Elsevier

Addictive Behaviors

Volume 32, Issue 6, June 2007, Pages 1189-1199
Addictive Behaviors

Which dimensions of impulsivity are related to cigarette craving?

https://doi.org/10.1016/j.addbeh.2006.08.007Get rights and content

Abstract

Cigarette smoking is a very important health problem and represents the largest preventable risk factor for premature death in developed countries. A considerable body of research indicates that impulsivity is a central etiological concept in many theoretical models of tobacco addiction. The aim of this study is to analyse which dimensions of impulsivity are related to cigarette craving. To this end, 40 undergraduate psychology students were screened using the revised Questionnaire on Smoking Urges (QSU-12) and the French adaptation of the UPPS Impulsive Behavior Scale (UPPS). This scale identifies four distinct components associated with impulsive behaviour: urgency, lack of premeditation, lack of perseverance, and sensation seeking. The results showed that urgency is a significant predictor of tobacco cravings, while depression and anxiety are not.

Introduction

Cigarette smoking is a very important health problem and represents the largest preventable risk factor for premature death in the developed countries (Bergen and Caporaso, 1999, Peto et al., 1992). Cigarette smoking is extremely prevalent worldwide: several studies (e.g., Centers for Disease Control and Prevention, 1999) have revealed that about a quarter of all American adults smoke cigarettes, and smoking rates are higher in many other countries. In Switzerland, the country in which the current study was done, 31% of the population (26% of females and 36% of males) were smokers in 2002 (Office Fédéral de la Santé Publique, 2003). Moreover, since the diagnosis of nicotine dependence appeared in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1987), it has become the single most common psychiatric diagnosis in the United States (Bergen & Caporaso, 1999). Tobacco, as a major cause of cardiac disease, vascular disease, pulmonary disease, and a variety of cancers, was responsible for 1 out of 10 deaths in the entire world in 2000 (Burnand & Cornuz, 2005).Through his research, Lopez (1997) estimated that about eight million people will die from smoking-related illnesses by 2020, compared to three million people in 1996. It is therefore obvious that cigarette smoking is a plague resulting in growing human and economic costs and is one of the most important public health problems we will have to deal with in the years to come.

Cigarette smoking is now viewed as a complex bio-psycho-social problem (e.g., Baker et al., 2004, Bergen and Caporaso, 1999). With regard to the biological aspects, evidence of genetic determinants affecting the smoking phenotype has been demonstrated (e.g., Straub et al., 1999) and addiction to nicotine has been established as the psychopharmacological cause that maintains smoking behaviours (e.g., United States Department of Health and Human Services, 1988). As for the social aspects, it has been proven that certain demographic factors such as male gender, young age, low socioeconomic status and low educational level are positively related to cigarette smoking (e.g., Bergen and Caporaso, 1999, Escobedo et al., 1990, Zhu et al., 1996). In addition, certain social and/or contextual influences play a role (e.g., peer smoking: Conrad et al., 1992, Derzon and Lipsey, 1999).

With regard to the psychological correlates of cigarette smoking, tobacco dependence must be considered as a prototypical addictive disorder which manifests classic characteristics such as tolerance, withdrawal, and use despite high personal costs (Baker et al., 2004). Extracting potential predictors from the literature, it appears that impulsivity (reflecting sensation seeking, behavioural under-control, and disorders of impulse control) has traditionally been a central etiological concept in many theoretical models of substance abuse (e.g., Acton, 2003, Finn et al., 2005, Johnson et al., 1993, Miller et al., 2003, Moeller et al., 2001b, Tcheremissine et al., 2003, Whiteside and Lynam, 2003, Zuckerman et al., 1990). More specifically, it has frequently been associated with cigarette smoking (e.g., Dinn et al., 2004, Doran et al., 2004, Granö et al., 2004, Johnson et al., 1993, Mitchell, 1999, Reuter and Netter, 2001, Whiteside and Lynam, 2003). In addition, several studies show that attention-deficit/hyperactivity disorder (ADHD) symptoms, which have been associated with increased impulsivity (e.g., Halperin et al., 1988, Moeller et al., 2001a), are related to tobacco use in adolescents (Aytaclar, Tarter, Kirisci, & Lu, 1999) and young adults (Kollins, McClernon, & Fuemmeler, 2005). To sum up, the data as a whole make it clear that smokers have more difficulties controlling impulses than non-smokers, and that sensation seeking may increase the probability of starting to smoke, rather than dependence on cigarette smoking.

