Smoking to Self-Medicate Attentional and Emotional Dysfunctions

Individuals with attentional and emotional dysfunctions are most at risk for smoking initiation and subsequentnicotine addiction. This article presents converging findings from human behavioral research, brain imaging, andbasic neuroscience on smoking as self-medication for attentional and emotional dysfunctions. Nicotine and othertobacco constituents have significant effects on neural circuitry underlying the regulation of attention and affect. Age,sex, early environment, and exposure to other drugs have been identified as important factors that moderate both theeffects of nicotine on brain circuitry and behavior and the risk for smoking initiation. Findings also suggest that theeffects of smoking differ depending on whether smoking is used to regulate attention or affect. Individual differencesin the reinforcement processes underlying tobacco use have implications for the development of tailored smokingcessation programs and prevention strategies that include early treatment of attentional and emotional dysfunctions.IntroductionSmoking prevalence rates in the general populationhave shown a steady decline in recent years becauseof increased efforts of anti-smoking campaigns andsmoking bans in many states. However, overallsmoking prevalence rates may have reached aplateau. Some studies suggest that individuals withattentional and emotional dysfunctions continue tosmoke at high rates and are less successful withsmoking cessation (Acierno et al., 2000; Beckham,1999; Beckham et al., 1997; Breslau, 1995; Breslau,Davis, & Schultz, 2003; de Leon, Diaz, Rogers,Browne, & Dinsmore, 2002; Dierker, Avenevoli,Merikangas, Flaherty, & Stolar, 2001; Glassmanet al., 1990; Glassman et al., 1988; Kendler et al.,1993; Kollins, McClernon, & Fuemmeler, 2005;Marmorstein & Iacono, 2003; O. F. Pomerleau,Downey, Stelson, & Pomerleau, 1995; Rohde,Kahler, Lewinsohn, & Brown, 2004; Sonntag,Wittchen, Hofler, Kessler, & Stein, 2000;Upadhyaya, Brady, Wharton, & Liao, 2003). Withthe majority of smokers beginning to smoke by age18 (Johnston, O’Malley, & Bachman, 1998), adoles-cents with attentional and emotional dysfunctionsalso have a higher risk for smoking compared withthose without such problems (Stevens, Colwell,Smith, Robinson, & McMillan, 2005; J. W. Weisset al., 2005; Whalen, Jamner, Henker, & Delfino,2001; Whalen, Jamner, Henker, Delfino, & Lozano,2002). Adolescents may self-medicate with tobaccoto regulate negative affect associated with attentionaland emotional dysfunctions (Whalen et al., 2001;Whalen et al., 2002). The notion that individuals withspecific deficits smoke for purposes of self-medication (Khantzian, 1997; C. S. Pomerleau,Marks, & Pomerleau, 2000) is supported by evidencethat nicotine treatment can attenuate dysfunction indepression (Haro & Drucker-Colin, 2004a, 2004b)