Behavioural tasks sensitive to acute abstinence and predictive of smoking cessation success: a systematic review and meta-analysis

BACKGROUND AND AIMS: Performance on cognitive tasks may be sensitive to acute smoking abstinence and may also predict whether quit attempts fail. Our aim was to conduct a systematic review and meta-analysis to identify cognitive tasks sensitive to acute abstinence and predictive of smoking cessation success.

METHODS: Embase, Medline, PsycInfo and Web of Science were searched up to March 2016. Studies were included if they enrolled adults and assessed smoking using a quantitative measure. Studies were combined in a random effects meta-analysis.

RESULTS: We included 42 acute abstinence studies and 13 cessation studies. There was evidence for an effect of abstinence on delay discounting [d = 0.26, 95% confidence interval (CI) = 0.07-0.45, P = 0.005], response inhibition (d = 0.48, 95% CI = 0.26-0.70, P < 0.001), mental arithmetic (d = 0.38, 95% CI = 0.06-0.70, P = 0.018), and recognition memory (d = 0.46, 95% CI = 0.23-0.70, P < 0.001). In contrast, performance on the Stroop (d = 0 .17, 95% CI = -0.17-0.51, P = 0.333) and smoking Stroop (d = 0.03, 95% CI = -0.11-0.17, P = 0.675) task was not influenced by abstinence. We found only weak evidence for an effect of acute abstinence on dot probe task performance (d = 0.15, 95% CI = -0.01-0.32, P = 0.072). The design of the cessation studies was too heterogeneous to permit meta-analysis.

CONCLUSIONS: Compared with satiated smokers, acutely abstinent smokers display higher delay discounting, lower response inhibition, impaired arithmetic and recognition memory performance. However, reaction-time measures of cognitive bias appear to be unaffected by acute tobacco abstinence. Conclusions about cognitive tasks that predict smoking cessation success were limited by methodological inconsistencies.