title: Impact of varenicline on cue-specific craving assessed in the natural environment among treatment-seeking smokers.
abstract: BACKGROUND
  Varenicline is believed to work, in part, by reducing craving responses to smoking cues and by reducing general levels of craving; however, these hypotheses have never been evaluated with craving assessed in the natural environments of treatment-seeking smokers.
  
  
  OBJECTIVE
  Ecological momentary assessment procedures were used to assess the impact of varenicline on cue-specific and general craving in treatment-seeking smokers prior to quitting.
  
  
  METHODS
  For 5 weeks prior to quitting, 60 smokers carried personal digital assistants that assessed their response to smoking or neutral cues. During week 1 (baseline), participants did not receive medication; during weeks 2-4 (drug manipulation), participants were randomized to receive varenicline or placebo; during week 5 (standard therapy), all participants received varenicline. Craving was assessed before each cue; cue-specific craving and attention to cue were assessed after each cue.
  
  
  RESULTS
  During all phases, smoking cues elicited greater craving than neutral cues; the magnitude of this effect declined after the first week. General craving declined across each phase of the study. Relative to the placebo condition, varenicline was associated with a greater decline in general craving over the drug manipulation phase. Varenicline did not significantly attenuate cue-specific craving during any phase of the study.
  
  
  CONCLUSIONS
  Smoking cues delivered in the natural environment elicited strong craving responses in treatment-seeking smokers, but cue-specific craving was not affected by varenicline administered prior to the quit attempt. These findings suggest that the clinical efficacy of varenicline is not mediated by changes in cue-specific craving during the pre-quit period of treatment-seeking smokers.
authors.affiliation: Department of Psychology, University at Buffalo, State University of New York, Park 206, Buffalo, NY 14260, USA.
authors.forename: Julie C
authors.initials: JC
authors.lastname: Gass
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Wray
authors.forename: Larry W
authors.initials: LW
authors.lastname: Hawk
authors.forename: Martin C
authors.initials: MC
authors.lastname: Mahoney
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Tiffany
mesh_terms: D000328:Adult; D001552:Benzazepines / Q000494:pharmacology*; D034201:Computers, Handheld; D003463:Cues; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018722:Nicotinic Agonists / Q000494:pharmacology*; D011810:Quinoxalines / Q000494:pharmacology*; D012907:Smoking / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D000068580:Varenicline
chemical_list: D001552:Benzazepines; D018722:Nicotinic Agonists; D011810:Quinoxalines; D000068580:Varenicline