Short CommunicationThe electronic-cigarette: Effects on desire to smoke, withdrawal symptoms and cognition
Highlights
► The e-cigarette can reduce desire to smoke and nicotine withdrawal symptoms 20 minutes after use. ► The nicotine content in this respect may be more important for males. ► The first study to demonstrate that the nicotine e-cigarette can improve working memory.
Introduction
Electronic cigarettes (e-cigarettes) are battery-operated devices that deliver nicotine via inhaled vapour. Since no tobacco is burned, inhaling nicotine in this way potentially provides a safer alternative to smoking since it eliminates the harmful tars and carbon monoxide. E-cigarettes may therefore have a role to play in smoking cessation/reduction. Although their efficacy in this respect has not been empirically explored, quit rates in the region of 22–49% are indicated in two recent studies (Polosa et al., 2011, Seigel et al., 2011).
Any possible effect on smoking cessation/reduction, however, is unlikely to occur unless e-cigarettes are satisfying to use, and can effectively reduce desire to smoke and withdrawal symptoms. Bullen et al. (2010) reported significant and comparable reductions in desire to smoke with the 16 mg Ruyan e-cigarette and nicotine inhalator but both were less effective than regular smoking. A second study also reported reduced desire to smoke and some withdrawal symptoms although both e-cigarette brands tested failed to raise blood nicotine levels and heart rate over a 45 minute period (Vansickel, Cobb, Weaver, & Eissenberg, 2010).
That desire to smoke and withdrawal symptoms were reduced in the absence of raised blood nicotine levels is consistent with the notion that other sensorimotor factors contribute to its reinforcing effects. Several studies have demonstrated preference for smoking, reduced desire to smoke and withdrawal symptoms following the use of denicotinised tobacco (DT) (e.g. Rose, Behm, Westman, & Johnson, 2000) particularly in females (Barrett, 2010).
In addition to the putative reinforcing effects of sensorimotor aspects of smoking, smokers often report that it aids concentration and cognition (Hughes and Hatsukami, 1986, McEwen et al., 2008) and there is empirical evidence to support this assertion (see review by Heishman, Kleykamp, & Singleton, 2010). Nevertheless, whether nicotine derived via e-cigarettes can impact on cognitive processes has not been explored.
The present study aimed to explore whether the e-cigarette can reduce desire to smoke and abstinence-related withdrawal symptoms over a twenty minute period. To determine whether the nicotine content itself rather than other sensory factors associated with smoking (e.g. visual cues, buccal sensations) are responsible for these effects, we compared the nicotine e-cigarette, placebo e-cigarette and a ‘just hold’ group (to control for visual and tactile aspects of handing, but not using the e-cigarette). It was hypothesised that after 5 min, desire to smoke and withdrawal symptoms would decline in both the nicotine and placebo conditions relative to the just hold condition (consistent with a sensorimotor explanation). After 20 min however, when nicotine reaches peak plasma levels (Bullen et al., 2010), it was predicted that the nicotine group would show a further reduction in symptoms relative to the ‘just hold’ and placebo groups. Given previous reports suggesting the importance of sensorimotor aspects of smoking in women (Barrett, 2010, Perkins et al., 1999) data were explored separately by gender. We also included two short cognitive tests (to tap attention/speed of processing and working memory) to explore whether nicotine derived via the e-cigarette is capable of enhancing cognitive functioning.
Section snippets
Methods
In this mixed experimental design, 86 e-cigarette naive smokers (43 female; age range: 18–52 [mean: 28.8]) were randomly allocated to either 18 mg nicotine e-cigarette (nicotine), 0 mg e-cigarette (placebo; nicotine and placebo conditions administered single-blind) or just hold the e-cigarette (just hold) condition. The ‘White Super’ electronic cigarette was used (devices and cartridges supplied by The Electronic Cigarette Company) with a new tobacco flavoured cartridge for each participant.
