Thesis (Ph. D.)--University of Chicago, Dept. of Economics, August 2003. / Includes bibliographical references. Also available on the Internet.

Most treatments for substance use disorders (SUDs) are based on a model that craving is a primary cause of relapse, and therefore they emphasize skills for preventing and reducing craving. Acceptance and Commitment Therapy (ACT) provides a theoretical rationale for "acceptance" of drug-related thoughts and cravings, and proscribes suppression, a more intuitive and commonly used coping strategy. However, it remains largely unknown whether various coping strategies differentially affect craving intensity, drug use behavior, or other relevant outcomes during a craving episode. Using a randomized, between-subjects design (acceptance-based coping, suppression-based coping, or no coping instructions/control), the current study compared the effect of acceptance versus suppression of cigarette craving on outcomes including craving intensity, affect, self-control (i.e., stamina on a physically challenging task), and number of thoughts about smoking in the laboratory, and smoking behavior and self-efficacy for cessation during a 3-day follow-up period. Contrary to the hypothesis that acceptance would be superior to suppression, results indicated that both strategies were associated with reduced craving intensity, decreased negative affect, and increased positive affect in the laboratory, and greater self-efficacy for cessation at 3-day follow-up, compared to the control group. There were no significant differences across groups in smoking behavior during the 3-day follow-up. Exploratory moderation analyses that must be interpreted cautiously suggested that the effects of acceptance and suppression on craving and affect may vary according to smoking rate and level of nicotine dependence. Overall, this study provides support for the value of acceptance-based coping strategies, but also suggests that more research is needed to differentiate their benefits compared to suppression-based coping.

Research on addictive behavior has traditionally emphasized the role that primary reinforcing effects of drugs of abuse plays in the development and maintenance of dependence. However, contemporary behavioral economic theory and animal models of nicotine dependence suggest the need for greater attention to the impact that response to alternative rewards may have on smoking behavior. The present study sought to investigate the impact of nicotine withdrawal on self-report, behavioral and neural indices of motivation, immediate response to rewards and the capacity to learn and modify behavior in response to positive and negative feedback. Heavy smokers (n = 48) completed two laboratory sessions following overnight deprivation, during which they smoked either nicotinized or denicotinized cigarettes. At each session, they completed a reward prediction and feedback learning task while electro-encephalographic recordings were obtained, as well as resting state recordings which were used to extract global indices of motivational state. Results confirmed that nicotine withdrawal produced an avoidant motivational state. This effect was strongly related to numerous indices of smoking motivation. Exploratory analyses also revealed numerous moderators of these effects. Behavioral data from tasks provided some support for the impact of nicotine withdrawal on reward and feedback processing, though minimal impact was observed for neural indices. Together, results confirm the manifestation of a broad-spanning impact of nicotine withdrawal on motivational state, but effects on specific reward systems remains unknown. Future research should examine the impact of nicotine withdrawal on other reward-related constructs to better delineate these effects.

published_or_final_version / Public Administration / Master / Master of Public Administration

published_or_final_version / Community Medicine / Master / Master of Public Health

published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Politics and Public Administration / Master / Master of Public Administration

published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Public Health / Master / Master of Public Health