The effects of varenicline on stress-induced and cue-induced craving for cigarettes

Background: Varenicline is a partial agonist of the alpha(4)beta(2) nicotinic acetylcholine receptor approved by the FDA for the treatment of nicotine dependence. While the clinical efficacy of varenicline for smoking cessation is well-supported, its biobehavioral mechanisms of action remain poorly understood. This randomized, crossover, placebo-controlled, human laboratory study combines guided imagery stress exposure with in vivo presentation of cigarette cues to test the effects of varenicline on stress-induced and cue-induced craving for cigarettes. Method: A total of 40 (13 females) daily smokers (>= 10 cigarettes per day) completed a guided imagery exposure (stress and neutral) followed by the presentation of cigarette cues at the target dose of varenicline (1 mg twice per day) and on matched placebo. Results: Multilevel regression models revealed a significant main effect of varenicline (p < .01) such that it reduced cigarette craving across the experimental paradigm, compared to placebo. There was also a significant medication x stress x trial interaction indicating that varenicline attenuated cue induced craving following neutral imagery but not when cues were preceded by stress induction (i.e., stress + cues). Conclusions: These results elucidate the biobehavioral effects of varenicline for nicotine dependence and suggest that varenicline-induced amelioration of cigarette craving is unique to tonic craving and cue-induced craving following neutral imagery but does not extend to the combination of stress plus cues. (C) 2013 Published by Elsevier Ireland Ltd.