Results
The three groups did not differ in age, gender, ethnicity or nicotine dependence (p > 0.15 in all cases). Mean FTND score was 5.2 (2.1). Guessing whether participants had received nicotine or placebo was at chance level: (χ2 (2) = 1.11, p > 0.05).
Discussion
Desire to smoke and some aspects of nicotine withdrawal were significantly reduced twenty (but not five) min after e-cigarette use; the nicotine e-cigarette was superior to placebo in this respect in males but not in females. Nicotine derived via use of the electronic cigarette also improved working memory performance particularly at the longer interference intervals.
The desire to smoke findings are consistent with Bullen et al. (2010) who reported that nicotine blood concentrations reached a
Role of funding sources
None.
Contributors
Dawkins and Turner designed the study. Hasna collected the data, conducted literature searches and ran preliminary analyses. Dawkins conducted further statistical analysis and wrote the first draft of the manuscript. Soar contributed to writing the manuscript and advised on the statistical analysis. All authors proof-read and approved the final version of the manuscript.
Conflict of interest statement
The first author has a collaborative relationship with Electronic Cigarette Company (TECC) who supplied the e-cigarettes and cartridges for this study. TECC had no involvement in the design or conduct of the study. All other authors have no conflicts of interest.
Acknowledgements
We would like to thank the participants who took part in this study and Dawn Markham and Tom Kent for their help in conducting the study.
References (14)
- et al.
Dissociating nicotine and nonnicotine components of cigarette smoking
Pharmacology, Biochemistry, and Behavior
(2000) The effects of nicotine, denicotinized tobacco, and nicotine-containing tobacco on cigarette craving, withdrawal, and self-administration in males and female smokers
Behavioral Pharmacology
(2010)- et al.
Effect of an electronic nicotine delivery device (e cigarette) on desire to smoke and withdrawal, user preferences and nicotine delivery: randomised cross-over trial
Tobacco Control
(2010) - et al.
Cognitive psychology
- et al.
The Fagerström Test for Nicotine Dependence: A revision of the Fagerström Tolerance Questionnaire
British Journal of Addiction
(1991) - et al.
Meta-analysis of the acute effects of nicotine and smoking on human performance
Psychopharmacology
(2010) - et al.
Signs and symptoms of tobacco withdrawal
Archives of General Psychiatry
(1986)
Cited by (150)
Nicotine-free electronic-cigarettes for smoking cessation: Occasional reinforcement during extinction
2021, Learning and MotivationCitation Excerpt :Namely, cravings can be extinguished by the repeated use of nicotine-free e-cigarettes. Many studies have used nicotine-free e-cigarettes or very low nicotine cigarettes for smoking cessation/reduction (Bullen et al., 2013; Dawkins et al., 2012, 2016; Donny et al., 2015; Przulj et al., 2016). However, the extinction approach has not always successfully reduced cravings (Van Gucht et al., 2010).
Distinct influences of nicotine and sensorimotor stimuli on reducing cravings to smoke and vape among dual users
2021, Addictive BehaviorsCitation Excerpt :We predicted that nicotine delivery would produce main effects on specific outcomes, such that those receiving nicotine may experience greater appetite changes, attentional control, enjoyment of respiratory tract sensations, and aversive sensations (Hull and Bond, 1986; Palmer & Brandon, 2019) than those not receiving nicotine. However, we also hypothesized that the sensorimotor manipulation would produce greater effects upon other outcomes, such that participants in the altered sensorimotor condition would report less craving reduction, and reduced affect improvement, psychological reward, and satisfaction(Dawkins et al., 2012; Palmer & Brandon, 2018; Van Heel et al., 2017) than those in the normal delivery condition. Participants (N = 128) were recruited through flyers at local vape shops, community locations, and online advertisements from August 2018 – October 2019.
E-Cigarette Use and Transition in Adult Smoking Frequency: A Longitudinal Study
2020, American Journal of Preventive MedicineNicotine or expectancies? Using the balanced-placebo design to test immediate outcomes of vaping
2019, Addictive Behaviors