nicotine and smoking: a review of effects on human …nicotine and smoking: a review of effects on...

Experimental and Clinical Psychopharmacology1994, Vol. 2, No. 4,345-395

In the public domain

Nicotine and Smoking:A Review of Effects on Human Performance

Stephen J. Heishman, Richard C. Taylor, and Jack E. Henningfield

The purpose of this review was to examine the effects of nicotine administra-tion and cigarette smoking on human performance to clarify the role of sucheffects in controlling smoking. The results of 101 studies (129 experiments)published in scientific journals from 1970-1993 were reviewed. In nonabsti-nent smokers and nonsmokers, nicotine enhanced finger tapping and motorresponses in tests of attention; cognitive functioning was not reliably en-hanced. It is unlikely that these limited performance-enhancing effects ofnicotine play an important role in the initiation of cigarette smoking. Incontrast, data from abstinent smokers support the conclusion that nicotinedeprivation functions to maintain smoking in nicotine-dependent persons, inpart, because nicotine can reverse withdrawal-induced deficits in several areasof performance.

Of the 46 million adults in the United Stateswho smoke cigarettes (Centers for Disease Con-trol, 1993), more than 90% are interested inquitting and approximately one in three (15-20million) attempt cessation each year (Fiore, 1992;Pierce, Fiore, Novotny, Hatziandreu, & Davis,1989). However, more than 90% of these cessationattempts are short lived; most individuals relapseduring the first few weeks after cessation when thenicotine withdrawal syndrome is most intense(Hughes, Higgins, & Hatsukami, 1990; Kottke,Brekke, Solberg, & Hughes, 1989).

Difficulty concentrating and impaired perfor-mance are components of the nicotine withdrawalsyndrome (American Psychiatric Association, 1987;U.S. Department of Health and Human Services[USDHHS], 1988), and performance has been

Stephen J. Heishman, Richard C. Taylor, and Jack E.Henningfield, Clinical Pharmacology Branch, AddictionResearch Center, National Institute on Drug Abuse(NIDA), National Institutes of Health, Baltimore,Maryland.

We thank Mary Pfeiffer, Janeen Nichels, and BruceLewis for assistance in obtaining, organizing, and typingreferences and four anonymous reviewers for theirextensive and constructive comments.

Correspondence concerning this article should beaddressed to Stephen J. Heishman, Clinical Pharmacol-ogy Branch, NIDA Addiction Research Center, P.O.Box 5180, Baltimore, Maryland 21224.

shown to be impaired within 4 to 12 hr of smokingcessation (Gross, Jarvik, & Rosenblatt, 1993; Hat-sukami, Fletcher, Morgan, Keenan, & Amble,1989; Heimstra, Fallesen, Kinsley, & Warner,1980; Snyder, Davis, & Henningfield, 1989). Thus,a decline in performance resulting from nicotinedeprivation is generally considered a relapse factorin persons attempting to quit smoking and as afactor in the maintenance of smoking in nicotine-dependent individuals.

The purpose of this review is to examine theeffects of nicotine administration and cigarettesmoking on a wide range of human behavior toclarify the role of nicotine-induced performanceeffects as determinants of the initiation and main-tenance of smoking behavior. Studies conductedwith nicotine-deprived smokers are most relevantto the maintenance of smoking, whereas studies inwhich nonsmokers are administered nicotine maybe more relevant to the initiation phase of smok-ing. Because effects of nicotine can differ in themaintenance and initiation phases of smoking,primarily as a function of tolerance (USDHHS,1988), a distinction between the performance ef-fects of nicotine under conditions of nicotinedeprivation and no deprivation is emphasizedthroughout the review.

An overview of nicotine dependence and rel-evant pharmacology precedes a critical analysis ofmethodological issues and summary of results of

345

346 S. HEISHMAN, R. TAYLOR, AND J. HENNINGFIELD

the entire literature. Because of a lack of method-ological rigor in the majority of reviewed studies, asecondary analysis follows in which we summarizeand draw conclusions from studies conducted us-ing rigorous experimental methodology (i.e., pla-cebo control and blind procedures). Our articleconcludes with a behavioral pharmacological per-spective, emphasizing the complex interactionsthat must be explored before a complete under-standing of the effects of nicotine on humanperformance is reached.

Nicotine Dependence andPerformance Effects

The offices of the U.S. Surgeon General, theWorld Health Organization, and other major na-tional and international health advisory organiza-tions have concluded that the pernicious use oftobacco products is largely due to the high depen-dence potential of nicotine (American PsychiatricAssociation, 1987; Royal Society of Canada, 1989;USDHHS, 1988, 1990; World Health Organiza-tion, 1992). Consistent with these organizations,we have denned drug dependence or drug addic-tion1 as a pattern of behavior focused on therepetitive and compulsive seeking and taking of apsychoactive drug (Heishman & Henningfield,1992). Numerous animal and human studies havedemonstrated that nicotine is psychoactive andreinforces behavior leading to its self-administra-tion. Thus, the majority of researchers in the fieldhave concluded that nicotine is a drug of depen-dence and the primary controlling variable incigarette smoking (USDHHS, 1988).

However, others have rejected the evidence thatnicotine is a dependence-producing or addictivedrug (Robinson & Pritchard, 1992; Warburton,1989). Alternatively, they argue that people smokecigarettes because smoking provides psychophar-macological benefits, such as increased mentalalertness and reduced tension, not because theyare dependent on nicotine (Warburton, 1990;Warburton, Revell, & Walters, 1988; Wesnes &Warburton, 1983b). However, these two views arenot mutually exclusive. Drug dependence is acomplex, multidetermined behavioral phenom-enon involving the myriad effects (e.g., reinforcing,harmful, pleasurable, beneficial) of a psychoactivedrug that are manifested in an individual interact-ing with the environment. Thus, a person may

continue to smoke because they are nicotine depen-dent, because they perceive beneficial behavioraland psychological effects from smoking, becausesmoking has become conditioned to daily activi-ties, because smoking strengthens belonging to aparticular group, and for many other reasons.Similar conclusions have been reached for otherdrugs of dependence, such as cocaine, heroin, andalcohol (USDHHS, 1988). This review will focuson the performance effects of nicotine and smok-ing and the possible role these effects play incontrolling smoking behavior.

In nicotine-dependent individuals, nicotine absti-nence can produce disruptions in concentrationand performance that can be reversed by cigarettesmoking or other forms of nicotine delivery (US-DHHS, 1988). This ability of nicotine to reversedeprivation-induced performance decrements topredeprivation levels should not be considered anabsolute enhancement of performance. Rather, itreflects the restoration of normal (drug-depen-dent) functioning from a state of abstinence-induced disequilibrium. In our view, absolute en-hancement is demonstrated only when nicotineproduces a statistically significant facilitation ofperformance over baseline levels in nonsmokers orin nicotine-dependent persons who are not nico-tine deprived. As this review indicates, few studieshave been designed adequately to determinewhether nicotine can function to enhance abso-lutely human performance.

Pharmacology of Nicotine

An understanding of the behavioral effects of apsychoactive drug requires knowledge of its phar-macological profile, which reflects the drug's chemi-cal structure, dosage form, and route of administra-tion. Important aspects of a drug's profile include

1 The terms dependence and addiction are generallyused synonymously. Drug dependence has become thepreferred term in the scientific community, whereasdrug addiction is often used in writings intended forgeneral audiences. Thus, being dependent on nicotine isthe same as being addicted to nicotine. Drug depen-dence should not be confused with physical dependence.The development of physical dependence on a drug maybe one component of the drug dependence syndrome,but it is neither a necessary nor sufficient condition tomaintain the behavioral pattern defined as drug depen-dence (cf. Jaffe, 1990; USDHHS, 1988).

NICOTINE AND HUMAN PERFORMANCE 347

its pharmacokinetics, pharmacodynamic effects,and ability to produce tolerance and physicaldependence. The behavior being measured is influ-enced by all of these factors.

Dosing and Pharmacokinetics

The effects of nicotine depend critically on thedose administered and the speed with which it isdelivered {Benowitz, 1990; Henningfield & Wood-son, 1989; USDHHS, 1988). Cigarette smokingdelivers nicotine in discrete doses that producerapid increases in plasma nicotine concentration;arterial levels may be 10 times greater than thoseof venous blood (Benowitz, 1990; Henningfield,Stapleton, Benowitz, Grayson, & London, 1993).Although not essential to sustain nicotine toler-ance and physical dependence, the rapid deliveryof nicotine achieved through smoking appears toenhance the addictive effects of nicotine (Benow-itz, 1990; Henningfield & Keenan, 1993) and couldbe an important determinant of the effects ofsmoking on performance.

Control over nicotine dosing through cigarettesmoking is complicated and has rarely beenachieved as investigators intended (Henningfield,1984; USDHHS, 1988). Smokers typically extract1-4 mg of a total of 7-9 mg of nicotine per cigarette(Benowitz, Jacob, Denaro, & Jenkins, 1991), result-ing in almost no direct relationship between esti-mated nicotine yields of cigarettes and nicotineintake (Benowitz et al., 1983; Gori & Lynch, 1985;Russell, Jarvis, Iyer, & Feyerabend, 1980).

