title: Using mediational models to explore the nature of tobacco motivation and tobacco treatment effects.
abstract: Various theories have proposed mechanisms for drug motivation and relapse. For instance, negative reinforcement theories focus on the alleviation of withdrawal. However, other theories and some data cast doubt on the importance of withdrawal as a motivator of addictive drug use. Using data from a randomized double-blind placebo-controlled smoking cessation treatment study (N=608), this research examined the impact of withdrawal on drug motivation and the ability to maintain abstinence. Withdrawal was experimentally manipulated by randomly assigning participants to receive active bupropion versus placebo. Mediation analyses revealed that active bupropion reduced the amount of withdrawal and craving that individuals reported in the 1st week post quit; modest support was also found for smaller declines in positive affect. These effects, in turn, were all positively associated with posttreatment abstinence. These results implicate withdrawal as an important factor in motivating persistent tobacco use.
authors.affiliation: Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin--Madison, Madison, WI 53711-2027, USA. mep@ctri.medicine.wisc.edu
authors.forename: Megan E
authors.initials: ME
authors.lastname: Piper
authors.forename: E Belle
authors.initials: EB
authors.lastname: Federmen
authors.forename: Danielle E
authors.initials: DE
authors.lastname: McCarthy
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Bolt
authors.forename: Stevens S
authors.initials: SS
authors.lastname: Smith
authors.forename: Michael C
authors.initials: MC
authors.lastname: Fiore
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Baker
mesh_terms: D000328:Adult; D016642:Bupropion / Q000627:therapeutic use*; D018765:Dopamine Uptake Inhibitors / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D009042:Motivation; D016540:Smoking Cessation / Q000379:methods*; D014029:Tobacco Use Disorder / Q000534:rehabilitation*; D016896:Treatment Outcome
chemical_list: D018765:Dopamine Uptake Inhibitors; D016642:Bupropion