Effects of Nicotine Deprivation on Alcohol-Related Information Processing and Drinking Behavior

Transcription

1 Journal of Abnormal Psychology 2000, Vol. 109, No. 1, Copyright 2000 by the American Psychological Association, Inc X/00/S5.00 DOI: // X Effects of Nicotine Deprivation on Alcohol-Related Information Processing and Drinking Behavior Tibor P. Palfai Boston University Peter M. Monti Providence Veterans Affairs Medical Center and Brown University Brian Ostafm Boston University Kent Hutchison University of Colorado at Boulder This study examined the influence of smoking cues and nicotine deprivation on responses to alcohol among hazardous drinkers. Fifty-six daily smoking, hazardous drinkers were exposed to either smoking cues or control cues after either 6 hr of nicotine deprivation or no deprivation. Urges to drink alcohol, alcohol-related cognitive processing, and alcohol consumption were assessed after cue exposure. Results indicated that nicotine deprivation increased urges to drink, the accessibility of alcohol outcome expectancies, and the volume of alcohol consumed. There was little influence of the smoking cue manipulation on these processes. Implications for understanding the mechanisms underlying alcoholtobacco interactions are discussed. The association between smoking and alcohol consumption has been well established in both clinical and nonclinical populations (Henningfield, Clayton, & Pollin, 1990; Istvan & Matazarro, 1984). Alcohol use is positively correlated with a number of indices of smoking, including number of cigarettes smoked per day and nicotine dependence (Monti, Rohsenow, Colby, & Abrams, 1995). Over 80% of alcoholics smoke, and they tend to be heavier smokers than individuals in the normal population (Hughes, 1993). Similarly, smokers are more likely to drink alcohol and drink larger quantities than nonsmokers (Zacny, 1990). Both alcohol and nicotine dependence place an individual at higher risk for dependence on the other substance (Henningfield et al., 1990; Kozlowski et al., 1993), and there is some evidence that use patterns of one substance may jeopardize efforts to reduce use of the other substance (Murray, Istvan, Voelker, Rigdon, & Wallace, 1995; Sobell, Sobell, Kozlowski, & Toneatto, 1990; Zimmerman, Warheit, Ulbrich, & Auth, 1990). The co-occurrence of alcohol and tobacco use presents a dilemma to health professionals who are trying to promote change in individuals who use both of these substances. For clinicians treating nicotine-dependent problem drinkers, a primary question is Tibor P. Palfai, Department of Psychology, Boston University; Peter M. Monti, Department of Psychiatry and Human Behavior, Providence Veterans Affairs Medical Center, and Center for Alcohol and Addiction Studies, Brown University; Brian Ostafln, Department of Psychology, Boston University; Kent Hutchison, Department of Psychology, University of Colorado at Boulder. This research was funded by Grant R03AA from the National Institute on Alcohol Abuse and Alcoholism and by a Department of Veterans Affairs Career Research Scientist Award. Correspondence concerning this article should be addressed to Tibor P. Palfai, 64 Cummington Street, Boston, Massachusetts Electronic mail may be sent to palfai@bu.edu. whether continued use of tobacco puts patients at risk for relapse to problem drinking patterns or whether nicotine abstinence may jeopardize efforts to change drinking behavior (Monti et al., 1995; Zacny, 1990). The ability to answer this question and to design optimal interventions will come from a better understanding of the mechanisms by which nicotine deprivation and nicotine use are associated with alcohol consumption. There is evidence to suggest that the use of alcohol or nicotine may increase motivation for the other substance. Studies of tobacco and alcohol use have demonstrated that the amount of alcohol or tobacco used by an individual within different contexts tends to covary with the use of the other substance. Laboratory studies have shown that heavy drinkers tend to show higher rates of smoking when they are given higher doses of alcohol (see Henningfield, 1984; Mintz, Boyd, Rose, Charuvastra, & Jarvik, 1985; Nil, Buzzi, & Battig, 1984), and studies have reported more anticipatory reward and postsmoking satisfaction after alcohol consumption (Glautier, Clements, White, Taylor. & Stolerman, 1996). Alcohol consumption has been shown to increase urges to smoke independent of exposure to explicit smoking cues (Burton & Tiffany, 1997). Increased self-administration of alcohol has been shown to be associated with increased rates of smoking in both laboratory (Mello, Mendelson, Sellers, & Kuehnle, 1980) and naturalistic studies (Shiffman et al., 1994). Considerably less is known about the cross-substance effects of nicotine deprivation. However, there is strong theoretical reason to believe that nicotine deprivation may increase motivation for alcohol. Behavioral choice models of alcohol use (Vuchinich & Tucker, 1988) are based on the well-established finding that individuals respond to restrictions on reinforcers with increased pursuit of alternate available reinforcers. Naturalistic studies of problem drinkers (Tucker, Vuchinich, & Pukish, 1995; Vuchinich & Tucker, 1996) and laboratory studies with social drinkers (Vuchinich & Simpson, 1998; Vuchinich & Tucker, 1983) have shown

2 NICOTINE DEPRIVATION AND RESPONSES TO ALCOHOL 97 that the way that individuals respond to alcohol varies with the value of alternative reinforcers and the constraints placed on them. Because these processes appear to be important across multiple substances (Higgins, 1997; Vuchinich & Tucker, 1988), restrictions on access to nicotine may result in an increase in alcohol use for those who use both substances for reinforcement. In addition to its role as an alternative reinforcer, alcohol use may provide a means of managing the aversive subjective consequences of nicotine deprivation. Two of the more frequently observed responses to nicotine deprivation are increased urges to smoke and negative affect. Not surprisingly, daily smokers who are deprived of nicotine report higher urges to smoke in laboratory studies (Maude-Griffin & Tiffany, 1996; Sayette & Hufford, 1994). They also exhibit higher levels of negative affect than those who are not deprived (Drobes & Tiffany, 1997; Zinser, Baker, Sherman, & Cannon, 1992), and longer periods of deprivation have been associated with higher levels of negative affect in some studies (Payne, Smith, Sturges, & Holleran, 1996). Urges to smoke in conjunction with restrictions on smoking