Commentary on Heckman et al. (2013): Negative affect increases craving-Questions about the relationship of affect, craving and smoking

Abstract

Heckman and colleagues 1 have done the field a service by carefully analyzing the relationship between affect induced in laboratory cue–reactivity (CR) settings and subsequent craving. Their finding that negative affect (NA) is associated with increased craving adds important information to our understanding of the inter-relationships among affect, craving and smoking. Each of these constructs and relationships is complex, and careful analysis is essential for understanding them. It is notable that the findings concern craving and not smoking itself. Although craving is a good proximal predictor of smoking 2, 3 the relationship is not perfect 4, so craving cannot necessarily be used as a proxy for smoking. Heckman et al. 1 describe CR studies as ‘laboratory analogues of drug-seeking’, yet CR studies seldom measure drug-seeking or drug use. Indeed, CR studies have been criticized for focusing on craving as a sole outcome, to the exclusion of smoking 5. Illustrating the issue, in a recent CR study we found that proximal smoking cues increased craving, but did not affect the probability of smoking, the latency to smoke or the amount of smoking 6. Ecological momentary assessment (EMA) data also illustrate some of the complexities of the relationship between craving and smoking. The observed relationship is curvilinear, such that initial increases in craving are associated with increased likelihood of smoking, but this relationship flattens at higher levels of craving 2, 3 (see al…