Smoking stimuli from the terminal phase of cigarette consumption may not be cues for smoking in healthy smokers

Background Stimuli from the terminal phase of smoke or drug intake are paired with drug effect but have surprisingly low cue reactivity. Smoking terminal stimuli were compared to cues under conditions of different perceived smoke intake to probe whether (1) terminal stimuli are only weak cues, (2) any effect is an artifact of rigid test conditions, and (3) terminal stimuli have a unique function during the intake ritual. Materials and methods Nonabstinent, healthy smokers were tested in three experiments with one-session, within-subject cue reactivity tests. Smoking terminal stimuli and cues were compared using pictures depicting events after completion (END) and before start of smoke inhalation (BEGIN). Test pictures were presented alone and in combination with no-go symbols (from no-smoking signs) or with extra cues to decrease and to increase perceived smoke availability, respectively. Measured were subjective effects and affect modulation of the startle reflex. Results END stimuli relative to BEGIN stimuli evoked less subjective craving and pleasure but more arousal. A no-go stimulus, which reduced reports of intention to smoke, reduced the reactivity to BEGIN but only marginally affected responses to END stimuli. This was confirmed with different sets of test pictures and using tests with the startle response. An extra cue did not affect reactivity to a BEGIN stimulus but increased craving and pleasure to the END stimulus, although not to the level of BEGIN stimuli alone. Conclusions This first systematic study of terminal stimuli found their effects to be robust and have test generality. They are probably not weak cues but evoke reactivity, which may oppose reactivity of cues. They may signal poor availability of drug. Methodological, clinical, and theoretical implications were noted.