Nicotine delivered through cigarette smokinghas an initial distribution half-life in plasma of10-20 min, followed by an elimination half-life of2-3 hr (Benowitz et al., 1991; Benowitz, Jacob,Jones, & Rosenberg, 1982). In daily smokers,nicotine plasma concentration reaches a peak of10-40 ng/ml in late afternoon, declining to 5-10ng/ml after overnight abstinence (Benowitz, Kuyt,& Jacob, 1982). Thus, daily smokers are constantlyexposed to nicotine. Nicotine administered throughother delivery systems (tablet, polacrilex gum,nasal spray, and injection) also has an eliminationhalf-life of about 2 hr, but these delivery systemsdo not produce the rapid and large increase inarterial nicotine concentration observed with ciga-rettes.

These other forms of nicotine delivery offerpharmacokinetic advantages and disadvantages

compared with cigarettes. Orally ingested forms ofnicotine provide a convenient means of blindingthe dosing procedure, but absorption is erratic andabout 70% of absorbed nicotine is metabolized inits first pass through the liver (USDHHS, 1988).Nicotine polacrilex gum is absorbed effectivelybuccally, is conveniently administered, allows forblinding, and produces dose-related effects, butprecision in dosing can be reduced by failure tocontrol chewing technique and dietary factors(Henningfield, Radzius, Cooper, & Clayton, 1990;Nemeth-Coslett, Benowitz, Robinson, & Henning-field, 1988). Absorption of nicotine from spraysand aerosols occur through the nasal or oralmucosa; these systems allow precise delivery ofmeasured nicotine doses under double-blind condi-tions (Perkins et al., 1986; Pomerleau, Flessland,Pomerleau, & Hariharan, 1992; Sutherland, Rus-sell, Stapleton, Feyerabend, & Ferno, 1992).

Pharmacodynamics

The effects of nicotine are complex. Peripheraleffects are mediated through nicotinic receptors atautonomic ganglia, sensory nerve endings, neuro-muscular junctions, and adrenal medulla (Clarke,1987; USDHHS, 1988). In the central nervoussystem (CNS), the psychoactive, reinforcing, andpossibly cognitive effects of nicotine are mediatedby several populations of nicotinic receptors thatappear to underlie nicotine-induced changes inelectrocortical activity and regional brain metabo-lism (London & Morgan, 1993). Thus, nicotinecould alter cognition and performance through theCNS but effects at peripheral sites could also beinvolved. For example, effects of nicotine on fingertapping and arousal could be mediated throughskeletal muscle and hormonal systems, respec-tively. To determine that an effect of nicotine isdue to its effects in brain would require pretreat-ment with central and peripheral nicotinic antago-nists. Only one experiment in this review adminis-tered nicotine after antagonist (mecamylamine)dosing (West & Jarvis, 1986, Experiment 3).

Studies have demonstrated the development ofacute and chronic tolerance to some, but not all, ofnicotine's effects (USDHHS, 1988). Interestingly,some tolerance is lost overnight, such that the firstfew cigarettes of the day produce greater subjec-tive reports of strength and greater increases inheart rate compared with cigarettes later in the


day (Henningfield, 1984; West & Russell, 1987).Physical dependence also develops with repeatednicotine administration, as documented by theemergence of an abstinence syndrome followingabrupt cessation of cigarette smoking (Hatsukami,Hughes, Pickens, & Svikis, 1984; Hughes et al.,1990) and use of smokeless tobacco products(Hatsukami, Anton, Keenan, & Callies, 1992; West& Russell, 1985).

Literature Survey Methods

Articles on the performance effects of nicotineappeared in the literature as early as the 1920s andsporadically through the 1960s (for reviews, seeHeimstra, Bancroft, & DeKock, 1967; Sherwood,1993; Wesnes & Warburton, 1983b). During the1970s, research in this field increased and contin-ues to be an area of considerable interest (Jarvik,1991; West, 1993). This review encompasses re-search published in the journal literature from1970 to 1993.

The literature was compiled by searching com-puter databases (e.g., Medline, Current Contents),references of published reviews, and bibliogra-phies of our personal reprint files, which includemore than 8,000 articles on smoking and nicotine.The 101 studies (129 experiments) in this reviewmet two criteria. First, articles were published inEnglish in journals;2 book chapters, technical re-ports, conference proceedings, and abstracts wereexcluded. Second, studies involved the administra-tion of nicotine through smoking or other deliverymethods during experimental sessions and thepostdosing measurement of one or more variablesrelated to human performance. Studies that didnot involve nicotine administration during at leastone experimental condition were excluded be-cause nicotine, as an independent variable, was notmanipulated and recent nicotine exposure was notcontrolled. We defined human performancebroadly to assess nicotine's effects across a widerange of behavior, from sensory and motor abilitiesthrough complex cognitive functioning. Excludedwere studies assessing the effect of nicotine onphysiological functioning or on behavior not re-lated to performance and studies manipulatingperformance testing as a stressor to investigate theinteraction with nicotine.

Methodological Problems and Limitations

There are fundamental methodological prob-lems in the majority of reviewed studies that limitmeaningful interpretation of results. A brief cri-tique of these methodological limitations will pro-vide an important perspective on the researchfindings summarized in the next section.

Small Sample Size

Studies conducted with a small number of sub-jects may have relatively low statistical power, andhence, the probability of concluding incorrectlythat the independent variable had no effect (TypeII error) is increased. However, it is important toremember that the power of a statistical test isdetermined not only by sample size but also byType I error rate (alpha level) and expected effectsize in the population (Rossi, 1990). To determinewhether sample size was related to conclusions(correct or incorrect) of no effect of smoking ornicotine, we classified the reviewed experimentsaccording to sample size, and the number ofexperiments reporting no effect on all dependentmeasures was noted. For experiments with n =1-10 (18% of total), 17% reported no effect; forn = 11-20 (40%), 34% reported no effect; for n =21-30 (14%), 39% reported no effect; for n =31^0 (11%), 45% reported no effect; for n =41-50 (4%), 20% reported no effect; and for n >50 (14%), 33% reported no effect. Thus, it wouldappear that experiments with small sample size didnot result in a disproportionate number of nulloutcomes.

Lack of Placebo Control

One of the hallmarks of sound experimentaldesign is the use of a placebo control, which allows,

2 Our original intent was to review only articlespublished in peer reviewed journals. However, on con-sulting Uhlrich 's International Periodicals Directory (1991-92), which, according to the National Library of Medi-cine is the definitive source for such information, wediscovered numerous instances of journals, known to bepeer reviewed, listed as not being peer reviewed. Thus,we have included all relevant journal articles, a minorityof which may have been published in journals that arenot peer reviewed.


but does not guarantee, a study to be conductedunder blind conditions. In clinical pharmacology,this means that appropriate control measures areused during drug administration to reduce thelikelihood of subject, or experimenter, or bothknowing the nature of the treatment. Unfortu-nately, the availability of an effective placebotobacco cigarette is limited, although some studieshave experimented with herbal or lettuce leafcigarettes (Andersson & Post, 1974; Wesnes &Warburton, 1983a; West & Hack, 1991) or denico-tinized cigarettes having a nicotine yield of lessthan 0.1 mg (Colrain, Mangan, Pellett, & Bates,1992; Hasenfratz, Baldinger, & Battig, 1993; Hous-ton, Schneider, & Jarvik, 1978; Robinson,Pritchard, & Davis, 1992; Warburton, Rusted, &Fowler, 1992). As a result, 74% of experiments inthis review involved subjects smoking cigarettes inat least one experimental session and not smokingin other sessions. These studies did not use aplacebo smoking condition and were not con-ducted in a single- or double-blind manner. With-out an effective placebo condition, results aredifficult to interpret, and data are clearly con-founded by subject and experimenter knowingwhether or not nicotine was being administered.

Use of Cigarettes to Deliver Nicotine

The use of tobacco cigarettes to deliver nicotinegeneralizes to the environment beyond the labora-tory; however, as discussed, cigarette smoking is animprecise method of nicotine dosing. It is wellknown that people differ in their puffing andinhalation strategies and are able to adjust theirsmoking behavior to compensate for actual orperceived changes in the nicotine yield of ciga-rettes (Gust & Pickens, 1982; Herning, Jones,Bachman, & Mines, 1981). Thus, use of cigarettesvarying in nicotine yield (e.g., Mangan & Golding,1983; Williams, 1980) does not guarantee effectivedose manipulation. Subjects smoked according toa paced or timed procedure in 28% of experimentsinvolving cigarette smoking; however, ad lib smok-ing was used in the majority (70%) of studies.Zacny, Stitzer, Brown, Yingling, and Griffiths(1987) have shown that experimental control overseveral elements of smoking topography is neces-sary to deliver nicotine doses precisely with to-bacco cigarettes.

In the absence of precise dosing capabilities,

knowledge of plasma nicotine concentration wouldprovide information concerning the delivered dose.However, only one study (Hindmarch, Kerr, &Sherwood, 1990) reported plasma nicotine levels,and this study administered nicotine polacrilex,which is a delivery system that can produce orderlydose-related effects (Nemeth-Coslett et al., 1988;Parrott & Craig, 1992). Future studies using to-bacco cigarettes to deliver nicotine that measureplasma nicotine concentration will allow thecorrelation of performance changes with thedelivered dose. However, for the experimentalanalysis of the effects of nicotine, we recommendthe use of delivery systems that provide a mea-sured dose of nicotine when administered in astandardized manner, such as polacrilex, nasalspray, or injections.

Use of Cigarette Smokers

As discussed, daily smokers are never com-pletely nicotine free. In studies in which smokersare required to smoke, a variable dose of nicotineis delivered to a person with an unknown preexist-ing plasma nicotine concentration. Such imprecisedosing methodology is likely to produce incon-clusive results and should be avoided in futurestudies.

