THE EFFECTS OF REDUCED CIGARETTE SMOKING ON DISCOUNTING FUTURE REWARDS: AN INITIAL EVALUATION.

To determine whether reduction of smoking via contingency management in dependent smokers would decrease the discounting of delayed reinforcers compared with smokers who did not reduce their smoking, moderate to heavy cigarette smokers were randomly assigned to one of two conditions: a contingency management condition and a control condition. In three phases (baseline discounting determination for hypothetical money and cigarettes, implementation of a contingency management or control condition, and postintervention discounting determination), the procedure to reinforce reduction in cigarette smoking produced CO decreases in all subjects exposed to that procedure. Discounting decreased significantly for both cigarettes and money among the group for whom smoking reductions were reinforced, whereas the control group showed no significant change for either commodity. Reductions in smoking can lead to reductions in discounting, and increased discounting in current smokers may be a reversible effect of nicotine dependence.

Altered states: the impact of immediate craving on the valuation of current and future opioids.

Based on prior research showing that people underestimate the influence of motivational states they are not currently experiencing, we predicted and found that heroin addicts would value an extra dose of the heroin substitute Buprenorphine more highly when they were currently craving (right before receiving BUP) than when they were currently satiated (right after receiving BUP) -- even when the extra BUP was to be received 5 days later. If addicts cannot appreciate the intensity of craving when they are not currently experiencing it, as these results suggest, it seems unlikely that those who have never experienced craving could predict its motivational force. Under-appreciation of craving by non-addicts may contribute to initial decisions to experiment with drugs.

Neuroactive steroids, negative affect, and nicotine dependence severity in male smokers.

RATIONALE: Nicotine administration alters neuroactive steroids in rodent models, and serum levels of the neuroactive steroid DHEAS (dehydroepiandrosterone sulfate) appear to be higher in smokers. These molecules may be relevant to tobacco addiction and affective symptoms. OBJECTIVES: This study aims to investigate DHEAS, allopregnanolone, pregnenolone, and other steroids in male smokers to determine potential associations with nicotine dependence severity and negative affect. MATERIALS AND METHODS: Allopregnanolone and pregnenolone serum levels were determined by gas chromatography/mass spectrometry, while DHEAS and other steroid levels were determined by radioimmunoassay in 28 male smokers. Correlational analyses were performed to determine potential associations with rating measures, including the Fagerstrom Test for Nicotine Dependence (FTND), the addiction subscale of the Ikard Smoking Motivation Questionnaire (ISMQ), the craving item on the Reasons to Smoke (RTS) Questionnaire, and the negative affect and craving subscales of the Shiffman-Jarvik Withdrawal Questionnaire. RESULTS: DHEAS levels were inversely correlated with the negative affect subscale of the Shiffman-Jarvik Withdrawal Questionnaire (r=-0.60, p=0.002) and the RTS craving item (r=-0.43, p=0.03), and tended to be inversely correlated with the FTND scores (r=-0.38, p=0.067) and the ISMQ addiction subscale (r=-0.38, p=0.059), adjusting for age. Allopregnanolone levels were positively correlated with cotinine levels (r=0.57, p=0.006); pregnenolone levels tended to be positively correlated with cotinine levels (r=0.40, p=0.066). CONCLUSIONS: DHEAS levels were inversely correlated with negative affect and craving measures, and may predict nicotine dependence severity. Allopregnanolone levels were positively correlated with cotinine levels, suggesting that this neuroactive steroid may be upregulated in smokers. Neuroactive steroids may represent novel smoking cessation agents.

Risk-sensitive foraging theory elucidates risky choices made by heroin addicts.

