The effects of prolonged abstinence on the processing of smoking cues: an ERP study among smokers, ex-smokers and never-smokers

Abstract Processing bias is an important feature of substance abuse. The issue whether processing bias is a more or less permanent feature of nicotine addiction remains to be resolved. The present study addresses the role of smoking status on smoking-related processing bias. We employed Event-Related Brain Potentials (ERPs) as measure of processing bias to investigate this issue. Further, self-report measures of nicotine craving and pleasantness ratings of smoking stimuli were obtained. Three groups, smokers, ex-smokers and never-smokers, were compared on their electrophysiological brain response to smoking-related and neutral pictures. The present study shows that both the P300 and SPW amplitudes in response to smoking-related pictures are significantly more enhanced for smokers than for ex-smokers and never-smokers at frontal and central sites, whereas the magnitude of the P300 and SPW amplitudes in response to neutral pictures does not differ between the three groups. Accordingly, it can be concluded that smokers show more bias for smoking-related pictures than ex-smokers and smokers. Because there is no significant difference between the P300 and SPW amplitudes of ex-smokers and never-smokers, it can also be concluded that ex-smokers display the same (low) level of processing bias as never-smokers. In addition, nicotine-craving ratings and pleasantness ratings of smoking stimuli were higher in smokers compared to ex-smokers. It can be concluded that the smoking-related craving, pleasantness rating, and processing bias decreases after a period of prolonged abstinence

Implicit and explicit selective attention to smoking cues in smokers indexed by brain potentials

Abstract Substance use disorders are characterized by cognitive processing biases, such as automatically detecting and orienting attention towards drug-related stimuli. However, it is unclear how, when and what kind of attention (i.e. implicit, explicit) interacts with the processing of these stimuli. In addition, it is unclear whether smokers are hypersensitive to emotionally significant cues in general or to smoking-related cues in particular. The present event-related potential study aimed to enhance insight in drug-related processing biases by manipulating attention for smoking and other motivationally relevant (emotional) cues in smokers and non-smokers using a visual oddball task. Each of the stimulus categories served as a target (explicit attention; counting) or as a non-target (implicit attention; oddball) category. Compared with non-smokers, smokers' P300 (350-600 ms) was enhanced to smoking pictures under both attentional conditions. P300 amplitude did not differ between groups in response to positive, negative, and neutral cues. It can be concluded from this study that attention manipulation affects the P300 differently in smokers and non-smokers. Smokers display a specific bias to smoking-related cues, and this bias is present during both explicit and implicit attentional processing. Overall, it can be concluded that both explicit and implicit attentional processes appear to play an important role in drug-related processing bias

Intentional modulation of the late positive potential in response to smoking cues by cognitive strategies in smokers

Attentional bias is considered an important concept in addiction since it has been found to correlate with subjective craving and is strongly associated with relapse after periods of abstinence. Hence, investigating in ways to regulate attention for drug cues would be of major clinical relevance. The present study examined deliberate, cognitive modulation of motivated attention for smoking cues in smokers. The effects of three different reappraisal strategies on an electrophysiological measure of attentive processing were investigated. Early and late LPP components in response to passively viewed neutral and smoking pictures were compared with LPPs in response to smoking pictures that were reappraised with three different reappraisal strategies. Results show that when smokers actively imagine how pleasant it would be to smoke (pleasant condition), their early LPP in response to smoking cues increases, but when smokers actively focus on an alternative stimulus (distraction condition) or think of a rational, uninvolved interpretation of the situation (rational condition), smoking-related late LPP amplitude decreases to the processing level of neutral stimuli. Present results are the first to indicate that smoking cue-elicited LPP amplitudes can be modulated by cognitive strategies, suggesting that attentive processing of smoking cues can be intentionally regulated by smokers with various levels of dependence. Although cognitive strategies can lead to enhanced processing of smoking cues, it is not completely clear whether cognitive strategies are also successful in reducing smoking-related motivated attention. Although findings do point in this direction, present study is best considered preliminary and a starting point for other research on this topic. A focus on the distraction strategy is proposed, as there are indications that this strategy is more successful than the rational strategy in decreasing LPP amplitude

Attentional bias for prescription opioid cues among opioid dependent chronic pain patients

Recurrent use of prescription opioid analgesics by chronic pain patients may result in opioid dependence, which involves implicit neurocognitive operations that organize and impel craving states and compulsive drug taking behavior. Prior studies have identified an attentional bias (AB) towards heroin among heroin dependent individuals. The aim of this study was to determine whether opioid-dependent chronic pain patients exhibit an AB towards prescription opioidrelated cues. Opioid-dependent chronic pain patients (n = 32) and a comparison group of non-dependent opioid users with chronic pain (n = 33) completed a dot probe task designed to measure opioid AB. Participants also rated their opioid craving and self-reported arousal associated with opioid-related and neutral images, pain severity, and relief from pain treatments. Repeated-measures ANOVA revealed a significant group (opioid-dependent vs. non-dependent opioid user) × presentation duration (200 ms. vs. 2000 ms.) interaction, such that opioid-dependent individuals evidenced a significant AB towards opioid cues presented for 200 ms but not for cues presented for 2000 ms, whereas non-dependent opioid users did not exhibit a significant mean AB at either stimulus duration. Among opioid-dependent individuals, 200 ms opioid AB was significantly associated with opioid craving, while among non-dependent opioid users, 200 ms opioid AB was significantly associated with relief from pain treatments. Furthermore, dependent and non-dependent opioid users experienced opioid cues as significantly more arousing than neutral cues. Opioid dependence among chronic pain patients appears to involve an automatic AB towards opioid-related cues. When coupled with chronic pain, attentional fixation on opioid cues may promote compulsive drug use and addictive behavior