A related issue that makes data interpretationdifficult is the use of smokers who are required tobe abstinent for some time before experimentalsessions. Of the 113 experiments in which smokerswere tested, 77 indicated the duration of tobaccodeprivation, 24 did not state either deprivationduration or whether smokers were deprived, and12 experiments tested nonabstinent smokers only.Of the experiments reporting deprivation dura-tion, subjects were abstinent less than 4 hr in 35%,4-8 hr in 5%, and more than 8 hr (typicallyovernight) in 60%. Smokers who are tobaccodeprived for 4-8 hr are in early nicotine with-drawal and may be experiencing impaired concen-tration and performance. When nicotine-deprivedsubjects are administered nicotine, any observedimprovement in performance may reflect a returnto predeprivation levels of performance. This isnot a new interpretation (Hindmarch et al., 1990;Hughes, 1991; USDHHS, 1988; West, 1990); how-ever, it bears repeating because with rare excep-tions (Parrott & Roberts, 1991; Peeke & Peeke,1984), data are not discussed in light of this


confounding variable. To address this problem,future studies testing deprived smokers shouldmeasure and report predeprivation baseline data.

Effects of Nicotine and Smokingon Human Performance

The methods and results of 101 studies (129experiments) are summarized according to theprimary behavior necessary to perform the varioustests as follows: sensory abilities (Table 1), motorabilities (Table 2), attentional abilities (Table 3),and cognitive abilities (Table 4). Such a classifica-tion scheme is somewhat arbitrary because someperformance tests require several skills, and sen-sory abilities are necessary for all performance.However, compared with a classification based onspecific performance tests, for example, the ap-proach used here allows a broader focus on behav-ior, which is our intent.

In each table, studies are arranged in chronologi-cal order. An experiment was classified as double-blind only if it was so stated in the article. If anexperiment appeared to be conducted in a double-blind manner but was not stated as such, it wasclassified as a single-blind experiment. Results aresummarized in the tables as main findings thatwere significant according to the statistical testused by the authors of the study; nonsignificantresults are indicated as "no effect" or a "trend."

In the following narrative analysis of each behav-ioral function, we have categorized experiments asadministering nicotine, in some form, to subjectsunder conditions of nicotine deprivation or nodeprivation (including nonsmokers who were ad-ministered nicotine). Some studies did not indicatewhether smokers were abstinent before testing andare omitted from the narrative because withoutthis basic information, data are uninterpretable.Within the two categories, the results of eachexperiment were classified as demonstrating en-hancement, impairment, or no effect of nicotine.However, such a discrete classification was difficultbecause in some experiments, a combination of thethree outcomes was reported.

Sensory Abilities

Table 1 summarizes the results of six studies (10experiments) that measured critical flicker fre-

quency (CFF) threshold. CFF is generally regardedas a measure of CNS functioning; an increase inthreshold frequency indicates increased corticaland behavioral arousal (J. M. Smith & Misiak,1976). Table 1 also includes seven studies thatmeasured other visual and auditory abilities.

Critical Flicker Frequency

Nicotine deprivation. In 5 of the 10 experi-ments, subjects were tobacco abstinent (overnightin four of five experiments) when CFF wasmeasured. All experiments reported that smok-ing or nicotine increased CFF threshold or en-hanced sensitivity of detection (Leigh, 1982,Experiments 1, 2, and 4; Sherwood, Kerr, &Hindmarch, 1992; Waller & Levander, 1980). Themagnitude of maximal increase was 3-9% of con-trol values in studies reporting data necessary forsuch calculations.

No deprivation. In 6 of the 10 experiments,subjects were either smokers who were not tobaccodeprived before experimental sessions or werenonsmokers who were administered nicotine. Twoexperiments reported that smoking increased CFFthreshold (Leigh, 1982, Experiments 3 and 4),whereas four experiments found nicotine had noeffect on CFF (Hindmarch et al., 1990, Experi-ments 1 and 2; Jones, Sahakian, Levy, Warburton,& Gray, 1992 [nonpatient control groups]; Kerr,Sherwood, & Hindmarch, 1991). In the only studythat directly compared tobacco-deprived and non-deprived smokers, Leigh (1982, Experiment 4)reported that predrug CFF threshold values werelower in deprived than in nondeprived smokers,suggesting a nicotine deprivation effect, and thatsmoking increased CFF threshold in both groups.

Other Sensory Abilities

Nicotine deprivation. Three of seven studieswere conducted with smokers who were abstinent1-12 hr. Tong, Knott, McGraw, and Leigh (1974)reported that cigarette smoking enhanced visualdiscrimination in a two-flash fusion test, and Tong,Booker, and Knott (1978) found that smokingproduced an underestimation of velocity and timeof visual stimuli in apparent motion. These resultsare suggestive of nicotine-induced behavioral orcortical arousal. However, Calissendorff (1977)


reported that smoking two cigarettes impaired thecourse of visual adaptation to the dark.

No deprivation. The only study to test nonde-prived smokers included abstinent smokers andnonsmokers as control groups, both of which didnot smoke (Fine & Kobrick, 1987). They reportedno effect of smoking on visual contrast sensitivityand that nonsmokers exhibited superior sensitivityin certain conditions compared with smokers.

Summary of Sensory Abilities

Seven of the eight experiments conducted withabstinent smokers in Table 1 reported that ciga-rette smoking enhanced sensory abilities. How-ever, none measured predeprivation performance,so a conclusion of absolute enhancement fromnicotine is unclear. In contrast, two of sevenexperiments found that smoking or nicotine en-hanced sensory abilities in nondeprived smokers ornonsmokers. Thus, when administered to absti-nent smokers, nicotine may mitigate the perfor-mance deficits associated with nicotine depriva-tion. Unfortunately, the lack of predeprivationbaseline data precludes drawing any firm conclu-sion about the effects of nicotine from such stud-ies. As stated, the most unambiguous data concern-ing the performance effects of nicotine are foundin studies testing nonabstinent smokers or non-smokers. On this basis, the enhancing effect ofnicotine on sensory abilities was not reliably ob-served and of limited generality.

Motor Abilities

Table 2 summarizes six studies (10 experiments)that measured finger tapping and eight studies (10experiments) that assessed hand steadiness ortremor. These measures are generally thought toreflect purely motor abilities.

Finger Tapping

Nicotine deprivation. In 4 of the 10 experi-ments, smokers were abstinent for 1-12 hr beforetesting. All but one study reported increasedfinger-tapping rate in some or all subjects aftersmoking (O'Connor, 1986b; Roth & Battig, 1991)or nicotine nasal spray (Perkins et al., 1990).Valeriote, Tong, and Durding (1979) found no

effect of smoking on either finger- or foot-tappingrate in 4-hr abstinent smokers.

No deprivation. No study administered nico-tine to nonabstinent smokers. Nonsmokers wereadministered nicotine through nasal spray or sub-cutaneous injection in seven experiments. Westand Jarvis (1986) conducted five experiments andfound that nicotine increased finger-tapping ratein all subjects. Perkins et al. (1990) reportedincreased tapping rate in 7 of 10 nonsmokers.Jones et al. (1992) reported that nicotine injectionsincreased tapping rate in nonpatient control groups,which comprised smokers (abstinence not indi-cated) and nonsmokers. Across these three stud-ies, the magnitude of the nicotine-induced in-crease in tapping rate was 4-6% of control values.

Hand Steadiness and Tremor

Nicotine deprivation. Smokers were abstinentfor 2-12 hr in 9 of the 10 experiments; two studiesdid not indicate the length of deprivation. Fiveexperiments reported that smoking or nicotineimpaired performance by either decreasing handsteadiness (Frankenhaeuser, Myrsten, & Post, 1970;D. L. Smith, Tong, & Leigh, 1977) or increasinghand tremor (Shiftman et al., 1983, Experiments 1,2, and 3). O'Connor (1986b) found an increase inhand steadiness after smoking that was not repli-cated in a subsequent session, and Perkins et al.(1990) reported a trend toward improvement inhand steadiness. Finally, two studies reported thatthe effect of smoking (Emre & de Decker, 1992)and nicotine polacrilex (Zdonczyk, Royse, & Kol-ler, 1988) did not differ from control conditions.

No deprivation. Nonabstinent smokers were notinvolved in any study, but two studies administerednicotine to nonsmokers. Perkins et al. (1990)reported that nicotine nasal spray produced atrend toward impaired hand steadiness, and Zdon-czyk et al. (1988) found no effect of nicotinepolacrilex on finger tremor in patients with essen-tial tremor and Parkinson's disease and controlsubjects.

Summary of Motor Abilities

With regard to finger tapping, in three of fourexperiments with abstinent smokers and in all

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seven experiments with nonsmokers, smoking ornicotine increased tapping rate. Thus, a modest,yet reliable, increase in finger-tapping rate is anabsolute enhancing effect of nicotine. In contrast,nicotine's effect on hand steadiness and tremor isless clear. In nine experiments with abstinentsmokers, five found impaired performance, tworeported a trend toward facilitation, and tworeported no effect. In nonsmokers, nicotine pro-duced a trend toward impaired hand steadiness inone study and had no effect on tremor in anotherstudy. Thus, the evidence for nicotine to improvehand steadiness and tremor is weak. Interestingly,nicotine-induced increases in such motor activa-tion could be interpreted as enhanced perfor-mance or not, depending on the nature of thebehavioral test.

