Do lab-based assessments of pretreatment smoking reinforcement and cue-specific craving predict smoking cessation with varenicline?

Objective: Individual differences in smoking reinforcement and cue-specific cigarette craving are theorized to influence smoking cessation and relapse. However, there has been little laboratory research that prospectively evaluates these relationships. The present study evaluated whether lab-based indices of pretreatment smoking reinforcement and cue-specific craving predicted subsequent bio-verified abstinence. Method: Participants were 253 adults (aged 28–70, 54% female, 78% White, 3% Hispanic) who reported smoking more than five cigarettes per day when enrolled in a randomized, double-blind, placebo-controlled smoking cessation trial (NCT03262662). During a lab visit ∼1 week before treatment began, participants completed the Choice Behavior under Cued Conditions task. On each of the 36 Choice Behavior under Cued Conditions trials, participants spent between $0.01 and $0.25 for a chance (5%–95%) to sample a cigarette or a cup of water. All participants received varenicline, either during Weeks 1–15 or 4–15 of the study, along with counseling at each visit, and attempted to quit smoking at the end of Week 4. Cotinine-bio-verified (< 15 ng/mL) 7-day point-prevalence abstinence was assessed at Weeks 6, 8, 15, and 28. The predictive validity of pretreatment smoking reinforcement and cue-specific craving on abstinence were examined in logistic regressions. Results: As predicted, greater pretreatment smoking reinforcement predicted lower odds of abstinence, an effect that did not vary significantly across time, treatment groups, or biological sex. Pretreatment cue-specific craving was not predictive of abstinence. Conclusions: This study highlights the theoretical importance of smoking reinforcement and the predictive utility of Choice Behavior under Cued Conditions in identifying those at risk for relapse.