Craving and Smoking in response to diverse cues

relapse. Such cues include proximal cues of smoking (e.g., a lit cigarette) and distal cues like negative affect and alcohol consumption. Cue reactivity methods assess reaction to cues (usually proximal cues), and have been criticized for assessing only craving and not smoking. We present a study of reactivity to a range of cues, assessing smoking as well as craving responses. We also examine gender differences, as it has been suggested that women’s smoking is more related to cues. In separate sessions, 207 smokers were exposed to visual images relevant to 6 sets of cues (total 1225 sessions): smoking, negative affect, positive affect, alcohol, non-smoking (e.g., no-smoking signs), and neutral cues. Craving (QSU) was assessed pre- and post- exposure. Subjects were then permitted to smoke, while cue exposure continued, and smoking topography was assessed. Compared to neutral cues, exposure to smoking cues increased craving, and positive affect decreased craving. Alcohol cues increased craving only among drinkers. Negative affect and non-smoking cues had no effect. Post-cue craving was a strong predictor of smoking, predicting whether a subject smoked, latency to smoking, number of puffs, puff duration, and carbon monoxide boost. Moreover, the increase in craving pre- to post-cue exposure significantly predicted subsequent smoking, over and above pre-cue craving. These effects were strong: e.g., for every 1-point increase on a 49-point craving scale, the “risk” of smoking over time (survival analysis) increased 12%. However, there were no differences across cues in subsequent smoking behavior, suggesting that idiosyncratic craving responses, rather than specific cue effects, drove smoking. The findings confirm the importance of cues in craving, and of craving in smoking, but suggest that cues may not drive smoking in laboratory settings. There were no gender differences on any outcome, contradicting the hypothesized role of cues in women’s smoking.