Attentional Abilities

Table 3 summarizes the results of 63 studies thatmeasured behaviors such as searching, scanning,and detecting visual and auditory stimuli for briefor extended periods of time. Such behaviors havebeen defined traditionally as attention (Kinchla,1992; Warm, 1984). Virtually all of the perfor-mance tests conducted in the studies of Table 3involved minimal cognitive or memorial processingand a clearly measurable psychomotor or verbalresponse. In all of these studies, responding wasmeasured in some temporal form, such as reactionor response time (the vast majority), time offtarget, or response rate. Some studies also in-cluded a measure of response accuracy whenappropriate.

On the basis of the nature of the attentionalprocess required to perform a test, we categorizedTable 3 into four sections: focused, selective,divided, and sustained attention. Each of theseaspects of attentional behavior are discussed in thefollowing subsections, which begin with a defini-tion and end with a summary of the researchresults.

Focused Attention

We defined focused attention as attending toone task or aspect of information for less than 10min; most tests actually lasted less than 5 min.Seventeen studies (19 experiments) met this crite-


rion, with the majority (12 studies) measuringsimple or choice reaction time. Some studiesdistinguished between recognition (time fromstimulus onset to movement off home key) andmotor (time from home to target key) componentsof the reaction response. Pursuit tracking, simu-lated driving, digit symbol substitution, and percep-tual speed were assessed in the remainder ofstudies.

Nicotine deprivation. In 10 of the 18 experi-ments, smokers were abstinent for 4-18 hr beforeexperimental sessions. Seven experiments re-ported that smoking or nicotine had no effect ontest behavior (Frankenhaeuser et al., 1970; Knott,1985a; Knott & Venables, 1980; Landers, Crews,Boutcher, Skinner, & Gustafsen, 1992, Experi-ments 1 & 2; Petrie & Deary, 1989; Valeriote et al.,1979). One study found that extroverts were faster,but introverts were slower, in reaction time aftersmoking (O'Connor, 1980), and two studies re-ported that recognition and motor reaction timeswere differentially affected by smoking (D. L.Smith et al., 1977) or nicotine polacrilex (Sher-wood et al., 1992).

No deprivation. Nonabstinent smokers and non-smokers were administered nicotine in six experi-ments. Three reported no effect of smoking (El-gerot, 1976; Knott & Venables, 1980) or nicotinepolacrilex (Hindmarch et al., 1990, Experiment 2)on reaction time and perceptual speed tasks. Twoexperiments found that nicotine polacrilex pro-duced faster motor reaction times (5-9% overplacebo values), but had no effect on recognitiontime in a choice reaction time test (Hindmarch etal., 1990, Experiment 1; Kerr et al., 1991). Spilich,June, and Renner (1992, Experiment 5) found thatnonabstinent smokers who smoked before testinghad more collisions in a computerized drivingsimulator than deprived smokers or nonsmokers.

Summary of focused attention. All 10 experi-ments with abstinent smokers and 6 experimentswith nonabstinent smokers and nonsmokers re-ported that smoking and nicotine either had noeffect or, in two studies, impaired test perfor-mance. Five experiments found enhanced perfor-mance in some subjects or on one aspect of thetest. Thus, nicotine does not reliably enhance theability to focus attention on a single task for a brieftime or enhance the psychomotor response re-quired in such tests.

Selective Attention

Selective attention was denned as the ability toattend to a target stimulus while simultaneouslyignoring irrelevant or distracting stimuli. Twelvestudies (13 experiments) assessed performance onsuch tests; duration of the tests was generally brief,but not always indicated. Searching for a targetletter amid an array of nontarget letters wasinvestigated in 8 experiments, and the Stroop testwas used in 6 studies. The Stroop test comparesthe time required for subjects to name the inkcolor of color words that are incongruent (e.g., theword red printed in blue) versus the ink color ofneutral stimuli, such as noncolor words or coloredsquares. Typically, the incongruent task takes moretime than the neutral stimulus task because thetendency to read the color word interferes withnaming its ink color; the difference in time be-tween the two tasks is considered a measure ofselective attention or distractibility (Stroop, 1935).

Nicotine deprivation. Smokers were abstinentfor 1-12 hr before experimental sessions in sevenstudies. Smoking or nicotine enhanced lettersearching (Parrott & Craig, 1992; Williams, 1980;Williams, Tata, & Miskella, 1984) and Stroop test(Hasenfratz & Battig, 1992; Landers et al., 1992,Experiment 2) performance. The enhancementwas modest (5-10% of control values); however,none of these studies measured predeprivationperformance. Two studies (Parrott & Roberts,1991; Snyder & Henningfield, 1989) avoided thismethodological pitfall by assessing performance ofsmokers during nonabstinent and abstinent statesand found that smoking and nicotine functioned torestore withdrawal-induced deficits to, but notabove, nonabstinent levels. Parrott and Craig (1992)also found that smoking and polacrilex had noeffect on Stroop test performance.

No deprivation. Five experiments tested theeffects of smoking in nonabstinent smokers ornicotine in nonsmokers. Provost and Woodward(1991) reported that polacrilex enhanced Strooptest performance in nonsmokers; however, threeexperiments found no effect of smoking or nicotineon letter-searching tests (Heishman, Snyder, &Henningfield, 1993; Spilich et al., 1992, Experi-ment 1) and the Stroop test (Wesnes & Revell,1984, Experiment 2). Spilich et al. (1992, Experi-ment 2) reported that nonabstinent smokers were


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slower than nonsmokers in detecting a change in aspan of letters.

Summary of selective attention. Five of sevenstudies conducted with nicotine-deprived smokersreported that smoking or nicotine enhanced selec-tive attention, but without predeprivation baselinedata, absolute enhancement must be questioned.In two studies, smoking and nicotine reverseddeprivation-induced deficits but did not enhanceperformance. Similarly, four of five studies withnonsmokers or nonabstinent smokers reportedthat nicotine had no effect or impaired test perfor-mance. Thus, in abstinent and nonabstinent smok-ers and nonsmokers, the evidence for nicotine toenhance selective attention is weak.

Divided Attention

The five studies (seven experiments) included inthis section incorporated tests that required sub-jects to divide their attention between two simulta-neous tasks for brief periods of time. In threestudies, subjects performed a 5-min compensatorytracking task while responding to peripheral visualstimuli. The other two studies involved auditorysignal detection tasks.

Nicotine deprivation. In four of the seven experi-ments, smokers were abstinent for 10-12 hr beforetesting. Sherwood et al. (1992) found that nicotinepolacrilex decreased tracking errors, but had noeffect on reaction time to peripheral lights. Leigh,Tong, and Campbell (1977) reported decreasederror rate in a binaural signal detection test aftersmoking three cigarettes (Experiment 1), but noeffect after one cigarette (Experiment 2). Knott(1985b) reported no effect of smoking on a testcombining auditory signal detection and visualchoice reaction.

No deprivation. Nonabstinent smokers and non-smokers were administered nicotine polacrilex inthree experiments. Tracking errors were reduced(4-8% of placebo values), yet reaction time wasunaffected by polacrilex in two experiments (Hind-march et al., 1990, Experiment 1; Kerr et al., 1991),and Hindmarch et al. (1990, Experiment 2) re-ported no effect of polacrilex on tracking orreaction time.

Summary of divided attention. The effect ofnicotine on divided attention has been studied inonly two experimental paradigms. Limited facilita-tion was reported in four of seven experiments. In

tobacco-abstinent smokers, error rates were re-duced by nicotine, but on only one of two tasks orafter smoking three, but not one, cigarettes. Simi-lar results were reported in nonabstinent smokersand nonsmokers, with modest nicotine-inducedenhancement observed in tracking performance,but no change in reaction time.

Sustained Attention

The effect of smoking and nicotine on sustainedattention has been the focus of much research; 38studies (43 experiments) are included in this sec-tion. All of the tests used in these studies, with oneexception (Jones et al., 1992), lasted at least 10min. Although many of these tests measured as-pects of focused, selective, and divided attention,we decided a separate section was appropriatebecause of the distinct results and processes (e.g.,vigilance decrement) observed in tests of sustainedattention that are not possible in tests of shorterduration (Warm, 1984). In addition to the subsec-tions differentiating between studies testing absti-nent and nonabstinent smokers or nonsmokers,two types of sustained attention testing, the rapidvisual information processing (RVIP) test andvigilance tests, are discussed separately.