behavior are likely to be aversive to most smokers (Tiffany, 1990). Indeed, negative affect and urges to smoke appear to be highly correlated for those who are deprived of nicotine (Zinser et al., 1992) or those who are exposed to smoking cues without being permitted access to cigarettes (Brandon, Wetter, & Baker, 1996; Drobes & Tiffany, 1997; Elash, Tiffany, & Vrana, 1995). Nicotine deprivation may result in enhanced motivation to drink alcohol because of a desire to reduce these subjective states. Social learning (Niaura et al., 1988; Marlatt, 1985), motivational (Cox & Klinger, 1988), and tension reduction theories (Cappell & Greeley, 1987) have clarified the important function of alcohol as a means of coping with aversive subjective states. Research has identified the central role of negative affect as a motive for drinking (Cooper, Russell, Skinner, & Windle, 1992) and a trigger for relapse (Marlatt, 1985). Moreover, individuals who have stronger expectancies of tension reduction from alcohol appear to drink more frequently and consume greater quantities of alcohol (Hittner, 1995; Mann, Chassin, & Sher, 1987). According to this coping hypothesis, individuals may show heightened urges to drink and/or increased alcohol consumption after nicotine deprivation in an effort to reduce negative affect and urges to smoke. Although coping processes may mediate the link between nicotine deprivation and alcohol motivation, a number of investigators have suggested that nicotine deprivation may have a much broader influence on drug motivational systems through the activation of substance use schema (Baker, Morse, & Sherman, 1987; Goldman & Rather, 1993; Tiffany, 1990). Adopting Lang's (1979) bioinformational model, it has been suggested that drug motivation may be understood as the activation of information schema concerning drug effects and drug use. These substance use schema contain information about stimulus cues; verbal, physiological, and behavioral responses; and interpretive information about the meaning of stimulus and response elements (Niaura, Goldstein, & Abrams, 1991). According to this perspective, the presentation of drug cues, whether internal (e.g., a memory of a typical smoking context) or external (e.g., observing someone smoke a cigarette), activates specific types of information in memory and modifies cognitive processing that guides substance use behavior. Theoretical models used to explain cross-substance effects have largely been influenced by research on use patterns of single substances. Motivation to use a given drug may be enhanced by appetitive stimuli, such as drug administration (Stewart, dewit, & Eikelboom, 1984; Wise, 1988), and withdrawal-eliciting stimuli, such as drug deprivation (Wilder, 1973). In an effort to integrate appetitive and withdrawal-based mechanisms of addiction, Baker et al. (1987) proposed that the motivation to use substances was mediated by two distinct urge networks, a positive affect urge network and a negative affect urge network. The positive affect network includes information on signals of drug availability, appetitive stimuli, cognitions about drug outcomes, and positive affect. According to this model, the use of a substance stimulates the positive affect network, a motivational system that mediates the pursuit of appetitive consequences. The negative affect urge network, on the other hand, contains information on withdrawalassociated physiology and behavior, stimuli signaling drug unavailability, negative affect, and expectations of the drugs' desirable effects. The activation of this network is due to drug withdrawal and is hypothesized to increase urges, increase negative affect, and increase expectations of the drugs' desirable effects. Baker et al. (1987) suggest that individuals are more likely to pursue drugs because the incentive salience of the drug is increased by deprivation. Information-processing models not only provide a framework for understanding the association between types of substancerelated responses and triggers, but they also elucidate specific changes in cognitive processing that may take place during a heightened drug motivational state. Two processes that appear to be important in motivation for alcohol and nicotine are substancespecific perceptual processing and substance use outcome expectancy accessibility. There have been a number of studies that have provided support for the view that chronic substance use and cue-induced drug motivational states may be associated with heightened processing of substance-specific cues. Studies using a variety of cognitive interference paradigms, such as the Stroop task (Johnsen, Laberg, Cox, Vaksdal, & Hugdahl, 1994) and dual-processing vigilance tasks (Sayette et al., 1994), have suggested that alcoholics exhibit greater interference in cognitive processing than social drinkers when the distraction information is alcohol related. Moreover, alcohol-specific Stroop interference among alcoholic patients appears to be associated with daily alcohol intake (Stetter, Ackermann, Bizer, Straube, & Mann, 1995). Research has supported the view that nicotine deprivation may cause changes in the speed with which smokers process smoking-related cues. Smokers who are deprived of nicotine appear to exhibit cue-specific interference from smoking-related information on the modified Stroop (Gross, Jarvik, & Rosenblatt, 1993) and dual-processing vigilance tasks (Sayette & Hufford, 1994). Thus, external smoking cues impair processing on tasks that require that the participant ignore substance cues. Conversely, on tasks that require attention to substance cues, nicotine deprivation appears to increase the speed at which individuals process smoking-related information as measured by lexical decision tasks (Jarvik, Gross, Rosenblatt, & Stein, 1995). In addition to changes in the way that external information is processed, substance-related cues may modify the processing of information about drug effects (Cox & Klinger, 1988; Goldman & Rather, 1993). Both smoking (Brandon et al., 1996) and alcohol researchers (Goldman & Rather, 1993) have pointed to the impor-