Light social drinkers are more distracted by irrelevant information from an induced attentional bias than heavy social drinkers

It is well established that alcoholics and heavy social drinkers show a bias of attention towards alcohol-related items. Previous research suggests that there is a shared foundation of attentional bias, which is linked to attentional control settings. Specifically, attentional bias relates to a persistent selection of a Feature Search Mode which prioritises attentional bias-related information for selection and processing. However, no research has yet examined the effect of pre-existing biases on the development of an additional attentional bias. This paper seeks to discover how pre-existing biases affect the formation of a new, additional attentional bias. Twenty-five heavy and 25 light social drinkers, with and without a pre-existing bias to alcohol-related items, respectively, had an attentional bias towards the colour green induced via an information sheet. They then completed a series of one-shot change detection tasks. In the critical task, green items were present but task-irrelevant. Irrelevant green items caused significantly more interference for light than heavy social drinkers. This somewhat counter intuitive result is likely due to heavy drinkers having more experience in exerting cognitive control over attentional biases, something not previously observed in investigations of the effects of holding an attentional bias. Our findings demonstrate for the first time that an established attentional bias significantly modulates future behaviour

Mechanisms of attention for cues associated with rewarding and aversive outcomes

Attentional biases arising from classical conditioning processes may contribute to the maintenance of drug addictions and anxiety disorders. This thesis examined whether attentional mechanisms for conditioned stimuli (CS) would be dominated by affective properties (Lang, Greenwald, Bradley, & Hamm, 1993), or the uncertainty of the stimulus in predicting the outcome (Pearce & Hall, 1980). In chapter one affective and uncertainty-driven mechanisms of attention are discussed in relation to rewarding and aversive outcomes. In experimental chapter 2 methodological issues are addressed. In experimental chapters three and four attentional mechanisms are tested using a discriminative conditioning procedure with visual stimuli of varying predictive certainty (CS+,CS+/-,CS-) for a monetary or noise outcome (US). Attention was measured using an eye-tracker, and emotional conditioning and learning were measured using Likert scales. It was found that attention was mediated by uncertainty (chapter 3), but increasing the intensity of the outcome switched attention to affective-driven mechanisms for the noise outcome (chapter 4). In a further experiment this effect on attention remained for the noise outcome even under conditions promoting uncertainty-driven mechanisms (chapter 6). When cigarettes were the unconditioned stimuli instead of money in the appetitive conditioning, attention was also mediated by stimulus affect (chapter 5). In chapter 7 the data are discussed and it is concluded that when the outcome is highly emotionally salient, affective-driven mechanisms of attention dominate over uncertainty

Mechanisms of attention for cues associated with rewarding and aversive outcomes

Attentional biases arising from classical conditioning processes may contribute to the maintenance of drug addictions and anxiety disorders. This thesis examined whether attentional mechanisms for conditioned stimuli (CS) would be dominated by affective properties (Lang, Greenwald, Bradley, & Hamm, 1993), or the uncertainty of the stimulus in predicting the outcome (Pearce & Hall, 1980). In chapter one affective and uncertainty-driven mechanisms of attention are discussed in relation to rewarding and aversive outcomes. In experimental chapter 2 methodological issues are addressed. In experimental chapters three and four attentional mechanisms are tested using a discriminative conditioning procedure with visual stimuli of varying predictive certainty (CS+,CS+/-,CS-) for a monetary or noise outcome (US). Attention was measured using an eye-tracker, and emotional conditioning and learning were measured using Likert scales. It was found that attention was mediated by uncertainty (chapter 3), but increasing the intensity of the outcome switched attention to affective-driven mechanisms for the noise outcome (chapter 4). In a further experiment this effect on attention remained for the noise outcome even under conditions promoting uncertainty-driven mechanisms (chapter 6). When cigarettes were the unconditioned stimuli instead of money in the appetitive conditioning, attention was also mediated by stimulus affect (chapter 5). In chapter 7 the data are discussed and it is concluded that when the outcome is highly emotionally salient, affective-driven mechanisms of attention dominate over uncertainty

Neurocognitive Predictors of Drug Relapse

Worldwide, about 35 million people, that is 0.8% of the world’s adult population, use heroin and/or cocaine and more than 10-13% of these drug users are or will become drug dependent (UNODC, World Drug Report, 2012). Drug dependency is characterized as a chronic relapsing disorder (Leshner, 1997; McLellan et al., 2000). Substance dependent individuals often relapse, despite their efforts to stay abstinent (APA, 1994). Hence, the major goal of treatment facilities is to prevent treatment dropout and subsequent relapse. Unfortunately, about 50% of heroin and cocaine dependent patients already dropout in the first phase of clinical treatments, which is the detoxification phase. These dropout rates are consistent across several countries and remained steady over the years (the Netherlands: Franken and Hendriks, 1999; Switzerland: Hättenschwiler et al., 2000; United Kingdom: Gossop et al., 2002; Day and Strang, 2011). In addition, treatment dropout is associated with higher relapse rates (Gossop et al., 1987, 2002). There is ample room for improving these dropout and relapse rates of substance dependent patients. To improve treatment for these patients we first have to know the factors predicting relapse