RVIP test. This test requires subjects to press abutton when they detect three consecutive even orodd digits in a series of single digits presentedvisually at 600-ms intervals. In modified versions,the digit presentation rate is increased after cor-rect responses and decreased after errors. Mea-sures typically include rate of correct target detec-tion (hits), errors (false alarms), digit presentationrate (modified versions), and reaction time. In thefirst studies reporting the effects of nicotine on theRVIP test (Wesnes & Warburton, 1983a, 1984a,1984b), it was performed for 10 min before and for20 min after smoking or nicotine administration.Some recent studies (e.g., Parrott & Craig, 1992)have shortened the postdrug testing to 10 min.Although frequently cited as a test that illustratesthe performance-enhancing effects of smoking ornicotine (e.g., Warburton, 1992; Warburton et al.,1988), the effects of nicotine on the RVIP test areinconsistent. Of the 19 experiments that investi-gated the effect of smoking or nicotine in healthysubjects on the RVIP test (Table 3), 15 reportedeither no effect or impaired performance on some


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ject

s wer

e to

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o de

priv

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r; sm

okel

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cco

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s to

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o ha

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actio

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me

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the

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nd; s

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or a

t lea

st 1

0 hr

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rs w

ere

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inis

tere

d

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hird

of t

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vera

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r one

and

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thir

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dos

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fou

r

w2n

0c

1s

sepa

rate

ran

dom

ized

ses

sion

s; n

onus

ers

rece

ived

noth

ing;

test

s pe

rfor

med

4 m

in a

fter

toba

cco

adm

in-

mea

n St

roop

test

: N

icot

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gum

and

sm

okin

g ha

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effe

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n pe

rfor

man

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tim

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priv

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or 1

2 hr

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cotin

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lacr

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gum

(0,

2, a

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was

che

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40

min

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refe

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cOJE

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ter

canc

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mok

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pare

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thro

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pace

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sess

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gum

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list

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g:

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te w

hen

clic

ks a

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ones

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ects

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lib t

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1.3

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st. A

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r se

para

te c

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e w

as n

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h co

nditi

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sted

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ing

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n tw

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para

te s

essi

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info

r 60

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ed in

cEof~i"o<u

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ver

cour

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ned

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omly

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ither

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igar

ette

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up (

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ode:

Z

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est

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me

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mok

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rate

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ses

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s; t

ask

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r 10

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;ed

corr

ect

resp

ondi

ng a

nd r

esul

tio

n ti

me

than

bot

h no

-sm

okin

g c<

rman

ce i

mpr

ovem

ents

wer

e se

enpu

ffs

and

gene

rall

y pe

rsis

ted

st o

f tas

k. N

o di

ffer

ence

bet

wee

nor

bet

wee

n tw

o co

ntro

l co

nditi

ocl

ined

dur

ing

pre-

and

pos

tsm

oki

s fo

r sm

okin

g an

d no

-sm

okin

gin

g in

crea

sed

num

ber o

f dig

its p

rnu

te f

rom

pre

- to

pos

tsm

okin

g te

; was

not

aff

ecte

d by

sm

okin

g.s t s . g g a s . g ' s - g o c4) nJ ^ > ^ * - ~ . 2 2 • =S S . g ^ g H g S j f e t ;c „ o, £?g 15 g o,^ o, §w > " jS o ofi.Sf S oo f> -o -sc j§ g s g o |.S §•£ S^ • ' " • - ' i C O o ' S o c SI . E ^ - s s S - c a f e g B Sco CL,

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(X, ^ So PL, '"I>:=a2 > «B! BS

g>o « j.•a E e . . o ... « S

ot b

lind;

sm

oker

s w

ere

over

nigh

t to

bacc

o de

priv

eisu

bjec

ts e

ithe

r sm

oked

one

cig

aret

te (

1.2

and

1.5

nico

tine)

, sha

m s

mok

ed a

n un

lit c

igar

ette

, or

did

smok

e in

fou

r sep

arat

e co

unte

rbal

ance

d se

ssio

nsci

gare

ttes

smok

ed o

ne p

uff p

er m

inut

e du

ring

Mi

6-15

of 2

0-m

in ta

skot

bli

nd;

subj

ects

wer

e to

bacc

o de

priv

ed f

or 1

0 hr

subj

ects

ass

igne

d ra

ndom

ly to

eith

er s

mok

ing

(n =

12)

or

no-s

mok

ing

(n =

12)

gro

ups;

30-

min

perf

orm

ed b

efor

e an

d af

ter

smok

ing

ad li

b on

e p

ferr

ed-b

rand

cig

aret

te o

r re

stin

g in

tw

o se

para

tese

ssio

ns

Z Z

| £C QJ

2 "o^1f 1S E jj^ o 13i * £C i/-} tUff> ^4 4— (

c •<*r<i (N

"of-C 00y ' 1*5 : C

SS- *mOO (o - , f — ,ON 3 $J ON

^^ ii3 ^"ON

1 l2^(2 x

Inte

rdig

it in

terv

al b

egan

at 6

66 m

s, i

ncre

ased

wit

hco

rrec

t re

spon

ding

and

dec

reas

ed w

ith

erro

rs b

y33

ms.

Sm

okin

g ha

d no

eff

ect o

n st

imul

us p

rese

n-ta

tion

rate

(di

gits

per

min

ute)

or

reac

tion

tim

eco

mpa

red

wit

h no

-sm

okin

g co

nditi

on.

The

re w

as n

o di

ffer

ence

in

reac

tion

tim

e or

num

ber

of e

rror

s be

twee

n us

ers

and

nonu

sers

at

Sess

ion

1. N

onde

priv

ed u

sers

and

non

user

s sh

owed

com

-pa

rabl

e de

crea

ses

in r

eact

ion

time

at S

essi

on 2

,w

here

as d

epri

ved

user

s w

ere

slow

er c

ompa

red

with

Ses

sion

1.

Dur

ing f

irst

10 m

in o

f pos

tdru

g te

st,

perf

orm

ance

(stim

ulus

pre

sent

atio

n ra

te a

nd r

eact

ion

tim

e)w

as im

prov

ed e

qual

ly f

or s

mok

ing

and

sham

smok

ing

over

pre

drug

test

. Pe

rfor

man

ce d

eclin

eddu

ring

sec

ond

10 m

in t

o gr

eate

r ex

tent

for

sha

mth

an a

ctua

l sm

okin

g.D

urin

g se

cond

5 m

in o

f te

st, s

mok

ing

and

4-m

gni

cotin

e gu

m i

ncre

ased

cor

rect

res

pond

ing

com

-pa

rabl

y ov

er p

lace

bo c

ondi

tion,

whi

ch s

how

ed a

decl

ine

in p

erfo

rman

ce.

Rea

ctio

n ti

me

and

erro

rsw

ere

not s

igni

fica

ntly

aff

ecte

d.

VIP

(m

odif

ied

vesi

on)

as

ot b

lind

; su

bjec

ts w

ere

not t

obac

co d

epri

ved;

sub

ject

sei

ther

sm

oked

ad

lib o

ne p

refe

rred

-bra

nd c

igar

ette

Z

or d

id n

ot s

mok

e in

tw

o se

para

te c

ount

erba

lanc

edse

ssio

ns;

20-m

in t

est c

ondu

cted

onc

e 10

min

aft

er

hoic

e re

actio

n

u

smok

ing

or r

estin

got

blin

d; u

sers

wer

e no

t to

bacc

o de

priv

ed a

t fir

st se

s-

Z

^ _ «1S.&8.2 Ss « SS S-C M> 3'S 'S X>

sion

; us

ers

rand

omly

ass

igne

d to

dep

rive

d (n

= 1

5) o

rno

ndep

rive

d (n

= 1

2) g

roup

s fo

r 24

hr

befo

re S

essi

on2;

toba

cco

chew

ed f

or 2

0 m

in a

t Ses

sion

1 (

all u

sers

)at

6:0

0 po

sitio

nan

d Se

ssio

n 2

(non

depr

ived

gro

up o

nly)

; 23

-min

test

cond

ucte

d on

ce a

fter

toba

cco

chew

ing

<uJ2O

is<L>U

PL,

>ai

ot b

lind

; su

bjec

ts w

ere

toba

cco

depr

ived

for

at

leas

t 2

Z

c~-ooCTv

13

hr;

subj

ects

sm

oked

ad

lib o

ne p

refe

rred

-bra

nd c

iga-

rett

e (M

= 0

.9 m

g ni

cotin

e) o

r sh

am s

mok

ed u

nlit

ciga

rette

and

rec

eive

d al

coho

l or

plac

ebo

in f

our

sepa

rate

cou

nter

bala

nced

ses

sion

s; 2

0-m

in te

st c

on-

duct

ed b

efor

e an

d af

ter

drug

adm

inis

trat

ion

VIP

(se

e W

esne

:&

War

burt

on,

1983

a)

K

oubl

e-bl

ind

(gum

onl

y);

subj

ects

wer

e to

bacc

ode

priv

ed f

or 3

-6 h

r; n

icot

ine

pola

crile

x gu

m (

0, 2

,an

d 4

mg)

was

che

wed

for

21

min

or p

refe

rred

-bra

nd

Q

ciga

rett

e w

as s

mok

ed t

hrou

gh p

aced

pro

cedu

re i

nfo

ur s

epar

ate

coun

terb

alan

ced

sess

ions

; in

gum

ses

-si

ons,

tes

ting

occu

rred

dur

ing

the

last

12

min

of

chew

ing;

in

smok

ing

sess

ion,

tes

ting

bega

n af

ter

two

puff

s, w

ith

cont

inue

d sm

okin

g (o

ne p

uff p

er m

inut

e)fo

r 5 m

in

N 3 M

S^'Sr.I*-H QJ ;CQg a - C Q g.S W

Mai

n fi

ndin

gs

U

£)c«034>

^5

^

CbO

'</)0)Q

<jD3

C/5

SCut-l4}

<4i0

O5

T3 E

„ E.3 ^ o S «1 g »?o c 152.£ " .S a, -0 £ n»* S j< (o M .S 2C 0 0 ft J3 *J -gjO , B S on u „

VIP

: Sm

okin

g pr

oduc

ed f

aste

r re

acti

duri

ng fi

rst,

but n

ot s

econ

d, 5

min

ol

pare

d w

ith n

o-sm

okin

g co

nditi

on.

