Implusiveness and Smoking

Why do nearly a quarter of American adults continue their smoking habit? Does nicotine provide, for a certain subgroup, greater emotional relief or relief from negative affect than it does for others? Is there a certain trait prevalent among this subgroup? Does this trait make cessation of smoking especially difficult? Doran, N. et al. (2006) document research pertaining to these questions in their article "Effects of nicotine on negative affect among more impulsive smokers" (Experimental and Clinical Psychopharmacology, 14, 287-295). The hypothesis was made based on recent studies linking impulsivity to substance abuse. It states that smoking provides more relief from negative affect for smokers with impulsive tendencies than it does for smokers who do not display impulsivity.

The experiment included a total of seventy participants (51% female) between the ages of 18 and 65 years old were recruited for this study through advertising and electronic mailing lists. A participant had to fit certain criteria: he or she had to have smoked fifteen or more cigarettes per day for at least the past year as well as be moderately dependent on nicotine (mean cigarette consumption was 20.3 a day for this group of participants). Participants were excluded if they were using nicotine replacement products, or had been diagnosed with an Axis I mental disorder (other than nicotine dependence or major depressive disorder within the past 6 months. Also excluded were those who were involved in substance abuse treatment within the past year, had problems completing questionnaires pertaining to mood, and perimenopausal women (negative affect associated with the transition into menopause might have a confounding effect on results).

Materials used in this experiment consisted mostly of surveys and tests that have been reliable in past studies. The Fagerstrom Test for Nicotine Dependence[FTND], a six item scale that focuses on behavioral characteristics, was introduced to perspective participants to evaluate individual differences in physiological dependence on nicotine. The Structured Clinical Interview for the DSM-IV, Nonpatient Version [SCID-NP] was another preliminary procedure: trained diagnosticians (monitored by clinical psychologists) determined whether a possible participant met criteria for an Axis I disorder those who did were excluded from the study. To measure impulsivity of the individuals, the Barratt Impulsiveness Scale, Version II [BIS-II]. This self-report questionnaire is divided into three subscales: nonplanning impulsivity, attention impulsivity, and motor impulsivity. This test requires that the participants read a series of statements and rate the extent to which the statements are applicable to them. All statements are based on the following definition of impulsivity: "tending to be oriented toward the present rather than the future...to act without considering consequences, and to make quick cognitive decisions." A negative memory questionnaire was administered: participants were asked to identify four autobiographical memories that induce negative mood--two of which were used to create experimental conditions for each individual. The questionnaire consisted of a ten point rating scale referring to memory vividness and sadness (1 being "extremely sad" and 10 being "not sad at all").

After participants were chosen based on the aforementioned tests, yet more tests were administered: before beginning trials, an ecolyzer measured expired CO levels; those who measured less than 8ppm were excluded from the trial and asked to reschedule. The Profile of Mood States [POMS] scale was utilized at various points in the experiment. The POMS contains six subscales--three of which were focused on in this study: tension/anxiety, depression/dejection, and anger/hostility. The 36 items on this evaluation are rated on a 4-point scale (4 indicating extreme affect). Both nicotinized and denicotinized cigarettes were provided for participants; a Cigarette Characteristic Rating Scale was used to assess possible differences in the effects of smoking each kind by requiring participants to rate, from 1 to 10, the taste and likeability of their preferred cigarette brand (baseline measurement: 1.0mg nicotine) verses the experimental denicotinized cigarettes (experimental variable: 0.1mg). Another material used in the study was music that has been shown to elicit dysphoric moods: Prokofiev's Russia Under the Mongolian Yoke and Barber's Adagio Pour Cordes.

Participants were involved in a "parent study" prior to the present experiment. Only some of the information from the parent study was applicable to the present one-that pertaining to how nicotine "differentially modulates negative affect among smokers with a positive depression history." Prospective participants were screened over the phone for basic information, then met with the coordinators for a SCID-NP diagnostic interview. The POMS was administered before and after a mock mood-induction trial was performed to ensure participants were somewhat susceptible to negative mood induction. These processes were followed by completion of the negative memory questionnaire, the FTND, BISII, as well as smoking history questionnaires.

Prior to a session, an ecolyzer was used to make sure the participant wasn't in a withdrawal state. After a questionnaire, a mood induction procedure was performed: participants recalled a negative autobiographical memory whilst listening to the musical scores described above. Three minutes post-session, participants completed the POMS, smoked a provided cigarette (sometimes nicotinized, other times denicotinized), then filled out questionnaires regarding mood and nicotine-withdrawal . Lastly, researchers made sure participants returned to their baseline mood through assessment after listening to positive music.

An analysis of the results support the hypothesis: high impulsivity predicts greater relief of negative affect through smoking. This only occurred with nicotinized cigarettes post mood induction-which means this relieving affect of smoking for impulsive individuals is primarily due to the nicotine rather than the sensory aspects of [the act of] smoking. Interestingly, scores from the Smoking Consequences Questionnaire indicate that the participants in this study were knowledgeable of the harmful effects of smoking; the reinforcing effects of smoking are so elevated for the impulsive individual that they apparently override his or her knowledge of the consequences.

This study implies that smoking cessation might be more successful (especially for the impulsive person) if negative affect is also treated in the process. It also suggests, in a subtle manner, that telling an impulsive smoker "don't smoke-its bad for you," is useless; he or she already knows. There is also an implication that impulsivity is tangent with negative affect.

The methodological strength in this study was the use of the Smoking Consequences Questionnaire. It is important to separate impulsivity from ignorance. Perhaps advertising companies and education programs can use these results. Smoking cessation advertisers that choose to focus on the health risks of smoking might never have an affect on that last subgroup of smokers...in fact, they might only be raising their negative affect and we know what that leads to. Schools might focus more on mood control rather than physical health in drug education courses.