3 98 PALFAI, MONTI, OSTAFIN, AND HUTCHISON tance of reinforcement expectancies as predictors of drug motivation. Positive expectancies about smoking have been shown to predict smoking frequency and relapse (Brandon et al., 1996). Similarly, alcohol outcome expectancies have been shown to be important correlates of the frequency and intensity of alcohol use across a number of studies (e.g., Goldman, Brown, Christiansen, & Smith, 1991; Rather, Goldman, Roehrich, & Brannick, 1992) and to predict subsequent drinking patterns among nonclinical (Christiansen, Smith, Roehling, & Goldman, 1989; Stacy, 1997) and clinical populations (Brown, 1985; Jones & McMahon, 1994). Although there are different models of how alcohol expectancies may influence alcohol motivation (Goldman & Rather, 1993; Marlatt, 1985; Niaura et al., 1988; Oei & Baldwin, 1994), they share the view that drug motivational states are influenced by the activation of these expectancies in memory. Research has shown that the presentation of alcohol cues in the environment increases the accessibility of these expectancies as measured by performance on implicit memory tasks with alcohol expectancy words (Goldman & Rather, 1993). Moreover, direct manipulations of expectancy accessibility have been shown to increase alcohol volume consumed (Roehrich & Goldman, 1995). Motivation for substances appears to be characterized by a broad range of behavioral, physiological, cognitive, and subjective responses. There is also suggestive evidence that cues for one substance may elicit cross-substance responses. Urges to smoke appear to be increased upon presentation of alcohol cues for alcoholics in treatment (Rohsenow et al., 1997), and the association between urges to drink and smoke are stronger when alcoholics are presented with alcohol cues (Gulliver et al., 1995). The propositional network memory model may help explain the effects of cues on cross-substance use (Baker et al., 1987). Through repeated co-occurrent use, and use in response to similar triggers (e.g., negative affect), smoking-related and drinking-related structures become associated in memory. Thus, the presentation of cues for smoking may automatically prime alcohol-related information. Cross-priming in memory may serve to increase speed and selectivity of alcohol cue processing, enhance the accessibility of alcohol-related outcomes, increase urges to drink, and intensify drinking behavior. The present study focused on providing a clearer understanding of how smoking-related cues in the environment and efforts to refrain from smoking influence processes related to alcohol consumption among daily smoking hazardous drinkers, nondependent alcohol users whose drinking patterns put them at risk for alcoholrelated harm (Higgins-Biddle & Babor, 1996). Using a factorial design, the independent and combined effects of mild nicotine deprivation and cigarette cues on alcohol-related information processing, urges to drink, and alcohol consumption were examined. It was hypothesized that the presence of smoking cues and nicotine withdrawal would intensify urges to drink, increase the accessibility of alcohol expectancies, and increase the speed of lexical processing of alcohol stimulus words. Moreover, it was predicted that these smoking triggers would increase urges to drink alcohol in anticipation of consumption and increase beer consumption during a taste-test procedure (Marlatt, Demling, & Reid, 1973). Through correlational and mediational analyses, this study examined the nature of the association between responses to smoking triggers and measures of motivation to consume alcohol. Participants Method Fifty-six participants were recruited from posted advertisements and college and local newspaper advertisements that requested social drinkers who were smokers. Inclusion criteria were: (a) hazardous drinkers (Alcohol Use Disorders Identification Test [AUDIT; Babor & Grant, 1992] scores of 8 or above) whose most frequently consumed beverage was beer, (b) age between 21 and 45 years, and (c) daily smokers of over 10 cigarettes per day. Participants were excluded if they had been hospitalized for psychiatric treatment, had been treated for alcohol abuse or dependence, were currently taking medications that could interact with alcohol, or were known to be pregnant. The final sample was evenly divided between males and females,' was predominantly Caucasian (93%), and had a mean age of 26.4 (SO = 6.34). Participants scored a mean of (SD = 5.65) on the AUDIT and consumed an average of (SD = 82.47) standard alcoholic drinks over the preceding month. They smoked an average of 17.6 cigarettes per day (SD = 6.33), scored a mean of 6.04 (SD = 1.8) on the Fagerstrom Tolerance Questionnaire (Fagerstrom, 1978), and reported regular smoking for a mean of 9.39 years (SD 5.9). Design The study was a 2 X 2 factorial design, with nicotine deprivation status (deprived and nondeprived) and cue (smoking cue vs. control cue) as the between-subjects variables. Participants were randomly assigned to one of four conditions stratified by gender. Additional analyses were conducted on urge and affect ratings that were taken at a number of points during the protocol. Three conceptually distinct phases for each participant were analyzed for these ratings in a 2 (nicotine deprivation) X 2 (cue) X 3 (trial) mixed factorial design. Measures AUDIT. The AUDIT (Babor & Grant, 1992) is a 10-item screening instrument used to identify persons whose alcohol consumption may be harmful to their health. Hazardous drinking scores are based on frequency of heavy consumption, frequency of intoxication, number of alcoholrelated problems, and concern about drinking. It has been cross-culturally validated and has been shown to have a adequate reliability. A cutoff score of 8 has been shown to detect 92% of those identified within primary care settings as being hazardous drinkers, with 94% of nonhazardous drinkers falling below this cutoff (Saunders et al., 1993). Time-line follow back (Sobell, Maisto, Sobell, & Cooper, This calendar-based instrument is used to gain information regarding patterns of drinking including frequency, intensity, and type of beverage consumed. It demonstrates high test-retest reliability and has been validated across a variety of alcohol-using populations. Fagerstrom tolerance questionnaire (Fagerstrom, 1978). This questionnaire is an eight-item, 11-point index that assesses smoking dependence. This highly utilized instrument provides information about number of cigarettes per day, nicotine yield, and contextual and temporal conditions of smoking (Fagerstrom & Schneider, 1989). Withdrawal symptoms questionnaire (Shijfinan & Jarvik, I976/, This is a 25-item, Likert-scale measure that is used to assess nicotine withdrawal symptoms. Four subscales have been shown to be reliable and valid 1 Post hoc analyses were also conducted with gender as an additional independent variable. There was no evidence that gender interacted with cue or deprivation for any analysis. Consequently, gender effects are not discussed further.