However, the concept of impulsivity comprises a heterogeneous cluster of lower-order components (Depue & Collins, 1999), which must be distinguished. Recently, Whiteside and Lynam (2001) revealed impulsivity to be a multi-faceted concept by identifying four separate components associated with impulsive behaviours; these served as the basis for the creation of a scale called the UPPS Impulsive Behavior Scale (UPPS). The four facets of impulsivity measured by the UPPS are: (1) urgency, defined as ‘the tendency to experience strong impulses, frequently under conditions of negative affect’; (2) premeditation, defined as ‘the tendency to think and reflect on the consequences of an act before engaging in the act’; (3) perseverance, defined as ‘the ability to remain focused on a task that may be boring or difficult’; (4) sensation seeking, defined as ‘a tendency to enjoy and pursue activities that are exciting, and openness for new experiences’. Several studies, based on Whiteside and Lynam's works on impulsivity, have established a relationship between certain facets of impulsivity and some psychopathological states. A recent study of bulimia nervosa (Claes, Vandereycken, & Vertommen, 2005) revealed that bulimic symptoms (such as vomiting) are positively related more to urgency and less to premeditation and perseverance. Another study (Lynam & Miller, 2004) showed that lack of premeditation and sensation seeking are related to self-reports of deviance (conduct problems, heavy alcohol consumption, use of marijuana, and harder drugs) in an undergraduate student sample. Along the same lines, Whiteside and Lynam (2003) suggested that urgency and sensation seeking are the impulsive-behaviour-related traits most strongly associated with alcohol abuse. A further example is a study done by Miller et al. (2003), which demonstrated that lack of premeditation is the most consistent dimension of impulsivity associated with externalising behaviours (antisocial personality disorder, psychopathy, and a variety of delinquent acts), and that sensation seeking is a significant predictor of involvement in delinquent acts, drug and alcohol use, and risky sexual behaviour.

This research will explore the relationship between the components of impulsivity and a key concept of cigarette dependence: the construct of craving. According to Tiffany (1990), drug cravings are subjective motivational states thought to encourage compulsive drug self-administration, hinder efforts to achieve abstinence and cause a relapse following sustained drug abstinence. Some authors restrict the concept of craving as meaning a strong desire for a specific substance (e.g., Brandon et al., 1996, Kozlowski et al., 1996), but an alternative conception leans towards a broader definition, which considers the anticipation of the consequences of drug use, intentions to use drugs, and drug-related cognitions and affects as dimensions characterising craving states (Cepeda-Benito et al., 2000, Cepeda-Benito et al., 2004, Tiffany and Drobes, 1991). From this perspective, Tiffany and Drobes (1991) developed the Questionnaire of Smoking Urges (QSU-32), which assesses two different dimensions of cigarette craving. The first factor primarily reflects intention and desire to smoke and anticipation of pleasure from smoking. The second factor comprises anticipation of relief from negative affect and nicotine withdrawal, and an urgent and overwhelming desire to smoke. However, a recent study (Toll, McKee, Krishnan-Sarin, & O'Malley, 2004) showed that a two-factor model composed of 12 of the original items fit the data better than the original 32-item questionnaire, while reflecting the same dimensions highlighted by Tiffany and Drobes (1991). Moreover, the original QSU-32 and other shorter versions of the questionnaire have successfully reported craving changes in a wide variety of studies (e.g., Burton and Tiffany, 1997, Conklin et al., 2000, Robinson et al., 2000, Teneggi et al., 2002).

Considering the findings of previous research, the aim of the present study is to determine which facets of impulsivity are associated with cigarette craving. In our opinion, the desire to smoke scale of the QSU could possibly be associated with sensation seeking, given that the desire to smoke may be influenced by the anticipation of pleasure and agreeable sensations resulting from tobacco use. In addition, it could be supposed that lack of perseverance, which may result in more difficulties inhibiting irrelevant thoughts or memories (Bechara & Van der Linden, 2005), may increase potential occasions to experience thoughts concerning cigarette smoking, resulting in an increasing urge to smoke. We also hypothesised a relationship between urgency, which could be related to the inability to suppress dominant or automatic responses (Bechara & Van der Linden, 2005), and the negative affect scale of the QSU (including anticipation of relief from nicotine withdrawal). Finally, we did not expect to find a relation between craving and lack of premeditation. Indeed, we postulated that lack of premeditation, which here reflects the tendency to ignore the negative long-term consequences of cigarette smoking, should be connected to cigarette use rather than directly to tobacco craving.

Section snippets

Participants

A total of 134 undergraduate psychology students at the University of Geneva (117 females and 17 males) took part in the study (the gender imbalance is due to the small number of male students in the psychology department at the University of Geneva). All participants filled out some questionnaires to get a course credit. Not all of the questionnaires fit into the framework of this study. However, data related to other questionnaires will be presented in other studies (e.g., Billieux, Van der

Results

The scores for the UPPS, the QSU-12, the BDI-2, and the STAI-S are summarised in Table 1.

As can be seen in Table 2, correlations were done between the four components of impulsivity (UPPS) and the questionnaires on smoking urges (QSU-12), depression (BDI-2), and anxiety (STAI-S). However, confirming or rejecting hypotheses based on p-value has been shown to be problematic because p-value depends on both effect size and sample size. Thus, following suggestions by several authors (e.g., Schmidt,

Discussion

The aim of this study was to identify which facets of impulsivity are associated with cigarette craving. The main result of the study may be summarised as follows: correlation analysis revealed that urgency is positively correlated with relief from withdrawal or negative affect (negative affect scale of the QSU-12). Moreover, a regression analysis showed that urgency is the only significant predictor of tobacco craving. However, there is no significant correlation between the intention and

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