The effects of varenicline on stress-induced and cue-induced craving for cigarettes

Ray, Lara A.; Lunny, Katy; Bujarski, Spencer; Moallem, Nathasha R.; Krull, Jennifer L.; Miotto, Karen

doi:10.1016/j.drugalcdep.2012.12.015

Cited by 26 publications

(30 citation statements)

References 54 publications

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“…There were no differences across medication groups on baseline (i.e., 12-hrs of nicotine abstinence) mood and craving. This was contrary to recent findings, including our own, demonstrating that varenicline attenuates tonic craving for cigarettes compared to placebo (Brandon et al 2012; Ray et al in press). However, following alcohol administration, an interesting pattern of medication effects emerged.…”

Section: Discussioncontrasting

confidence: 99%

Varenicline, low dose naltrexone, and their combination for heavy-drinking smokers: human laboratory findings

et al. 2014

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Rationale Heavy drinking smokers constitute a sizeable and hard-to-treat subgroup of smokers, for whom tailored smoking cessation therapies are not yet available. Objectives The present study used a double-blind, randomized, 2×2 medication design, testing varenicline alone (VAR; 1mg twice daily), low dose naltrexone alone (L-NTX; 25mg once daily), varenicline plus naltrexone, and placebo for effects on cigarette craving and subjective response to alcohol and cigarettes in a sample (n=130) of heavy drinking daily smokers (≥10 cigarettes/day). Methods All participants were tested after a 9-day titration period designed to reach steady state on the target medication. Testing was completed at 12-hrs of nicotine abstinence, after consuming a standard dose of alcohol (target Breath Alcohol Concentration = 0.06 g/dl), and after smoking the first cigarette of the day. Results The combination of VAR+L-NTX was superior to placebo, and at times superior to monotherapy, in attenuating cigarette craving, cigarette and alcohol “high,” and in reducing ad-lib consumption of both cigarettes and alcohol during the 9-day medication titration period. Conclusions These preliminary findings indicate that clinical studies of the combination of VAR+L-NTX for heavy drinkers trying to quit smoking are warranted and may ultimately improve clinical care for this sizeable and treatment-resistant subgroup of smokers.

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Section: Discussioncontrasting

confidence: 99%

Varenicline, low dose naltrexone, and their combination for heavy-drinking smokers: human laboratory findings

et al. 2014

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“…Item selection was informed by a principal component analysis on data collected during overnight abstinence from a similar sample (i.e., daily non-treatment seeking smokers) recruited for a human laboratory study (Ray et al, 2013). …”

Section: Methodsmentioning

confidence: 99%

Modeling naturalistic craving, withdrawal, and affect during early nicotine abstinence: A pilot ecological momentary assessment study.

Bujarski¹,

Roche²,

Sheets³

et al. 2015

Experimental and Clinical Psychopharmacology

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Despite the critical role of withdrawal, craving, and positive (PA) and negative affect (NA) in smoking relapse, relatively little is known about the temporal and predictive relationship between these constructs within the first day of abstinence. This pilot study aims to characterize dynamic changes in withdrawal, craving and affect over the course of early abstinence using ecological momentary assessment. Beginning immediately after smoking, moderate and heavy smoking participants (n = 15 per group) responded to hourly surveys assessing craving, withdrawal, NA, and PA. Univariate and multivariate multilevel random coefficient modeling was used to describe the progression of craving, withdrawal/NA and PA and to test correlations between these constructs at the subject-level over the course of early abstinence. Heavy smokers reported greater craving from 1–4 hours of abstinence and greater withdrawal/NA after 3 or more hours as compared to moderate smokers. Level of withdrawal/NA was strongly positively associated with craving, and PA was negatively correlated with craving, however the temporal dynamics of these correlations differed substantially. The association between withdrawal/NA and craving decreased over early abstinence, whereas the reverse was observed for PA. These findings can inform experimental studies of nicotine abstinence as well as their clinical applications to smoking cessation efforts. In particular, these results help to elucidate the role of PA in nicotine abstinence by demonstrating its independent association with nicotine craving over and above withdrawal/NA. If supported by future studies, these findings can refine experimental methods and clinical approaches for smoking cessation.

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“…Interestingly, although this trial was not designed to evaluate the issue, smoking status appeared not to moderate these effects, suggesting that varenicline’s influence on drinking may not be limited to individuals with comorbid alcohol and nicotine dependence. Among smokers, varenicline is believed to reduce nicotine intake via saturation of nAChRs normally bound by nicotine, thereby reducing cigarette craving (Ray, et al, 2013). Some data suggest that it also reduces alcohol craving (Fucito, et al, 2011, Litten, et al, 2013), but other mechanisms have been suggested (Childs, et al, 2012, Kamens, et al, 2010a), and the neurobiological mechanism of action of varenicline for reducing alcohol craving is less clear than for its nicotine effects.…”

Section: Introductionmentioning

confidence: 99%

Varenicline effects on drinking, craving and neural reward processing among non-treatment-seeking alcohol-dependent individuals

et al. 2014

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Rationale The α4β2 nicotinic acetylcholine receptor partial agonist varenicline has been reported to reduce drinking among both heavy-drinking smokers and primary alcoholics, and this effect may be related to varenicline-mediated reduction of alcohol craving. Among smokers, varenicline has been reported to modulate cigarette cue-elicited brain activation in several reward-related areas. Objectives This pilot study tested varenicline’s effects on drinking, alcohol craving, and alcohol cue-elicited activation of reward-related brain areas among non-treatment-seeking alcohol-dependent individuals. Methods Thirty-five such individuals (mean age = 30, 57% male, 76% heavy drinking days in the past month, 15 smokers) were randomized to either varenicline (titrated to 2 mg) or placebo for 14 days, and were administered an alcohol cue reactivity fMRI task on day 14. A priori regions of interest (ROIs) were bilateral and medial orbitofrontal cortex (OFC), right ventral striatum (VS), and medial prefrontal cortex (mPFC). Results Despite good medication adherence, varenicline did not reduce heavy drinking days or other drinking parameters. It did, however, increase self-reported control over alcohol-related thoughts and reduced cue-elicited activation bilaterally in the OFC, but not in other brain areas. Conclusions These data indicate that varenicline reduces alcohol craving and some of the neural substrates of alcohol cue reactivity. However, varenicline effects on drinking mediated by cue-elicited brain activation and craving might be best observed among treatment-seekers motivated to reduce their alcohol consumption.

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The effects of varenicline on stress-induced and cue-induced craving for cigarettes

Cited by 26 publications

References 54 publications

Varenicline, low dose naltrexone, and their combination for heavy-drinking smokers: human laboratory findings

Varenicline, low dose naltrexone, and their combination for heavy-drinking smokers: human laboratory findings

Modeling naturalistic craving, withdrawal, and affect during early nicotine abstinence: A pilot ecological momentary assessment study.

Varenicline effects on drinking, craving and neural reward processing among non-treatment-seeking alcohol-dependent individuals

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