4 NICOTINE DEPRIVATION AND RESPONSES TO ALCOHOL 99 indicators of nicotine withdrawal: craving, physical symptoms, psychological discomfort, and stimulation-sedation. Positive and Negative Affect Schedule (Watson, Clark, & Tellegen, 1988). This 20-item measure provides assessment of positive (10 items) and negative affect (10 items). Participants rate positive and negative adjectives on a 7-point Likert scale. The subscales have good internal consistency and test retest reliability (Watson et al., 1988). This measure has been used extensively in studies of mood including studies of mood variability among smokers (Zinser et al., 1992). Urge rating forms. Urge to drink and urge to smoke measures were taken after each experimental trial. Participants rated their urge on two 11-point Likert scales. These ratings have been used in several previous studies as well validated and reliable self-report measures of craving (Rohsenow et al., 1997). Taste test. To measure alcohol consumption, a modified taste-test procedure (Marlatt et al., 1973) was used. Participants were informed that they would be tasting three different brands of beer. Three glasses were presented to each participant, each of which contained 360 ml of beer. Each glass contained 240 ml of nonalcoholic beer, which has effectively been used as placebo (Martin, Earleywine, & Young, 1990), and 120 ml of one of three different alcoholic beers. Participants were provided with a tastetest rating form and were told that a series of adjectives would be presented on the computer screen one at a time. They were informed that they would not be expected to complete the ratings of all the adjectives during the taste test. For each adjective, participants were asked to rate each of the three beverages. Participants were instructed that they could take as much time as needed to make each rating and sample as much as they liked to make each judgment. A computer key was pressed to move from one adjective to the next. They were given 10 min to sample the beer and make their ratings of each adjective, although they were not explicitly informed about the duration of the task. As in Marlatt et al. (1973), the task was designed so that participants would continue tasting throughout the taste-test period. Consequently, no participant finished the rating task before the end of the 10-min period, Computerized expectancy task. This task was utilized to assess the accessibility of positive and negative alcohol outcome expectancies {Palfai, Monti, Colby, & Rohsenow, 1997). The task was adapted from work on attitude accessibility (Fazio, Sanbonmatsu, Powell, & Kardes, 1986) and involves the use of response times to assess momentary changes in the degree to which expectancy information is accessible to the participant. Alcohol expectancy items were adapted from the Alcohol Expectancies Inventory (Rather & Goldman, 1994). For the alcohol-related items, participants were presented with the phrase "Alcohol makes me" followed by a stimulus word. Using a computer key, participants were asked to respond as quickly as possible to indicate whether or not the expectancy item applied to their own experience with alcohol. Participants also made timed responses to a series of traits that they judged as either applicable or not applicable to themselves. These self-items served as an internal control for response speed. These items followed the phrase, "I am generally." Expectancy accessibility was calculated as the difference between response time to endorse self-items versus alcohol-related items. Lexical decision task. To measure the processing of alcohol-related information, participants performed a lexical decision task after exposure to either control or cigarette cues. The lexical decision task consisted of a series of 80 letter strings presented on an IBM microcomputer one at a time. Upon presentation of each letter string, participants had to judge by means of a response key whether the string was a word or a nonword. Of these letter strings, 20 items were alcohol-related words (e.g., drink, bottle), 20 were control items that were matched for length and frequency in the English language (Francis & KuCera, 1982), and 40 were nonsense strings. Presentation of letter strings was randomized for each participant, and lexical decision response times were recorded using Micro Experimental Laboratory (Schneider, 1988) computer software. Response times to control and alcohol-related items provided information regarding the influence of smoking cues on information-processing speed and assessed the relative speed with which participants processed alcohol-related information. Procedure Participants were screened by phone to determine eligibility for the study. During the initial phone interview, the study was briefly described and participants were informed that they might be asked to abstain from smoking for 6 hr before the study. Those who expressed interest were then screened. After the screening process, all participants were instructed not to consume alcohol within 12 hr of the study and were asked to either not smoke for one half hour (nondeprived) or 6 hr before the study (nicotine deprived). No participant declined participation after the assignment to condition. To increase compliance, participants were informed that they would be asked to sign an affidavit and provide breath samples to ensure that they met these conditions before participating. They were informed that if they did not meet these criteria at the time of testing they would be excluded without compensation. (No participant was actually excluded on this basis.) Carbon monoxide (CO) samples were taken upon the participants' arrival at the laboratory. Because this study involved alcohol consumption, all female participants were asked to take a pregnancy test before participation, and all participants had to present proof of age (e.g., driver's license). After completing consent and preexperimental procedures, participants in the nondeprived condition were asked to smoke one of their usual cigarettes. This was done to ensure similar levels of nicotine deprivation for those in the