Sino

eff

ect o

n nu

mbe

r of

cor

rect

res

pcer

rors

. Ins

pect

ion

time

test

: Sm

okin

effe

ct o

n th

is 1

5- 2

0-m

in t

est,

whi

chtr

ansf

er r

ate

of v

isua

l inf

orm

atio

n tc

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measure. Nicotine or smoking improved accuracy,reaction time, or both in 10 experiments; however,all were conducted with smokers who were tobaccodeprived for 3-12 hr before sessions and noneincluded a nonabstinent baseline assessment. Thus,these studies reporting facilitation may have sim-ply documented reversal of withdrawal-induceddeficits to predeprivation performance levels.

Vigilance tests. Tests of sustained attention last-ing at least 30 min are considered tests of vigilance(Jerison, 1970; Warm, 1984). The typical decline inperformance over time in such tests is referred toas the vigilance decrement. There were 15 studiesthat involved vigilance testing, and a clear interpre-tation of the data was possible in 12 studies. Allinvolved cigarette smoking, except Wesnes, War-burton, and Matz (1983), who administered nico-tine tablets orally. The tests used were varied andmeasured divided attention (Heimstra et al., 1980;Myrsten, Andersson, Frankenhaeuser, & Elgerot,1975), reaction time (Frankenhaeuser, Myrsten,Post, & Johansson, 1971; Myrsten, Post, Franken-haeuser, & Johansson, 1972), signal detection(Mangan, 1982; Morris & Gale, 1993, Experiment3; Taylor & Blezard, 1979; Tong, Henderson, &Chipperfield, 1980; Tong, Leigh, Campbell, &Smith, 1977; Wesnes et al., 1983), and RVIP(Hasenfratz, Michel, Nil, & Battig, 1989; Nil,Woodson, Michel, & Battig, 1988). Of the 12studies, 8 found that smoking or nicotine pre-vented the vigilance decrement. However, only 4 ofthe 12 studies reported that nicotine enhancedperformance over baseline or control group levels.In 3 of these 4 studies, subjects were abstinent for3-15 hr before sessions, and the 4th study did notindicate abstinence instructions; none of the stud-ies measured performance when subjects were nottobacco deprived.

Nicotine deprivation. In 23 of the 43 experi-ments testing sustained attention, smokers wereabstinent for 1-14 hr before testing. Thirteenexperiments reported that smoking or nicotineenhanced some aspect of performance; however,none measured baseline performance before en-forced abstinence, so again, absolute improvementmust be questioned. Seventeen experiments foundno effect of nicotine and 3 experiments reportedimpaired performance. Thirteen other experi-ments did not indicate whether subjects weretobacco deprived.

No deprivation. Nonabstinent smokers, nonab-stinent smokeless tobacco users, and nonsmokerseither smoked or were administered nicotine in 9of the 43 experiments. In 8 experiments, 5 of whichused the RVIP test, performance was not affectedby smoking or nicotine (Hasenfratz, Pfiffner, Pel-laud, & Battig, 1989, Experiment 2; Jones et al.,1992; Keenan, Hatsukami, & Anton, 1989; Taylor& Blezard, 1979; Wesnes & Revell, 1984, Experi-ments 1 & 2; Wesnes & Warburton, 1984b, Experi-ment 2; Wesnes et al., 1983). One study reportedthat smoking enhanced reaction time in a simplecontinuous performance test (Pritchard, Robin-son, & Guy, 1992).

Summary of sustained attention. In studies withabstinent smokers, the evidence that smoking ornicotine facilitates sustained attention is mixed,with 13 of 23 experiments indicating enhancement(5-15% of control values), but 20 of 23 experi-ments reporting no effect or impairment on someaspect of test performance. There is strongerevidence that smoking or nicotine can prevent theperformance decrement observed in vigilance tests.In eight of nine studies with nonabstinent tobaccousers and nonsmokers, smoking or nicotine had noeffect on sustained attentional abilities.

Cognitive Abilities

Table 4 summarizes the results of 35 studies (43experiments), and is divided into three sections:learning, memory, and other cognitive abilities.Although learning and memory have been studiedfor decades in psychology as distinct, yet obviouslyrelated, cognitive processes, the vast majority ofnicotine research has focused on memory com-pared with learning. Relatively few studies haveinvestigated other cognitive abilities such as prob-lem solving and reasoning skills.

Learning

Traditional rote, serial, or paired-associate learn-ing paradigms were used in six of seven experi-ments. Dependent measures included number oferrors or correct responses over a fixed number oftrials or number of trials required to reach a setcriterion of errorless trials.

Nicotine deprivation. Three studies used apaired-associate paradigm and tested smokers who


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were minimally abstinent (1-2 hr) before experi-mental sessions. Mangan (1983, Experiment 1)reported that smoking had no effect on acquisitionof word pairs immediately after smoking but pro-duced fewer errors 30 min later. Acquisition test-ing preceded smoking in two studies, which re-ported conflicting results. Mangan and Golding(1983) found that nonsmokers made fewer errorsthan smoking groups when retested at 30 min, 1day, and 1 week. In contrast, Colrain et al. (1992)reported smoking reduced errors 1 week afterinitial acquisition. Smokers were abstinent for8-10 hr in two studies assessing rote learning ofnonsense syllables; both reported impaired re-sponding immediately after smoking (Andersson,1975; Andersson & Post, 1974).

No deprivation. Roth, Lutiger, Hasenfratz, Bat-tig, and Knye (1992) compared nonabstinent smok-ers who smoked at testing and 11-hr abstinentsmokers who did not smoke at testing and foundno difference between the groups on maze learn-ing and recall 1 hr later.

Summary of learning. There is little evidencethat smoking and nicotine enhance learning abili-ties. Only one of seven studies reported an unam-biguous improvement from smoking (Colrain etal., 1992). It is difficult to generalize from resultson the basis of only three experimental models tolearning on a broader scale. Clearly, more researchis needed in which other paradigms are used toclarify nicotine's effect, if any, on the initial acqui-sition of information.

Memory

Memorial functions were measured in 25 studies(32 experiments). The most common method ofassessing memory was to present visually or audito-rily a list of words or numbers to subjects andrequire immediate or delayed recall of all or partof the stimulus information. This paradigm wasused in 23 experiments, yielding a measure ofresponse accuracy (number of correct responses orerrors) and, in some studies, response time. Sixexperiments used a test of information retrievalfrom short-term memory, in which the primarymeasure was the time to respond to whether aprobe digit was present or absent from an originalseries of digits (Sternberg, 1966).

Nicotine deprivation. Smokers were abstinentfor 1-24 hr before testing in 22 of the 32 experi-

ments. Length of deprivation did not consistentlyaffect results. Thirteen experiments reported thatsmoking or nicotine had no effect on some subjectsor aspect of memory, 9 found enhancement, and 7reported impairment. Firm conclusions are elusivewhen differential effects of nicotine on variousmeasures of memory are found in one third of theexperiments. It is clear, however, that nicotinedoes not enhance memory under a broad range ofexperimental conditions.T No deprivation. Ten experiments included non-abstinent smokers and nonsmokers. Two studieswere conducted with nonsmokers diagnosed withAlzheimer's disease. Newhouse et al. (1988) re-ported that a moderate dose of intravenous nico-tine improved delayed recall of a word list but hadno effect on retrieval of word categories. Jones etal. (1992) found that subcutaneous injections ofnicotine reduced attentional, but not memorial,errors in a delayed matching test. Of the nineexperiments testing healthy subjects, four reportedno effect of nicotine (Heishman et al., 1993;Hindmarch et al., 1990, Experiments 1 and 2;Jones et al., 1992), three found impairment (Dunne,MacDonald, & Hartley, 1986; Spilich et al., 1992,Experiments 3 and 4), one reported enhancement(Kerr et al., 1991), and one found enhancedreaction time to a longer, but not shorter, digitspan condition of the Sternberg test (West &Hack, 1991).

Summary of memory. There is no consensus onthe effects of smoking and nicotine on memory.Under conditions of nicotine deprivation and nodeprivation, a roughly equal number of experi-ments indicated that smoking and nicotine eitherhad no effect, enhanced, or impaired memorialfunctions. Nearly one third of the 32 experimentsreported varying effects as a function of the depen-dent measures or individual subject differences.

Other Cognitive Abilities

Nicotine deprivation. Abstinent tobacco userswere tested in four studies. Landers et al. (1992,Experiment 2) reported that smokeless tobaccoenhanced mental arithmetic ability in 10-hr absti-nent users, but the effect was not dose-related. Incontrast, Pritchard (1991) found no effect of smok-ing on mental arithmetic in overnight-deprivedsmokers, and Morris and Gale (1993, Experiment2) reported no effect of smoking on the Raven


Progressive Matrices test in 1-hr abstinent smok-ers. In the only study that measured baselineperformance before enforced abstinence, Snyderand Henningfield (1989) reported that nicotinepolacrilex enhanced response time above baselinein an arithmetic test but had no effect on accuracy.Snyder and Henningfield also reported no effect ofpolacrilex on either speed or accuracy in a test oflogical reasoning.

No deprivation. In two studies, polacrilex wasadministered to nonsmokers and results showedno effect on problem-solving skills (Dunne et al.,1986) or on tests of mental arithmetic and logicalreasoning (Heishman et al., 1993). Elgerot (1976)found that nonabstinent smokers who smokedduring testing solved fewer items on the RavenProgressive Matrices, reasoning, and mentalarithmetic tests compared with when they wereabstinent.