AIM: The behavioral process of risk-sensitive foraging (RSF) specifies that the level of satiation or deprivation determines choice between a constant and variable quantity of food. Specifically, RSF stipulates that organisms experiencing satiation and deprivation prefer constant (risk-averse) and variable (risk-prone) choices, respectively. The relevance of this behavioral process to risky choices of opioid-dependent patients is examined in this study. METHODS: Thirty adult opioid-dependent out-patients made hypothetical choices between constant and variable heroin sources with equivalent means. Preferences for constant (e.g. three bags of heroin) and variable heroin sources (e.g. on average produces three bags of heroin, but vary from one to five bags of heroin on any instance) were assessed using questionnaires that manipulated the amount, delay to receipt and drug potency of heroin across approximately 20 levels. Subjects made choices between constant and variable options after hearing scripts describing the signs and symptoms of opioid satiation and opioid deprivation. RESULTS: Consistent with the prediction of RSF, subjects purchased significantly more hypothetical heroin from a variable source when exposed to an opioid-deprived script than an opioid-satiated script. This pattern was observed across manipulations of heroin amount, delay to receipt of heroin and heroin potency. Selection of the variable option increased as a function of magnitude under the deprived conditions. The selection of the variable option generally did not increase as a function of magnitude under the satiated conditions except when delay to heroin delivery increased. As delay increased, selection of the variable option increased under the satiated script, but at a lower level observed with the deprived script. CONCLUSIONS: These data suggest that risky choices of heroin-dependent individuals can be understood and predicted with the application of RSF theory. This research suggests that an evolutionarily old behavioral process may contribute to the risky behavior of the drug-dependent.

Psychological aspects of persistent pain: current state of the science.

UNLABELLED: This article provides an overview of current research on psychological aspects of persistent pain. It is divided into 3 sections. In section 1, recent studies are reviewed that provide evidence that psychological factors are related to adjustment to persistent pain. This section addresses research on factors associated with increased pain and poorer adjustment to pain (ie, pain catastrophizing, pain-related anxiety and fear of pain, and helplessness) and factors associated with decreased pain and improved adjustment to pain (ie, self-efficacy, pain coping strategies, readiness to change, and acceptance). In section 2, we review recent research on behavioral and psychosocial interventions for patients with persistent pain. Topics addressed include early intervention, tailoring treatment, telephone/Internet-based treatment, caregiver-assisted treatment, and exposure-based protocols. In section 3, we conclude with a general discussion that highlights steps needed to advance this area of research including developing more comprehensive and integrative conceptual models, increasing attention to the social context of pain, examining the link of psychological factors to pain-related brain activation patterns, and investigating the mechanisms underlying the efficacy of psychological treatments for pain. PERSPECTIVE: This is one of several invited commentaries to appear in The Journal of Pain in recognition of The Decade of Pain Research. This article provides an overview of current research on psychological aspects of persistent pain, and highlights steps needed to advance this area of research.

Mild opioid deprivation increases the degree that opioid-dependent outpatients discount delayed heroin and money.

RATIONALE: A growing literature suggests that excessive temporal discounting of delayed rewards may be a contributing factor in the etiology of substance abuse problems. Little is known, however, about how drug deprivation may affect temporal discounting of delayed rewards by drug-dependent individuals. OBJECTIVE: To examine the extent to which opioid deprivation affects how opioid-dependent individuals discount small, medium and large quantities of delayed heroin and money. METHODS: Thirteen opioid-dependent individuals maintained on buprenorphine completed a hypothetical choice task in which they choose between a constant delayed reward amount and an immediate reward amount that was adjusted until they expressed indifference between both outcomes. The task was completed for three values of heroin and money rewards during eight sessions under conditions of opioid deprivation (four sessions) and satiation (four sessions). RESULTS: Across conditions, hyperbolic functions provided a good fit for the discounting data. Degree of discounting was significantly higher when subjects were opioid deprived. Consistent with previous findings, degree of discounting was higher for heroin than money and inversely related to the magnitude of the reward. CONCLUSION: Opioid deprivation increased the degree to which dependent individuals discounted delayed heroin and money. Understanding the conditions that affect how drug-dependent individuals discount delayed rewards might help us understand the myopic choices made by such individuals and help improve treatment outcomes.