nondeprived condition (Payne et al., 1996). Participants then completed a questionnaire battery that included a variety of measures of smoking and drinking history. Thirty minutes after participants began these measures, the baseline procedure began. Participants were instructed lo sit quietly for 5 min while heart rate and skin conductance level (SCL) were taken (results of these measures are discussed elsewhere). After the baseline procedure, participants were asked lo rate their urges to drink, urges to smoke, and affect. Participants were then presented with the smoking cue exposure task modified from Sayette and Hufford (1994). In this task, participants were presented with either smoking or control cues in two 1-min cue exposure periods. In the smoking cue condition, participants were presented with a lighter, an ashtray, a cigarette, and a packet of their favorite cigarette- At the beginning of each trial participants were asked to light the cigarette and hold it comfortably in their dominant hand. Participants in the control cue condition were presented with a pencil and a packet of pencils. They were asked to lift the pencil and hold it comfortably in their dominant hand in a writing posture for 1 min. After each trial, participants were asked to rate their urge to smoke, urge to drink, and affect. After each of the cue exposure trials, participants completed one of two computer tasks, the alcohol expectancy task or the lexical decision task, in counterbalanced order. The second computer task was followed by a 1-min relaxation period followed by a 1-min anticipation period. During this phase, the beer for the taste-test procedure was brought before the participants, and they were reminded about the upcoming drinking task that was to take place in the next few minutes. After this 1-min anticipation phase, participants again filled out subjective rating forms. Upon completion of these measures, participants were instructed on the taste-test procedure and were allowed to begin tasting for the 10-min period. After rating the three types of beer on a variety of dimensions, participants filled out a final rating of urge to smoke, urge to drink, and affect. The cue exposure protocol is summarized in Figure I. Manipulation Check Results Although the experimental protocol precluded multiple assessment of CO levels, breath samples were taken to compare CO

5 100 PALFAI, MONTI, OSTAFIN, AND HUTCHISON Questionnaires» Baseline * [Trial 1: Baseline Ratings] * Cue Exposure #1 Cognitive Task #1 > Cue Exposure #2» [Trial 2: Cue Exposure Ratings] * Cognitive Task #2 > [Trial 3: Anticipation Ratings] * Taste Test Figure 1. Experimental procedure and measurement. levels between deprived and nondeprived groups. Results indicated that CO levels were significantly greater for the nondeprived smokers (M = 22.3, SD 7.8) than for deprived smokers (M = 12.1, SD = 10.3), F(l, 55) = 5.66, p <.01. Multivariate analysis of the Withdrawal Symptoms Questionnaire subscales demonstrated a significant difference between groups, F(4, 48) = 7.39, p <.001. Subsequent univariate tests showed that deprived participants reported significantly greater craving and psychological discomfort than nondeprived participants. Baseline Data To compare experimental characteristics across conditions, we conducted a 2 (nicotine deprivation) X 2 (cue) aualysis of variance (ANOVA) on AUDIT scores, standard drinks per month, and average number of cigarettes per day. No group differences were observed. Urge to Smoke A 2 X 2 X 3 (trial) ANOVA was conducted to examine the influence of nicotine deprivation and cigarette cue on urge to smoke at the different time periods: after baseline, after the cue exposure trials, and after the anticipation of alcohol consumption. Greenhouse-Geiser corrections were used in this and subsequent within-subject analyses to protect against within-trial covariance heterogeneity. Mean urge to smoke ratings by condition are presented in Table 1. Results indicated a main effect for nicotine deprivation only. F(l, 51) = 13.25, p <.05. Post-cue exposure ratings of urge to smoke were not influenced by cue condition, and there was no interaction with nicotine deprivation condition. Thus, the presentation of the cigarette cue did not appear to intensify urge to smoke ratings for either nicotine-deprived or nondeprived participants. Affect Ratings Ratings of positive and negative affect were subjected to separate 2 X 2 X 3 repeated-measures ANOVAs. As expected, participants in the deprived condition exhibited significantly higher levels of negative affect, F(l, 51) = 8.93, p <.05, than those in the nondeprived condition. This difference did not interact with trial or cue type. Negative affect ratings remained stable from baseline (for deprived, M = 18.7, SD = 7.3; for nondeprived, M 13.6, SD 5.0) to post-cue exposure (for deprived, M = 18.5, SD = 7.0; for nondeprived, M = 13.9, SD = 5.2). Ratings of positive affect, on the other hand, were not influenced by nicotine deprivation or cue. Urge to Drink A 2 X 2 X 3 (trial) ANOVA was conducted to examine the influence of nicotine deprivation and cigarette cue on urge to drink at baseline, after cue exposure, and in anticipation of alcohol consumption. Results indicated a main effect for nicotine deprivation, F(l, 51) = 6.79, p <.05, that was qualified by a Nicotine Deprivation X Trial interaction, F(2, 102) = 4.48, p <.05. Mean urge ratings by nicotine deprivation condition are presented in Figure 2. Simple effects analyses demonstrated a significant difference between baseline ratings and anticipation ratings of urge to drink for participants in the deprived condition. This difference Table 1 Urge to Smoke Ratings by Deprivation and Cue Condition Baseline Cue exposure Anticipation Variable M SD M SD M SD NONDEP-CTRL NONDEP-CIG DEP-CTRL DEP-CIG Baseline Cue Exposure Anticipation Note. NONDEP-CTRL = nondeprived/control exposure; NONDEP- CIG = nondeprived/cigarelte exposure; DEP-CTRL - nicotine deprived/ control exposure; DEP-CIG = nicotine deprived/cigarette exposure. Figure 2. Trial Urge to drink ratings by nicotine deprivation across trials.