Summary of other cognitive abilities. In tobacco-abstinent smokers, two studies reported that smoke-less tobacco and nicotine polacrilex enhancedmathematical abilities. However, three studies in-dicated that smoking and nicotine had no effect onmathematical and reasoning abilities. Similarly,three studies with nonabstinent smokers or non-smokers reported no effect or impaired perfor-mance on tests of mathematical, reasoning, andproblem-solving abilities. Thus, there is little evi-dence for smoking and nicotine to enhance thesecognitive abilities.

Summary of Effects of Nicotine and Smokingon Performance

Nicotine Deprivation

As discussed, results of studies conducted withnicotine-deprived smokers are difficult to inter-pret. Without predeprivation baseline data, whichfew studies reported, it is difficult to concludewhether nicotine functioned to reverse deprivation-induced deficits or to enhance performance be-yond that observed in the nonabstinent state.Most, but not all, studies in the areas of sensoryabilities, finger tapping, selective attention, andsustained attention found a facilitating effect ofnicotine and smoking in abstinent smokers. Incontrast, half or fewer of the studies reportedpositive effects in tests of hand steadiness, focusedand divided attention, learning, memory, and other

cognitive abilities. Thus, in abstinent smokers,nicotine and smoking may at least reverse depriva-tion-induced deficits in certain abilities, but suchbeneficial effects have not been observed consis-tently across a range of performance measures.

No Deprivation

Studies conducted with nonabstinent smokers ornonsmokers provide a stronger test of the hypoth-esis that nicotine and smoking absolutely enhanceperformance. Such studies indicated that nicotinereliably enhanced finger-tapping rate and pro-duced modest, but limited, improvement in a testof divided attention. In all other areas of perfor-mance, the evidence for an enhancing effect ofnicotine was weak or nonexistent.

Studies Using Rigorous ExperimentalMethodology

Because of the preponderance of methodologi-cal shortcomings in this literature, a secondaryanalysis was conducted of studies that, in ouropinion, used rigorous experimental methodology.Results of these studies would presumably form astrong basis for conclusions concerning the effectsof smoking and nicotine on performance. Theprimary selection criterion was use of a placebocontrol, and a secondary criterion was use ofsingle- or double-blind procedures. Twenty-fivestudies (31 experiments) met these criteria and areidentified in Tables 1-4. All experiments wereplacebo-controlled, and all but two administerednicotine under blind conditions. Other positivedesign features were frequently used. For ex-ample, nonsmokers or nonabstinent smokers weretested in 18 experiments and nicotine was adminis-tered in a form other than smoking (i.e., nasalsolution or spray, polacrilex gum, or tablets) in 24experiments. The seven experiments in which sub-jects smoked used nicotine-free or denicotinizedcigarettes as placebos.

Sensory Abilities


Sherwood et al. (1992) administered nicotinepolacrilex (0 and 2 mg) to overnight-deprived


smokers three times at 1-hr intervals, measuringCFF after each administration. They found thatCFF threshold was increased over predose base-line after the first 2-mg dose, but no furtherincrease after the second and third doses wasobserved. This suggests that the initial dose re-versed deprivation-induced deficits, and subse-quent doses maintained normal functioning. Base-line CFF was not measured in a nonabstinentstate.

No Deprivation

Nicotine was administered through polacrilex orsubcutaneous injection to nonabstinent smokersand nonsmokers in four experiments, and allreported no effect of nicotine on CFF (Hindmarchet al., 1990, Experiments 1 & 2; Jones et al., 1992;Kerr et al., 1991). This lack of effect of nicotine inthe absence of nicotine deprivation is consistentwith the data of Sherwood et al. (1992), furthersuggesting that nicotine functions to reverse with-drawal-induced deficits but does not produce abso-lute enhancement in tests of CFF threshold.

Motor Abilities


Perkins et al. (1990) administered placebo andnicotine (15 jxg/kg) nasal spray to smokers whowere tobacco deprived for at least 12 hr. Theyreported that nicotine reliably increased finger-tapping rate in all subjects and produced a nonsig-nificant trend toward improved hand steadiness.

No Deprivation

In six experiments, nonsmokers were adminis-tered nicotine nasal solution or spray (Perkins etal., 1990; West & Jarvis, 1986, Experiments 1, 2, 3,& 4) or subcutaneous injection (Jones et al., 1992).Finger-tapping rate was increased by nicotine in allexperiments. Perkins et al. also reported thatnicotine nasal spray produced a nonsignificanttrend toward impairment in nonsmokers on a testof hand steadiness.

Attentional Abilities

Focused Attention

Nicotine deprivation. Sherwood et al. (1992)administered polacrilex (0 and 2 mg) to overnight-deprived smokers three times at 1-hr intervals andmeasured recognition and motor reaction timeafter each administration. They reported that rec-ognition time was not affected by nicotine, butmotor reaction time was increasingly faster afterthe second and third doses compared with prenico-tine baseline. However, it should be noted that themean predose baseline assessment for the nicotinesession was 29 ms slower than that for the placebosession, such that motor time after the thirdnicotine dose was only 5 ms faster than the predosebaseline score in the placebo session. Post hoccomparisons between nicotine and placebo ses-sions were not reported.

No deprivation. The Hindmarch group (Hind-march et al., 1990; Kerr et al., 1991) examined theeffect of nicotine polacrilex on choice reactiontime, again differentiating between recognitionand motor components. Testing nonsmokers, Hind-march et al. (1990, Experiment 1) reported noeffect of 2-mg polacrilex on test performance.However, in nonabstinent smokers (Hindmarch etal., 1990, Experiment 2) and a group of nonabsti-nent smokers and nonsmokers (Kerr et al., 1991),polacrilex produced faster motor reaction time butdid not affect recognition time. Between-sessionbaseline differences were not large in these twostudies.

Selective Attention

Nicotine deprivation. Snyder and Henningfield(1989) tested smokers before enforced abstinenceand administered polacrilex (0, 2, and 4 mg) after12 hr of tobacco deprivation. They found thatdeprivation (0-mg condition) produced slowedresponding on a letter-searching test and that 2and 4 mg of polacrilex returned performance topredeprivation baseline. Parrott and Craig (1992)reported that polacrilex (2 and 4 mg) had no effecton Stroop and letter cancellation tests in 12-hrdeprived smokers.

No deprivation. Three studies tested the effectsof nicotine in nonsmokers. Using the Stroop test,Wesnes and Revell (1984, Experiment 2) found no


effect of 1.5-mg nicotine tablets, whereas Provostand Woodward (1991) reported faster responsetime after 2 mg of polacrilex. Heishman et al.(1993) found no effect of polacrilex (2 and 4 mg)on letter-searching response time or accuracy.

Divided Attention

Nicotine deprivation. Using a test that requiredsubjects to perform a central tracking task andrespond to peripheral visual stimuli, Sherwood etal. (1992) found that 2 mg of polacrilex decreasedtracking errors but had no effect on reaction timeto the peripheral lights in overnight deprivedsmokers. Tracking errors were more reduced afterthe third nicotine dose compared with the firstdose and placebo responding was unchanged,suggesting an absolute enhancement of perfor-mance.

No deprivation. Using the same divided atten-tion paradigm with nonabstinent smokers andnonsmokers, Hindmarch et al. (1990, Experiment1) and Kerr et al. (1991) also found that polacrilexdecreased errors on the tracking task but had noeffect on reaction time to peripheral stimuli. Test-ing nonsmokers only, Hindmarch et al. (1990,Experiment 2) reported no effect of 2 mg ofpolacrilex on either tracking or reaction timeperformance.

Sustained Attention

Nicotine deprivation. The RVIP test was usedin four experiments. Wesnes and Warburton(1983a, Experiment 2) reported that test accuracyand reaction time were improved in overnightdeprived smokers after smoking active cigarettescompared with a nicotine-free cigarette. In smok-ers who were tobacco deprived for 3-12 hr, twostudies (Parrott & Craig, 1992; Parrott & Winder,1989) found that correct responding on the RVIPtest was improved by polacrilex (2 and 4 mg)relative to placebo, but reaction time was notaffected. Michel, Hasenfratz, Nil, and Battig (1988)tested the effect of polacrilex (0 or 4 mg) in 2-hrabstinent smokers and found that RVIP test accu-racy and reaction time were not affected by nico-tine. Lastly, Wesnes et al. (1983) administerednicotine tablets (0, 1, and 2 mg) to 12-hr deprivedsmokers three times during an 80-min vigilance

test. Signal detection declined from baseline in alldose conditions, but the decline was less withactive nicotine compared with placebo.

No deprivation. Nonsmokers were adminis-tered nicotine tablets or injections in five experi-ments. Four experiments found that nicotine hadno effect on the RVIP test compared with placeboconditions (Jones et al., 1992; Wesnes & Revell,1984, Experiments 1 & 2; Wesnes & Warburton,1984b, Experiment 2). Nonsmokers were also ad-ministered nicotine tablets in the Wesnes et al.(1983) study, in which vigilance performance de-clined less after nicotine than placebo. There wasno difference between abstinent smokers and non-smokers, suggesting that nicotine functioned to re-verse a vigilance decrement and potential withdrawal-induced deficits in the 12-hr abstinent smokers.

Cognitive Abilities

Learning

Two studies investigated the effect of smoking innicotine-deprived smokers. Using a verbal rote-learning paradigm, Andersson and Post (1974)presented a list of nonsense syllables 30 times toovernight-deprived smokers. One cigarette (activeor nicotine-free) was smoked after the 10th and20th trial. Following the first cigarette, anticipatoryresponding was improved in the placebo comparedwith the nicotine condition; after the second ciga-rette, there was no difference between conditions.Because of the decreased scores after the firstnicotine cigarette, the gain in learning from Trials11-20 to Trials 21-30 was greater for the nicotinecondition compared with placebo. In a study byColrain et al. (1992), smokers who were 2-hrabstinent learned a list of word pairs to criterion,then rested or smoked one cigarette with a nico-tine yield of 0.07 (denicotinized), 0.6, or 1.1 mgnicotine. When retested 1 week later, number oferrors to criterion was reduced by nicotine in adose-related manner.

