Cue-Induced Drug Seeking and Its Association with Craving and Dependence in Cigarette Smokers

Increased salience of drug-related cues over non-drug reinforcers can drive drug use behaviors and contribute to tobacco use disorder (TUD). An important scientific and clinical goal is to effectively measure this elevated drug-seeking behavior in TUD. However, most TUD assessments rely on self-reported cravings and cigarette consumption, not providing an objective measure of cue-induced drug seeking. The probabilistic image choice (PIC) task, initially developed and validated for cocaine use disorder (and since validated in users of methamphetamine and opioids), investigates the choice of viewing drug-related pictures as compared to other salient pictures (e.g., pleasant and unpleasant cues). This study aimed to develop and validate the PIC task for TUD and evaluate the associations between behavioral choice and tobacco craving, daily cigarette consumption, and nicotine dependence (the Fagerström score). We recruited 468 smokers and 121 nonsmokers using the Prolific online platform. Participants performed the PIC task twice (at a one-month interval) and completed other measures relevant to TUD. As expected, compared to nonsmokers, tobacco smokers selected to view significantly more tobacco images and less pleasant (non-drug reinforcer) images, a profile that remained stable at retest. Drug seeking on the PIC task was associated with craving but not with the other tobacco dependence measures, suggesting that the task is better at modeling current drug “wanting” rather than cumulative nicotine exposure or physical dependence. In conclusion, these results suggest that the PIC task can be a valuable tool for objectively assessing craving-associated tobacco seeking in TUD.