6 NICOTINE DEPRIVATION AND RESPONSES TO ALCOHOL 101 was not shown for participants in the nondeprived condition. This finding is consistent with the view that deprivation may increase incentive motivation for alcohol. Expectancy Accessibility Because the shape of the data distribution was positively skewed, response latencies to alcohol expectancy words and selfrelated items were subjected to a negative reciprocal transformation. Mean scores were calculated for each participant on items that were endorsed (i.e., "yes" responses) for both alcohol expectancies and self-related items. Participants endorsed more positive expectancies (M 8.21, SD = 3.87) than negative expectancies (M = 5.98, SD = 3.36), and 2 participants did not endorse any negative expectancies. There were no effects of deprivation or cue on response latencies to alcohol expectancies or self-related items; however, participants endorsed self-related items more quickly than alcohol-related items. To assess accessibility (Fazio et al., 1986), difference scores were calculated between response times to positive expectancies and self-related items and between response times to negative expectancies and self-related items. Because there was no significant interaction between expectancy type and the independent variables, a 2 (cue) X 2 (nicotine deprivation) ANOVA was conducted with mean response differences between alcohol expectancy and self-related items. Smaller differences between expectancy responses and self-responses were indicative of greater accessibility of alcohol outcome expectancies. These analyses showed a significant main effect for nicotine deprivation, F(\, 52) = 5.47, p <.05, suggesting that participants who were deprived responded relatively faster to alcohol expectancy items than those who were not (for deprived group, M.10, SD =.11; for nondeprived group, M =.18, SD =.12). There was no effect for cue, however, F(l, 52) =.27, p - ns. Lexical Decision Performance Because of the distributional characteristics of these data, response latencies to the lexical decision words were normalized using a logarithmic transformation. Two separate mean scores were then calculated for each participant, one for alcohol and one for control words. Response times to identify alcohol words were subtracted from control items to produce a measure of alcoholrelated processing speed. A one-way ANOVA did not demonstrate an effect of cue, F(\, 52) = 1.47, p = ns, or nicotine deprivation, F(l, 52) = 2.46,p = ns, on alcohol-related processing. Thus, these analyses did not support an effect of smoking cue or nicotine deprivation on the relative speed with which individuals process alcohol-related external cues. Taste Test A modified taste-test methodology was utilized to examine the influence of nicotine deprivation and external smoking cues on alcohol consumption. It was hypothesized that those in the cigarette cue and deprived conditions would consume more alcohol during the taste-test procedure. A 2 X 2 ANOVA revealed a main effect for nicotine deprivation status on amount of alcohol consumed, F(l, 52) = 5.02, p <.05. Participants who were in the nicotine-deprived condition (M = , SO = ) consumed more beer than those in the nondeprived condition (M = 250.6, SD = ). However, there were no differences between the cue groups (cigarette vs. pencil) on consumption, F(1, 52) =.09, nor was there a Cue X Deprivation interaction, F(\, 52) =.55. Mediations! analyses were conducted to examine whether the effects of nicotine deprivation on alcohol consumption could be explained by changes in negative affect, urge to smoke, urge to drink, or the accessibility of alcohol expectancies. Ratings after the cue exposure were used in these mediational analyses. Separate regression analyses were conducted to examine whether nicotine deprivation was significantly associated with the mediational variable, whether the mediational variable predicted volume consumed, and whether the effect of nicotine deprivation on drinking volume was reduced by regressing volume on nicotine deprivation and the mediator simultaneously (Baron & Kenney, 1986; Holmbeck, 1997). These analyses suggested that urge to smoke, urge to drink, and alcohol expectancies each served as a partial mediators for the relation between nicotine deprivation and drinking. Nicotine deprivation significantly predicted volume (j8 =.29, p <.05), post-cue exposure ratings of urge to drink (j9.30, p <.05), alcohol expectancy activation ()3 =.31, p <.05), and urges to smoke (/3 =.39, p <.05). Moreover, urges to smoke (0 =.28, p <.05), urges to drink (/3 =.46, p <.05), and alcohol expectancy latencies ( 3 =.34, p <.05) each predicted volume consumed. Post-cue exposure negative affect was not significantly associated with drinking volume (/3 =.15, p = ns). When nicotine deprivation and the predictor variables were entered simultaneously, the effect of nicotine deprivation on drinking volume was reduced by alcohol expectancies ((3 =.21), urges to drink (fi =.17), and urges to smoke ( =.22), suggesting partial mediation. Finally, to examine the association between urge to drink in anticipation of drinking and actual consumption, urge ratings during anticipation were regressed on volume. Again, urges to drink before alcohol consumption was also strong predictors of volume (13 =.59, p <.05). When urges to drink and nicotine deprivation were entered simultaneously, nicotine deprivation status no longer predicted drinking behavior ( 3 =.05, p = ns). Although urges to smoke after cue exposure was also positively correlated with alcohol consumption (r.28, p <.05), this relation was no longer, significant when urge to drink was controlled (pr.15). Conversely, urge to drink was still a significant predictor of drinking behavior even when urge to smoke was controlled (pr.43). Correlations Among Post-Cue Exposure Measures, Urge to Drink in Anticipation of Drinking, and Alcohol Consumption Correlations between alcohol expectancy response times, subjective ratings after the cue exposure phase, urge to drink during anticipation, and drinking volume are presented in Table 2. Significant associations were observed between each of these measures after cue exposure. Moreover, these post-cue exposure ratings were correlated with urge to drink when participants anticipated drinking. Most notably, although post-cue exposure negative affect was not significantly associated with drinking behavior, it was strongly associated with urge to drink just prior to drinking. Relative latencies to endorse alcohol expectancies were negatively correlated with urge to drink, urge to smoke, and

