BACKGROUND The Food and Drug Administration can set standards that reduce the nicotine content of cigarettes. METHODS We conducted a double-blind, parallel, randomized clinical trial between June 2013 and July 2014 at 10 sites. Eligibility criteria included an age of 18 years or older, smoking of five or more cigarettes per day, and no current interest in quitting smoking. Participants were randomly assigned to smoke for 6 weeks either their usual brand of cigarettes or one of six types of investigational cigarettes, provided free. The investigational cigarettes had nicotine content ranging from 15.8 mg per gram of tobacco (typical of commercial brands) to 0.4 mg per gram. The primary outcome was the number of cigarettes smoked per day during week 6. RESULTS A total of 840 participants underwent randomization, and 780 completed the 6-week study. During week 6, the average number of cigarettes smoked per day was lower for participants randomly assigned to cigarettes containing 2.4, 1.3, or 0.4 mg of nicotine per gram of tobacco (16.5, 16.3, and 14.9 cigarettes, respectively) than for participants randomly assigned to their usual brand or to cigarettes containing 15.8 mg per gram (22.2 and 21.3 cigarettes, respectively; P<0.001). Participants assigned to cigarettes with 5.2 mg per gram smoked an average of 20.8 cigarettes per day, which did not differ significantly from the average number among those who smoked control cigarettes. Cigarettes with lower nicotine content, as compared with control cigarettes, reduced exposure to and dependence on nicotine, as well as craving during abstinence from smoking, without significantly increasing the expired carbon monoxide level or total puff volume, suggesting minimal compensation. Adverse events were generally mild and similar among groups. CONCLUSIONS In this 6-week study, reduced-nicotine cigarettes versus standard-nicotine cigarettes reduced nicotine exposure and dependence and the number of cigarettes smoked. (Funded by the National Institute on Drug Abuse and the Food and Drug Administration Center for Tobacco Products; ClinicalTrials.gov number, NCT01681875.)

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A behavioral economic approach to alcohol use disorders (AUDs) emphasizes both individual and environmental determinants of alcohol use. The current study examined individual differences in alcohol demand (i.e., motivation for alcohol under escalating conditions of price) and delayed reward discounting (i.e., preference for immediate small rewards compared to delayed larger rewards) in 61Correspondence regarding this study should be addressed to James MacKillop, PhD, Department of Psychology, University of Georgia, Athens, GA 30602; or via at jmackill@uga.edu. Lara Ray is now at the University of California, Los Angeles. Publisher's Disclaimer:The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/pubs/journals/abn. NIH Public AccessAuthor Manuscript J Abnorm Psychol. Author manuscript; available in PMC 2011 February 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript heavy drinkers (62% with an AUD). In addition, based on theoretical accounts that emphasize the role of craving in reward valuation and preferences for immediate rewards, craving for alcohol was also examined in relation to these behavioral economic variables and the alcohol-related variables. Intensity of alcohol demand and delayed reward discounting were significantly associated with AUD symptoms, but not with quantitative measures of alcohol use, and were also moderately correlated with each other. Likewise, craving was significantly associated with AUD symptoms, but not with alcohol use, and was also significantly correlated with both intensity of demand and delayed reward discounting. These findings further emphasize the relevance of behavioral economic indices of motivation to alcohol use disorders and the potential importance of craving for alcohol in this relationship. KeywordsAlcohol; Behavioral Economics; Discounting; Demand; CravingBehavioral economics integrates the principles of psychology and economics to understand how individuals make transactions with the world Camerer, 1999). The approach has been extensively applied to both normal and abnormal behavior, particularly in the area of alcohol use disorders (AUDs) and other substance use disorders (Vuchinch & Heather, 2003). As it is applied to substance use, behavioral economics has made major contributions to characterizing how environmental factors, such as increases in cost or the presence of alternative reinforcers, affect alcohol and other substance use (Bigelow, Cohen, Liebson, & Faillace, 1972;Higgins, Bickel, & Hughes, 1994;Winger, Galuska, & Hursh, 2007). Behavioral economics also recog...

Background Contingency management (CM) has not been thoroughly evaluated as a treatment for alcohol abuse or dependence, in part because verification of alcohol use reduction requires frequent in-person breath tests. Transdermal alcohol sensors detect alcohol regularly throughout the day, providing remote monitoring and allowing for rapid reinforcement of reductions in use. Methods The purpose of this study was to evaluate the efficacy of CM for reduction in alcohol use, using a transdermal alcohol sensor to provide a continuous measure of alcohol use. Participants were 13 heavy drinking adults who wore the Secure Continuous Remote Alcohol Monitoring (SCRAM) bracelet for three weeks and provided reports of alcohol and drug use using daily web-based surveys. In Week 1, participants were asked to drink as usual; in Weeks 2 and 3, they were reinforced on an escalating schedule with values ranging from $5-$17 per day on days when alcohol use was not reported or detected by the SCRAM. Results Self-reports of percent days abstinent and drinks per week, and transdermal measures of average and peak transdermal alcohol concentration and area under the curve declined significantly in Weeks 2-3. A nonsignificant but large effect size for reduction in days of tobacco use also was found. An adjustment to the SCRAM criteria for detecting alcohol use provided an accurate but less conservative method for use with non-mandated clients. Conclusion Results support the efficacy of CM for alcohol use reductions and the feasibility of using transdermal monitoring of alcohol use for clinical purposes.

