting task for hypothetical monetary values. Data were fit to Mazur's hyperbolic equation to derive the discounting rate k. Results showed that delay discounting was significantly greater in the cocaine- and nicotine-dependent group, compared to the nicotine-dependent only group, compared to control group. Delay discounting was also greater in the cocaine-dependent only group relative to the nicotine-dependent only and control groups, but no differences were observed between the cocaine- and nicotine-dependent group and the cocaine-dependent only group. This study provides evidence that delay discounting differs depending on the type of SUD but not on the number of SUDs.

Peak provoked craving after smoking cessation.

Peak provoked craving (PPC) is an alternative approach to cue-induced craving that focuses on the highest craving level experienced during the exposure to drug-related cues. The main objective of this study was to assess the effect of abstinence on PPC in smokers and to determine whether PPC is altered by continuous abstinence. Results showed reductions on PPC levels only 24 hours after achieving abstinence and craving levels remain significantly lower after 7 days of abstinence.

Smoking a virtual cigarette increases craving among smokers.

Previous studies have shown the efficacy of virtual reality (VR) environments that reproduce smoking-related stimuli for increasing self-reported craving and psychophysiological reactivity in smokers. However, no study to date has attempted to simulate smoking behavior itself by means of VR technology. The aim of this study was to assess the effect of smoking a virtual cigarette on self-reported craving levels and heart rate (HR) in a sample of smokers. Participants were 45 smokers randomly assigned to three VR conditions built into a virtual pub: smoking a virtual cigarette, throwing virtual darts at a virtual dartboard or just being in the virtual pub. Results showed that smoking a virtual cigarette significantly increased self-reported craving and HR when compared to the other two conditions. These results reveal that simulation of smoking behavior in a VR environment functions as an efficacious proximal cue that can be used for triggering craving under the cue-exposure paradigm.

Probability and predictors of relapse to smoking: results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

BACKGROUND: The goal of this study was to estimate rates of relapse to smoking in the community and to identify predictors of relapse. METHODS: Data were drawn from the Waves 1 and 2 of the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC). Logistic regression analyses were used to estimate the probability of relapse at Wave 2 among individuals who were abstinent at Wave 1 given length of abstinence as well as the presence of several sociodemographic, psychopathologic and substance use-related variables at Wave 1. RESULTS: The risk for relapse among individuals who had been abstinent for 12 months or less at the baseline assessment was above 50%. Among individuals who had been abstinent for over a year, risk of relapse decreased hyperbolically as a function of time, and stabilized around 10% after 30 years of abstinence. Although several sociodemographic, psychopathologic and tobacco-related variables predicted relapse in univariate analyses, only younger age at cessation and shorter duration of abstinence independently predicted risk of relapse in multivariable analyses. CONCLUSIONS: The first year after a quit attempt constitutes the period of highest risk for relapse. Although the risk for relapse decreases over time, it never fully disappears. Furthermore, younger age at smoking cessation also increases the risk for relapse. This information may help develop more targeted and effective relapse prevention programs.