The effects of trauma recall on smoking topography in posttraumatic stress disorder and non-posttraumatic stress disorder trauma survivors
Introduction
Despite representing 22% of the adult U.S. population, individuals with psychiatric conditions consume 44% of all cigarettes sold in the U.S. (Lasser et al., 2000). Given that cigarette smoking costs an estimated 419,000 American lives and US$100 billion in direct and indirect health care expenses annually (CDC, 1994), it is of vital importance to our national health care to learn more about why people with psychiatric conditions smoke at this alarming rate.
Posttraumatic stress disorder (PTSD) is a prevalent psychiatric disorder estimated to occur in 8% Helzer et al., 1987, Kessler et al., 1995 of the U.S. population and is chronic in a third of sufferers. Fifty-three percent to 60% of individuals with PTSD smoke (Beckham, 1999) and they are more likely to be heavy smokers (48% compared with 28% in non-PTSD smokers; Beckham et al., 1997). When individuals with PTSD were exposed to trauma-related stimuli using a modified Stroop procedure, they experienced increased smoking craving compared with those without PTSD (Beckham et al., 1996). These results suggest that trauma-related stimuli may serve as a compelling cue for smoking in individuals with trauma exposure or PTSD. Whether trauma stimuli affect smoking behavior has not yet been examined.
Smokers report anxiety reduction as a motivation to smoke (Brandon, 1994) and there is a growing body of literature examining the relationship among nicotine, smoking, and stress/negative affect (for reviews, see Gilbert, 1995, Kassel et al., 2003). Controlling for smoker expectancies about cigarette nicotine content, smoking nicotine-containing cigarettes after anxiety induction produced greater relief from anxiety than denicotinized cigarettes (Juliano & Brandon, 2002). Kassel and Unrod (2000) observed reductions in anxiety in subjects smoking cigarettes during anxiety induction, but only when a distracting stimulus was present. Relatively fewer laboratory studies have assessed the effects of stress and negative affect on smoke self-administration using smoking topography methods.
Smoking topography methodology is a valuable tool for assessing the effects of subject (e.g., Eissenberg, Adams, Riggins, & Likness, 1999) and experimental manipulations (e.g., Cohen et al., 1999, Palfai et al., 1997) on cigarette smoke self-administration. Studies where stress/anxiety are induced have typically observed changes in smoking behavior consistent with increased smoke administration. Using a learned helplessness paradigm, Payne, Schare, Levis, and Colletti (1991) observed greater number of puffs and total puff duration following negative affect induction. Similarly, Rose, Ananda, and Jarvik (1983) found greater puff volumes and increased puff frequencies in two tension-inducing conditions compared with a relaxation condition.
Based on previous work suggesting that trauma reminders affect smoking craving (Beckham et al., 1996), we hypothesized that recalling traumatic versus neutral experiences would result in smoking behavior indicative of increased smoke intake following trauma recall versus a neutral condition. Further, we hypothesized that smoking intake would be significantly greater in the PTSD group following trauma recall.
Section snippets
Participants
The sample of 110 smokers consisted of 74 individuals diagnosed with PTSD and 36 individuals with trauma history but without PTSD based on the clinician-administered PTSD scale (Blake et al., 1995). This sample was part of a larger study examining mood and smoking in PTSD patients (Beckham et al., 2004). Inclusion criteria were 18 years of age, a smoking history of >10 cigarettes per day for the past year, and at least one lifetime trauma exposure. The Structured Interview for DSM-IV Diagnosis
Mean puff volume
As shown in Fig. 1, larger mean puff volumes were observed in the PTSD group (adjusted mean=35.41 ml) than in the non-PTSD group (adjusted mean=29.95 ml), [F(1,103)=4.32, P=.040]. Additionally, mean puff volumes were larger in men (adjusted mean=36.10 ml) compared with women (adjusted mean=29.27 ml) [F(1,103)=8.49, P=.004].
Mean puff onset interval
As shown in Fig. 1, a Recall Condition×PTSD group interaction was observed for the log of mean puff onset interval [F(1,103)=7.00, P=.009]. Post hoc tests indicated that in
Discussion
The present study partially supported the initial hypotheses. As expected, smokers with PTSD reported significantly higher negative affect and PTSD symptoms following trauma recall compared with a neutral recall condition. Controlling for nicotine dependence and the presence of current major depressive disorder, the non-PTSD group took less time between puffs in response to trauma recall compared with neutral recall. However, in the PTSD group, rather than differentially responding to the
Acknowledgements
This work was supported by NCI R01 CA 81595 and VA Merit Review MH-0011.
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