Contexts enhance ratings of craving and psychophysiological responses of cue-reactivity in tobacco use disorder

IntroductionConfrontation with smoking-related cues can provoke craving and relapse, even after long periods of abstinence. The context of these cues might be important for the elicitation of craving. In this study we examined the effects of social, physical and consumptive contexts on cue-reactivity in smokers using ratings and physiological measures. MethodA total of 22 smokers (12 male, 10 female) with tobacco use disorder (TUD) assessed using a cue-reactivity picture perception paradigm in a laboratory setting. Pictures of smoking in different physical and social contexts and of different phases of the smoking ritual were used. Ratings of cigarette craving, valence and arousal as well as startle reflex modulation, skin conductance responses and heart rate were assessed. ResultsWe observed an increased startle modulation in the bar versus control context and a stronger heart rate deceleration in the social versus neutral context. Social smoking induced more craving than neutral context, and cues from the beginning of the smoking ritual induced more craving than in the terminal phase. Social smoking context was rated as more arousing than neutral context, and cigarettes of the terminal phase of the smoking ritual were rated as least pleasant. ConclusionsThe results indicate that physical, social and consumptive contexts differentially affect cue-reactivity in TUD. ImplicationsCues in contexts lead to more pronounced indicators of craving than cues alone. Thus, contexts should be included in both, the assessment and treatment of TUD.