Pupil size as a robust marker of attentional bias toward nicotine-related stimuli in smokers.

Spatial attention can be magnetically attracted by behaviorally salient stimuli. This phenomenon occasionally conflicts with behavioral goals, leading to maladaptive consequences, as in the case of addiction, in which attentional biases have been described and linked with clinically meaningful variables, such as craving level or dependence intensity. Here, we sought to probe the markers of attentional priority in smokers through eye-tracking measures, by leveraging the established link between eye movements and spatial attention. We were particularly interested in potential markers related to pupil size, because pupil diameter reflects a range of autonomic, affective, and cognitive/attentional reactions to behaviorally significant stimuli and is a robust marker of appetitive and aversive learning. We found that changes in pupil size to nicotine-related visual stimuli could reliably predict, in cross-validated logistic regression, the smoking status of young smokers (showing pupil constriction) better than more traditional proxy measures. The possibility that pupil constriction may reflect a bias toward central vision, for example, attentional capture, is discussed in terms of sensory tuning with respect to nicotine-related stimuli. Pupil size was more sensitive at lower nicotine dependence levels, and at increased abstinence time (though these two variables were collinear). We conclude that pupillometry can provide a robust marker for attentional priority computation and useful indications regarding motivational states and individual attitudes toward conditioned stimuli.