Cook Jessica W, Lanza Stephanie T, Chu Wanghuan, Baker Timothy B, Piper Megan E
Center for Tobacco Research and Intervention, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
William S. Middleton Memorial Veterans Hospital, Madison, WI.
Nicotine Tob Res. 2017 Jun 1;19(6):703-709. doi: 10.1093/ntr/ntw247.
Research shows that abstinence from tobacco leads to a withdrawal-related decrement in responsivity to nondrug rewards (ie, anhedonia). However, it remains unclear how anhedonia relates to other key withdrawal symptoms and withdrawal-related constructs over time. We analyzed ecological momentary assessment data to examine whether a decrement in response to rewards during a 10-day period following quitting shows a pattern of associations with other variables (ie, treatment, tobacco dependence, negative affect, and craving) that is consistent with anhedonia being a tobacco withdrawal symptom.
As part of a randomized controlled trial of smoking cessation therapies, 1122 adults (58% female) were assigned to: placebo (n = 131), bupropion (alone or with nicotine lozenge; n = 401), or nicotine replacement therapy (NRT; lozenge, patch, both; n = 590). Participants completed 4 ecological momentary assessments per day for 10 days postquit, resulting in 22 575 assessments.
Time-varying effect modeling showed that anhedonia was significantly greater among those high in dependence relative to lower dependent smokers out to day 9 postquit. The placebo group showed elevated anhedonia immediately postquit, which fell to levels similar to the treatment groups by day 7. NRT effectively reduced anhedonia and its time-varying association with craving early in the quit attempt. The positive association between negative affect and anhedonia was moderate and stable over time for both active treatment groups.
These results provide additional support that anhedonia following quitting smoking is a manifestation of the tobacco withdrawal syndrome.
This study supported the hypothesis that diminished responsivity to nondrug rewards (ie, anhedonia) is a symptom of the tobacco withdrawal syndrome. Results showed that anhedonia: (1) was significantly associated with dependence, especially during the early postquit period when withdrawal was at its peak intensity; (2) showed significant time-varying associations with other withdrawal symptoms, especially craving; and (3) was significantly suppressed by agonist administration as was its association with craving over time.
研究表明，戒烟会导致与戒断相关的对非药物奖励反应性下降（即快感缺失）。然而，随着时间的推移，快感缺失与其他关键戒断症状及与戒断相关的结构之间的关系仍不清楚。我们分析了生态瞬时评估数据，以检验在戒烟后的10天内对奖励反应的下降是否显示出与其他变量（即治疗、烟草依赖、消极情绪和渴望）的关联模式，这种模式与快感缺失作为一种烟草戒断症状相一致。
作为一项戒烟疗法随机对照试验的一部分，1122名成年人（58%为女性）被分配到：安慰剂组（n = 131）、安非他酮组（单独使用或与尼古丁含片联合使用；n = 401）或尼古丁替代疗法组（含片、贴片或两者皆用；n = 590）。参与者在戒烟后10天内每天完成4次生态瞬时评估，共得到22575次评估。
时变效应模型显示，在戒烟后第9天之前，与依赖程度较低的吸烟者相比，依赖程度高的吸烟者的快感缺失明显更严重。安慰剂组在戒烟后立即显示出较高的快感缺失，到第7天时降至与治疗组相似的水平。尼古丁替代疗法在戒烟尝试早期有效降低了快感缺失及其与渴望的时变关联。对于两个积极治疗组，消极情绪与快感缺失之间的正相关在一段时间内适中且稳定。
这些结果进一步支持了戒烟后的快感缺失是烟草戒断综合征的一种表现这一观点。
本研究支持了对非药物奖励反应性降低（即快感缺失）是烟草戒断综合征症状的假设。结果表明，快感缺失：（1）与依赖显著相关，尤其是在戒断强度达到峰值的早期戒断期；（2）与其他戒断症状，尤其是渴望，显示出显著的时变关联；（3）随着时间的推移，激动剂给药可显著抑制快感缺失及其与渴望的关联。
