Memory Updating Intervention Reduces Cravings and Smoking Behavior

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smoking behavior

People with smoking addiction report that cue-induced cravings contribute to their inability to quit smoking. A study determined the effect of a memory updating intervention on smoking behavior.

 

Currently, there is an unmet need to develop treatments that reduce cue-induced cravings for people who suffer from substance addiction. Addictive substances alter the brain’s reward learning and memory processes. In smoking addicts, the mere observation of another person lighting up a cigarette could cause them to engage in smoking. Smoking addicts who are trying to quit often fail because of their increased vulnerability to cue-induced relapses. In addition, first line cessation methods remain inadequate in terms of reducing cue-induced cravings.

A behavioral method called retrieval-extinction (RE) training was developed to override the brain’s original memory related to substance use. During RE training, individuals are exposed to cues (videos of substance use) that allow them to retrieve their memory of substance use and for a short time, individuals are then presented with an extensive variety of other substance-related cues (extinction). This approach is thought to provide the brain with updated information (exposure cues without reward) that could lead to a decrease in cravings and altogether, substance use. RE training on detoxified heroin addicts has shown substantial reduction in cue-induced cravings which can last up to 6 months. Thus, RE training may be adapted for addiction treatment to other substances such as nicotine.

Published in the Journal of American Medical Association, a randomized clinical study determined whether RE training could reduce cravings and smoking behavior in treatment-seeking cigarette smokers. A total of 44 participants were randomly assigned either to the RE group or the non-smoking related retrieval-extinction (NRE) control group. Participants in the study needed to be DSM-IV classified nicotine addicts, who were smoking 10 or more cigarettes per day over 3 years, and were willing to attempt a 3-day cessation without cessation aids, tobacco, or electronic cigarettes. Participants who were pregnant, who were dependent on other substances aside from nicotine, or who suffered from untreated psychological disorders were excluded. Participants in the study attended an assessment session, 2 consecutive RE or NRE intervention training sessions, and 24-hour, 2-week, and 1-month follow-up sessions. Intervention sessions consisted of participants watching a 5-minute smoking video (RE group) or non-smoking video (NRE group) as retrieval cues. 10 minutes after, participants in both study groups were given extinction cues via presentation of images and videos associated with smoking. Follow-up sessions exposed participants to smoking videos and novel picture cues. The study primarily determined cravings, negative affect, blood pressure, and heart rate related to RE or NRE training. Secondary outcomes were number of cigarettes smoked per day, breath carbon monoxide (CO) levels, percentage reduction in number of cigarettes smoked from baseline, number of days abstinent from use, lapse, and relapse.

Participants in the study attended an assessment session, 2 consecutive RE or NRE intervention training sessions, and 24-hour, 2-week, and 1-month follow-up sessions. Intervention sessions consisted of participants watching a 5-minute smoking video (RE group) or non-smoking video (NRE group) as retrieval cues. 10 minutes after, participants in both study groups were given extinction cues via presentation of images and videos associated with smoking. Follow-up sessions exposed participants to smoking videos and novel picture cues. The study primarily determined cravings, negative affect, blood pressure, and heart rate related to RE or NRE training. Secondary outcomes were number of cigarettes smoked per day, breath carbon monoxide (CO) levels, percentage reduction in number of cigarettes smoked from baseline, number of days abstinent from use, lapse, and relapse.

The study found that compared with the NRE group, the RE group had significantly reduced cravings within 1 month of training. There was no significant overall main effect on negative affect, blood pressure, and heart rate during all test sessions. The study also found that the average self-reported number of cigarettes smoked per day were reduced by 25% in the RE group relative to the NRE group within 2 weeks to 1 month of follow-up. CO levels further corroborated these results as they also decreased within 1 month in the RE group versus the NRE group. Urine cotinine levels, total number of days abstinent, and smoking lapse, however, were not different between the two groups.

The study concluded that RE training could reduce cravings and number of cigarettes smoked in nicotine addicts. Future studies regarding the utility of RE in curbing smoking addiction could provide more detailed information about smoking lapse and maintenance if conducted over a longer time period. Additionally, a larger cohort of participants could be useful in determining a range of smoking outcomes and could clarify any marginal trends. While the study has limitations, it provides further evidence that memory updating interventions like RE training could be a promising strategy in helping smoking addicts overcome their cravings and preventing their relapse.

 

Written By: Joan Zape, PhD(c)