Can Smoking for Positive or Negative Reinforcement Together With Dependence Help Us Better Diagnose Smokers?

Abstract

With more medications available for smoking cessation treatment the need to diagnose the tobacco dependence for better tailoring of treatment is growing. It has been suggested that smokers can be peak seekers or trough maintainers vis-à-vis blood nicotine concentrations (Russell, 1990), or smoking predominantly for coping with withdrawal or smoking for pleasure (Juniper et al., 2005). In this article a related concept, smoking for negative reinforcement (NR) or positive reinforcement (PR), is investigated. A simple 1-question assessment of type of reinforcement is suggested. From data from smokers attending smoker's clinics — 2 from Sweden using varenicline and 1 from Spain using nicotine patches — it looks as if smokers smoking predominantly for PR do better than NR smokers when treated with varenicline, while there is no difference when they are treated with nicotine replacement. When degree of nicotine dependence is crossed with type of reinforcement it looks as if NR/low nicotine dependent smokers have the best outcome (64%) compared with 47% (p < .01) for the whole sample treated with nicotine replacement. When varenicline is used, the PR/low dependent group had the best quit rate with 85% compared with 67% (p < .05) for the whole sample. This brief report proposes that smoking for PR or NR, possibly combined with degree of dependence, should be further studied as a tool for tailoring smoking cessation treatments.