Exposure to either aversive or rewarding environmental stimuli increases extracellular dopamine (DA) concentrations in terminal areas of the mesocorticolimbic dopamine system. Furthermore, behavioral reactivity to an environmental stressor has been shown to correlate with latency to initiate self-administration of psychomotor stimulant drugs. The present study examined the behavioral and dopaminergic responses of rats to social defeat stress and compared latencies to initiate cocaine self-administration in defeated and non-defeated rats. In vivo microdialysis was used to examine the effects of social defeat stress on DA concentrations in nucleus accumbens of freely-moving rats. During the experimental session, dialysate and video recording samples were collected from previously-defeated and non-defeated "intruder" rats in consecutive phases, while (1) in the home cage, (2) when placed in the empty, soiled cage of a resident rat which had previously defeated them, and (3) when exposed to threat of defeat by the resident. Immediately following threat of defeat, previously-defeated and non-defeated intruders were given the opportunity to self-administer cocaine IV. When exposed to the olfactory cues of an aggressive resident, extracellular DA levels in nucleus accumbens increased to approximately 135% of baseline in previously defeated rats versus 125% of baseline in non-defeated rats. When exposed to social threat by the resident, DA levels further increased to 145% of baseline in previously defeated rats versus 120% in non-defeated rats. Previously defeated rats acquired cocaine self-administration in approximately half the time of non-defeated rats, consistent with the hypothesis that prior stress exposure may induce a cross-sensitization to the rewarding effects of cocaine. These results are consistent with the idea that exposure to stress may induce changes in central dopaminergic activity, which may render an individual more vulnerable to acquiring psychomotor stimulant self-administration.

Rationale-Behavioral economic demand curves are quantitative representations of the relationship between consumption of a drug and its cost. Demand curves provide a multidimensional assessment of reinforcement, but the relationships among the various indices of reinforcement have been largely unstudied.Objectives-The objective of the study is to use exploratory factor analysis to examine the underlying factor structure of the facets of alcohol reinforcement generated from an alcohol demand curve.Materials and methods-Participants were 267 weekly drinkers [76% female; age M=20.11 (SD=.1.51); drinks/week M=14.33 (SD=11.82)] who underwent a single group assessment session. Alcohol demand curves were generated via an alcohol purchase task, which assessed consumption at 14 levels of prices from $0 to $9. Five facets of demand were generated from the measure [intensity, elasticity, P max (maximum inelastic price), O max (maximum alcohol expenditure), and breakpoint], using both observed and derived calculations. Principal components analysis was used to examine the latent structure among the variables.Results-The results revealed a clear two-factor solution, which were interpreted as "Persistence," reflecting sensitivity to escalating price, and "Amplitude," reflecting the amount consumed and spent. The two factors were generally quantitatively distinct, although O max loaded on both.Conclusions-These findings suggest that alcohol reinforcement as measured via a demand curve is binary in nature, with separate dimensions of price-sensitivity and volumetric consumption. If

Rationale Craving as a motivational determinant of drug use remains controversial because of ambiguous empirical findings. A behavioral economic approach may clarify the nature of craving, theorizing that subjective craving functionally reflects an acute increase in a drug’s value. The current study tested this hypothesis via a multidimensional assessment of alcohol demand over the course of an alcohol cue reactivity procedure. Method Heavy drinkers (n = 92) underwent exposures to neutral (water) cues followed by personalized alcohol cues. Participants were assessed for craving, alcohol demand, affect, and salivation following each exposure. Findings Alcohol versus neutral cues significantly increased craving and multiple behavioral economic measures of the relative value of alcohol, including alcohol consumption under conditions of zero cost (intensity), maximum expenditure on alcohol (Omax), persistence in drinking to higher prices (breakpoint) and proportionate price insensitivity (normalized Pmax). Craving was significantly correlated with demand measures at levels ranging from .21 – .43. Conclusions These findings support the potential utility of a behavioral economic approach to understanding the role of environmental stimuli in alcohol-related decision making. Specifically, they suggest that the behavioral economic indices of demand may provide complementary motivational information that is related to though not entirely redundant with measures of subjective craving.

Reducing the nicotine content of cigarettes may decrease their addiction potential in populations that are highly vulnerable to tobacco addiction. Smokers with psychiatric conditions and socioeconomic disadvantage are more addicted and less likely to quit and experience greater adverse health impacts. Policies to reduce these disparities are needed; reducing the nicotine content in cigarettes should be a policy focus.