Psychological mediators of bupropion sustained-release treatment for smoking cessation.
OBJECTIVE
The study aimed to test simultaneously our understanding of the effects of bupropion sustained-release (SR) treatment on putative mediators and our understanding of determinants of post-quit abstinence, including withdrawal distress, cigarette craving, positive affect and subjective reactions to cigarettes smoked during a lapse. The specificity of bupropion SR effects was also tested in exploratory analyses.


METHODS
Data from a randomized, placebo-controlled clinical trial of bupropion SR were submitted to mediation analyses.


METHODS
Center for Tobacco Research and Intervention, Madison, WI, USA.


METHODS
A total of 403 adult, daily smokers without contraindications to bupropion SR use.


METHODS
Participants were assigned randomly to receive a 9-week course of bupropion SR or placebo pill and to receive eight brief individual counseling sessions or no counseling.


METHODS
Ecological momentary assessment ratings of smoking behavior and putative mediators were collected pre- and post-quit.


RESULTS
Results of structural equation and hierarchical linear models did not support the hypothesis that bupropion SR treatment improves short-term abstinence by reducing withdrawal distress or affecting the subjective effects of a lapse cigarette, but provided partial support for mediation by cigarette craving reduction and enhanced positive affect. Bupropion SR effects on point-prevalence abstinence at 1 month post-quit were also mediated partially by enhanced motivation to quit and self-efficacy.


CONCLUSIONS
Results provided some support for models of bupropion SR treatment and relapse and suggested that motivational processes may partially account for bupropion SR efficacy.
McCarthy
Danielle E
DE
Department of Psychology, Rutgers-The State University of New Jersey, 152 Frelinghuysen Road, Piscataway, NJ 08854, USA. demccart@rci.rutgers.edu
Piasecki
Thomas M
TM
Lawrence
Daniel L
DL
Jorenby
Douglas E
DE
Shiffman
Saul
S
Baker
Timothy B
TB
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016739:Behavior, Addictive / Q000188:drug therapy; D016642:Bupropion / Q000008:administration & dosage*; D003692:Delayed-Action Preparations; D018765:Dopamine Uptake Inhibitors / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D012008:Recurrence; D012044:Regression Analysis; D012907:Smoking / Q000523:psychology; D016540:Smoking Cessation / Q000523:psychology*; D000074606:Smoking Prevention; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy; D016896:Treatment Outcome
D003692:Delayed-Action Preparations; D018765:Dopamine Uptake Inhibitors; D016642:Bupropion
Lancet. 2001 May 19;357(9268):1571-5
11377644
J Consult Clin Psychol. 1994 Jun;62(3):463-76
8063973
J Abnorm Psychol. 2006 Aug;115(3):454-66
16866586
Nicotine Tob Res. 2005 Apr;7(2):257-68
16036283
Exp Clin Psychopharmacol. 1999 Nov;7(4):354-61
10609970
Psychol Methods. 2002 Mar;7(1):83-104
11928892
Clin Ther. 2002 Apr;24(4):540-51
12017399
Nature. 1998 May 7;393(6680):76-9
9590692
Health Psychol. 2000 Jul;19(4):315-23
10907649
Drug Alcohol Rev. 2003 Jun;22(2):203-20
12850907
Psychopharmacology (Berl). 2003 Aug;169(1):1-9
12811464
N Engl J Med. 1999 Mar 4;340(9):685-91
10053177
Nicotine Tob Res. 2004 Feb;6(1):55-61
14982688
JAMA. 2002 Jul 24-31;288(4):468-74
12132977
Psychol Addict Behav. 2006 Mar;20(1):36-43
16536663
N Engl J Med. 1997 Oct 23;337(17):1195-202
9337378
J Pers Soc Psychol. 1988 Jun;54(6):1063-70
3397865
J Pharmacol Exp Ther. 2000 Oct;295(1):321-7
10991997
J Intern Med. 2003 Aug;254(2):184-92
12859700
Pain. 1996 Jul;66(1):3-8
8857625
Psychopharmacology (Berl). 2005 Nov;183(1):1-12
16160876
Behav Res Methods. 2007 Aug;39(3):384-9
17958149
Cochrane Database Syst Rev. 2000;(4):CD000031
11034670
J Abnorm Psychol. 1997 Feb;106(1):104-16
9103722
Psychopharmacology (Berl). 2000 Jan;148(1):33-40
10663415
Br J Addict. 1991 Sep;86(9):1119-27
1932883
Psychol Rev. 2004 Jan;111(1):33-51
14756584
BMC Public Health. 2006 Dec 11;6:300
17156479
Addiction. 2004 Jan;99(1):29-38
14678060
J Abnorm Psychol. 2008 Feb;117(1):94-105
18266488
J Clin Psychiatry. 1995 Sep;56(9):395-401
7665537
Psychopharmacology (Berl). 2003 Jul;168(3):347-58
12698231
Arch Intern Med. 1997 Feb 10;157(3):335-40
9040302
Drug Alcohol Depend. 2002 Jul 1;67(2):219-23
12095672
J Abnorm Psychol. 2003 Feb;112(1):14-27
12653410
J Subst Abuse Treat. 2008 Mar;34(2):234-41
17600649
Nicotine Tob Res. 2008 Apr;10(4):717-29
18418793
Psychopharmacology (Berl). 1995 May;119(2):171-8
7659764
J Affect Disord. 1998 Dec;51(3):237-54
10333980
Addict Biol. 2005 Sep;10(3):219-31
16109583
J Consult Clin Psychol. 2006 Dec;74(6):1153-61
17154744
Health Psychol. 2000 Jan;19(1S):17-31
10709945
Addiction. 2002 Sep;97(9):1093-108
12199822
Exp Clin Psychopharmacol. 2003 Nov;11(4):276-85
14599261
J Abnorm Psychol. 2003 Nov;112(4):558-77
14674869