7 102 PALFAI, MONTI, OSTAFIN, AND HUTCHISON Table 2 Correlations Between Urge to Drink, Urge to Smoke, Alcohol Expectancy Accessibility, Affect, and Alcohol Consumption Variable UD EXP NA PA US UDA Volume.46*.34* *.59* UDA.85*.35*.47*.13.43* US.33.33*.66*.12 PA NA.45*.41* EXP.28* Note. Volume = beer volume consumed; UDA = urge to drink alcohol after the anticipation phase; US = urge to smoke after the cue exposure trial; PA = positive affect after the cue exposure trial; NA = negative affect after the cue exposure trial; EXP = alcohol expectancy accessibility (difference between reciprocal response time to endorse alcohol expectancy items and self-items); UD = urge to drink alcohol after the cue exposure trial. * p <.05. negative affect after cue exposure. This suggests that heightened accessibility of positive alcohol expectancy information was associated with stronger urges to drink and negative affect. There was no association between negative outcome latencies and these measures. Discussion The present study sought to examine the effects of mild nicotine deprivation and cigarette cues on alcohol-related responses. Results suggest that nicotine deprivation may intensify subjective, cognitive, and behavioral responses to alcohol. Daily smokers who were asked to refrain from smoking for 6 hr before the study reported more intense urges for alcohol before drinking, demonstrated heightened accessibility of alcohol expectancies, and consumed more beer during a taste test compared to smokers who were not deprived. Moreover, urge to drink and the accessibility of alcohol expectancy information partially mediated the effects of nicotine deprivation on alcohol consumption. Nicotine deprivation also appeared to increase the incentive value of alcohol (Baker et al., 1987; Cox & Klinger, 1988; Stewart, dewit, & Eikelboom, 1984). The interaction between nicotine deprivation and trial showed that participants who were deprived demonstrated a significantly greater increase in urges to drink from baseline to anticipation than those who were not deprived. Taken together, these results are consistent with the view that nicotine deprivation may increase drinking behavior by activating alcoholrelated information in memory. These findings suggest that crosssubstance use may be mediated by changes across multiple information-processing systems that reflect altered incentive motivation for a highly associated substance (Baker et al., 1987). This study provided less evidence for the view that changes in drinking behavior due to nicotine deprivation are a result of efforts to cope with negative affect. Consistent with previous research (Drobes & Tiffany, 1997; Maude-Griffin & Tiffany, 1996), nicotine deprivation influenced negative affect and urges to smoke. Participants who were deprived of nicotine experienced higher levels of negative affect whether or not they were exposed to smoking cues. However, negative affect had a different relation to urges to drink in anticipation of alcohol consumption than to alcohol consumption itself. Post-cue exposure negative affect was highly correlated with urges for alcohol and predicted anticipatory urges for alcohol. It was not, however, associated with drinking behavior during the taste test. A number of studies have shown that negative affect may differentially influence urges and substance use behavior (Herman, 1974; Payne, Schare, Levis, & Colletti, 1991). These findings are consistent with the view that information-processing systems that mediate conscious elements of drinking motivation may operate independently from those that direct routinized behavioral components of drinking (Tiffany, 1990). Certainly, the similarity in assessment methods for verbal compared to behavioral components of drinking motivation may also account for these differences. Another consideration is the low level of negative affect exhibited by both groups. It appears that, although participants in the deprived condition experienced more negative affect, the effects of 6 hr of nicotine deprivation on negative affect for this sample of smokers was relatively mild. Negative affect may be a stronger predictor of alcohol-related behavior under conditions of longer periods of nicotine abstinence (Baker et al., 1987). Although negative affect differentially predicted alcohol consumption and urges to drink, urges to drink after cue exposure were highly correlated with both anticipatory urges to drink and drinking behavior. Indeed, anticipatory urges to drink fully mediated the effects of nicotine deprivation on drinking volume. These findings appear to suggest a strong concordance between alcoholrelated subjective experience and behavior, a finding that has not been observed consistently across laboratory studies (Tiffany, 1990). This may be due, in part, to the nature of the drinking task. Participants are asked to inhibit nicotine use (in the nicotinedeprived condition) and delay alcohol consumption before the taste test (during the anticipation phase). Such impediments to the use of substances may increase the likelihood that nonautomatic processes (e.g., urge processing) are activated during the drug use sequence (Tiffany, 1990). These results also provide support for the view that the accessibility of alcohol outcome expectancies may mediate increased drinking behavior. Alcohol outcome expectancy accessibility was associated with both anticipatory urges to drink and increased alcohol consumption. This cue-elicited activation of expectancy information in memory is theorized to be a central mechanism in the link between drinking triggers and alcohol use (Goldman & Rather, 1993). Previous work has shown that cues influence the accessibility of alcohol outcome expectancies (Goldman & Rather, 1993) and that the direct activation of alcohol outcome expectancies leads to increased alcohol consumption (Roehrich & Goldman, 1995). The present study has extended this work to show the link between cues, expectancy accessibility, and drinking behavior in a single study. These results provide suggestive evidence that alcohol expectancy activation may partially mediate the link between smoking and drinking patterns for those whose access to nicotine is restricted. Nicotine deprivation did not, however, result in enhanced processing across both information-processing tasks. Neither cue nor nicotine-deprivation status was associated with facilitated processing of alcohol-related information on the lexical decision task. Clearly, a number of differences in the nature of the task may have lead to this discrepancy. However, the differential effects of nic-

8 NICOTINE DEPRIVATION AND RESPONSES TO ALCOHOL 103 otine deprivation on lexical decision performance and the alcohol expectancy task speak to the importance of distinguishing between cognitive-processing systems in future work on the effects of cues on alcohol-related processing. A large body of research has shown that depression and anxiety may have mood-congruent effects on specific cognitive processes (Mineka & Sutton, 1992). Early stage cognitive-processing systems that identify the presence of alcoholrelated cues (as measured by the lexical decision task) may be differentially affected by mild nicotine deprivation than processes that mediate higher order information about alcohol outcome expectancies. Similarly, our study found little evidence for the influence of nicotine deprivation on enhanced reactivity to smoking cues. Smoking cues did not differentially increase urges to smoke among smokers who were deprived of nicotine. This may be partially due to the fact that urges to smoke were very high after the baseline phase for smokers who were deprived. Consequently, a number of smokers may have already rated their urges as extremely high before the cue manipulation. This absence of differential reactivity to smoking cues among smokers with longer nicotine deprivation is consistent with other studies on urge processing (Maude-Griffin & Tiffany, 1996). The motivational context of the smokers' nicotine deprivation must also be considered when interpreting these results. In this study, smokers are motivated by an external contingency (i.e., participation in a study) to abstain from smoking. These results may be different among participants who abstain due to a desire to quit (Maude-Griffin & Tiffany, 1996) Another factor that may have influenced the impact of the external smoking cue is the availability of nicotine in the cue exposure protocol (Droungas, Ehrman, Childress, & O'Brien, 1995; Juliano & Brandon, 1998). Participants in our study did not expect to smoke during the experimental procedure. Recent work has suggested that the influence of cigarette cues on urge reactivity may be increased by perceived availability of the cigarette, whereas their influence on cognitive processing may be increased by perceived unavailability (Juliano & Brandon, 1998). Finally, one must consider the nature of the specific procedure used in this study. Participants in the nondeprived condition did not begin the cue reactivity assessment until 30 min after their cigarette, and they were required to complete a computer task before the post-cue exposure assessment of urge to smoke. This time period without smoking and the demands of a computer task may have lead to mild increases in urges for those in the nondeprived condition that may have obscured differences between smoking cue and control cue conditions (Sayette & Hufford, 1994). Although the presentation of cigarette cues did increase urges to smoke among nondeprived smokers over baseline, cigarette cues appeared to have little differential effect on smokingrelated or alcohol-related responses. It will be important to clarify in future studies how factors such as the presence and availability of cigarettes, abstinence duration, and the motivational context of nicotine abstinence interact to influence smoking-related and alcohol-related responses. This study examined the effects of nicotine deprivation on distinct responses believed to relate to alcohol use. A number of investigators have suggested that these responses are interconnected as part of an information-processing subsystem that is believed to underlie drug motivation (Baker et al., 1987; Niaura et al., 1991). Correlational analyses from our study provide some support for this view. Consistent with studies that have examined urge responses to alcohol cues (Gulliver et al., 1995; Rohsenow et al., 1997), our study found that urges to drink and urges to smoke were positively correlated. Correlations between expectancy and subjective measures revealed that the accessibility of alcohol expectancy information (which includes information about positive and negative reinforcement from alcohol) was positively correlated with urges for alcohol and negative affect across smoking conditions. This suggests that for participants who are deprived and participants who are nondeprived, urges for alcohol may be associated with negative affect. Future work may profit from the examination of how nicotine use influences these response associations. In sum, our study found that nicotine deprivation influenced a number of processes that are associated with increased motivation for alcohol, including urges to drink, negative affect, and the accessibility of alcohol outcome expectancies. Although these findings provide support for an information-processing perspective, they are also consistent with other models of cross-substance use, including behavioral choice theories (Vuchinich & Tucker, 1988), which view preferences for reinforcers to be influenced by both access to a given substance and access to alternative reinforcers. Daily smoking hazardous drinkers responded to restrictions on nicotine with increased use of an alternative available substance. 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