Memory

Nicotine deprivation. Abstinent smokers weretested in nine experiments. In each of threeexperiments conducted with 10-hr abstinent smok-ers (Warburton, Rusted, & Fowler, 1992, Experi-ments 1 & 2; Warburton, Rusted, & Miiller, 1992),


individual differences were evident, such that mostsubjects recalled more words after nicotine tabletsor cigarettes, yet some subjects' recall improvedafter placebo tablets or denicotinized cigarettesand some showed no difference between condi-tions. Reaction time on the Sternberg (1966)memory test was faster after smoking (Sherwoodet al., 1992) and polacrilex (West & Hack, 1991)compared with placebo conditions. In contrast tothese positive effects of nicotine on memory, threestudies reported no effect of nicotine tablets orpolacrilex on tests of immediate and delayed recall(Parrott & Winder, 1989; Rusted & Eaton-Williams, 1991; Snyder & Henningfield, 1989).Finally, Houston et al. (1978) reported that imme-diate and delayed recall of 3-hr abstinent smokerswas impaired after smoking a nicotine cigarettecompared with a nicotine-free cigarette.

No deprivation. The eight well-designed experi-ments were discussed in the preceding narrative ofthe entire literature. Briefly, two experiments re-ported that nicotine improved some aspects ofmemorial functioning in patients with Alzheimer'sdisease (Jones et al., 1992; Newhouse et al., 1988),two found enhanced reaction time on the Stern-berg test (Kerr et al., 1991; West & Hack, 1991),four reported no effect of nicotine on tests ofimmediate and delayed recall (Heishman et al.,1993; Hindmarch et al., 1990, Experiments 1 & 2;Jones et al., 1992), and one found that polacrileximpaired immediate and delayed recall and recog-nition memory (Dunne et al., 1986).

Other Cognitive Abilities

Nicotine deprivation. Testing 12-hr abstinentsmokers, Snyder and Henningfield (1989) reportedthat polacrilex (2 and 4 mg) enhanced responsetime above predeprivation baseline in an arith-metic test but had no effect on accuracy. Polacrilexalso had no effect on either speed or accuracy in atest of logical reasoning.

No deprivation. Two studies conducted withnonsmokers reported no effect of nicotine onseveral cognitive tests. Dunne et al. (1986) foundthat 4 mg of polacrilex did not affect the ability togenerate correct answers to word and numberproblems. Heishman et al. (1993) reported thatpolacrilex (2 and 4 mg) had no effect on responsetime and accuracy on tests of logical reasoning andmental arithmetic.

Summary of Studies Using RigorousMethodology


The issue of distinguishing between nicotineproducing reversal of deprivation-induced perfor-mance deficits and absolute enhancement remainsa methodological problem in placebo-controlledstudies conducted with abstinent smokers. Anadditional problem in drawing conclusions fromstudies in this category is that only one rigorousstudy was identified in each of six areas of perfor-mance (sensory; motor; focused, selective, anddivided attention; and other cognitive abilities).About half of the studies assessing sustained atten-tion and memory reported a positive effect ofnicotine; however, the effects were limited to somesubjects or one aspect of test performance.

No Deprivation

The strongest conclusions concerning the effectsof nicotine and smoking on human performancecan be drawn from studies in this category. Thesestudies indicated that nicotine absolutely en-hanced finger-tapping rate and motor respondingin tests of focused and divided attention. On thebasis of more limited evidence, nicotine producedfaster motor responses in the Sternberg (1966) testof memory and reversed the vigilance decrementin a sustained attention test. However, no studiesreported absolute enhancement of sensory abili-ties, hand steadiness, selective and sustained atten-tion, learning, and other cognitive abilities. Thus,on the basis of placebo-controlled studies con-ducted with nonabstinent smokers or nonsmokers,nicotine and smoking reliably enhanced only mo-tor abilities, including motor responses to visualstimuli in brief tests of attention.

A Behavioral Pharmacological Analysis:Modulating Variables

That nicotine's effects on performance differunder conditions of nicotine deprivation versus nodeprivation should not be surprising when oneconsiders the behavioral pharmacological prin-ciple that the effect of a drug in an individual is aninteractive function of organismic and environmen-tal conditions (Thompson & Schuster, 1968). Thus,


the mechanisms by which a drug alters perfor-mance are varied and complex (Heishman &Henningfield, 1991). Some of the numerous inter-acting variables that determine the ultimate effectof a drug include: (a) drug dose and route ofadministration; (b) physiological and psychologicalstate of the individual, including degree of previ-ous experience with the drug; (c) reinforcementcontingencies maintaining behavior, and (d) na-ture and demands of the performance test. Theeffects of nicotine on performance will be dis-cussed in terms of these variables.

Nicotine Dose

A basic principle in pharmacology is that magni-tude of effect varies with drug dose. However, thedose-response function of nicotine has not beenadequately characterized for measures of humanperformance. Because of the difficulties associatedwith effective dose control during cigarette smok-ing, we examined only placebo-controlled studiesin which at least two active doses of nicotine wereadministered in a form other than smoking.

Of the 11 studies that met these criteria, 8involved the administration of two active nicotinedoses (Heishman et al, 1993; Hindmarch et al.,1990, Experiment 1; Parrott & Craig, 1992; Parrott& Winder, 1989; Rusted & Eaton-Williams, 1991;Snyder & Henningfield, 1989; Wesnes et al., 1983;West & Jarvis, 1986, Experiment 2), and 3 studiesadministered three active doses (Jones et al., 1992;Newhouse et al., 1988; Wesnes & Warburton,1984b, Experiment 2). Most studies measuredseveral aspects of performance, and all categoriesof performance were represented. Seven studiesreported no effect of nicotine dose on some or allperformance tests (Heishman et al., 1993; Hind-march et al., 1990, Experiment 1; Jones et al., 1992;Parrott & Craig, 1992; Parrott & Winder, 1989;Rusted & Eaton-Williams, 1991; Wesnes & War-burton, 1984b, Experiment 2). Three studies re-ported nicotine effects that were comparable inmagnitude for all active doses (Hindmarch et al.,1990, Experiment 1; Jones et al., 1992; Wesnes etal., 1983). However, dose-related^ effects wereobserved in 7 studies. In 6 of these studies,dose-response curves were essentially linear forvarious measures across all performance catego-ries (Hindmarch et al., 1990, Experiment 1; Joneset al., 1992; Newhouse et al., 1988; Parrott &

Winder, 1989; Snyder & Henningfield, 1989; West& Jarvis, 1986, Experiment 2). In two studies, doseeffects were curvilinear; optimal performance wasobserved at mid-range nicotine doses in tests ofsustained attention (Parrott & Craig, 1992) andfinger tapping (Jones et al., 1992).

That only 11 studies administered placebo andmultiple doses of nicotine in a form other thantobacco cigarettes and that only 1 study (Hind-march et al., 1990) measured plasma nicotineconcentration suggest that more research is neededbefore definitive answers are reached concerningthe relation between delivered dose of nicotineand magnitude of performance effect.

Physiological and Psychological State

The most frequently manipulated state variableamong the reviewed studies was tobacco depriva-tion. This variable was not investigated systemati-cally in most studies, rather, subjects were re-quired to abstain from smoking for some period oftime before experimental sessions, and verificationof abstinence was based only on a verbal responsefrom subjects. In general, this review has shownthat facilitating effects of nicotine were morefrequently reported in studies with abstinent smok-ers than in those testing nonabstinent smokers ornonsmokers. These salutary effects indicate nico-tine's ability to reverse deprivation-induced defi-cits in concentration and task performance.

Another state-related issue is the possibility thatnonsmokers respond differently to the effects ofnicotine than smokers. Numerous studies testedsmokers who smoked and nonsmokers who did notsmoke (e.g., Mangan & Golding, 1983; Spilich etal., 1992); however, nicotine was administered tosmokers and nonsmokers and their performancecompared under identical test conditions in onlysix studies. All of these studies administered nico-tine to nonsmokers in a form other than tobaccocigarettes for ethical and scientific reasons. Twostudies reported differential responding (Hind-march et al., 1990; Perkins et al., 1990), whereasfour found no differences (Jones et al., 1992; Kerret al., 1991; Wesnes et al., 1983; Zdonczyk et al.,1988). Further research comparing performanceeffects of nicotine in smokers and nonsmokers mayelucidate important behavioral processes underly-ing individual differences in the etiology of tobaccouse and dependence.


Reinforcement Contingencies

The field of behavioral pharmacology has usedmany of the principles of operant psychology inanalyzing experimentally the interactions of drugsand behavior. One of the most important determi-nants of behavior are the reinforcement contingen-cies maintaining that behavior (Thompson &Schuster, 1968). The arrangement specifying therelation between the behavior (response) of inter-est and reinforcement is referred to as a scheduleof reinforcement. Because an individual's perfor-mance can vary due to many factors, it would seemthat studying test performance under explicitlydefined reinforcement (e.g., monetary) contin-gency conditions would be important to an analysisof a drug's effect on performance. However, onlythree studies (Perkins et al., 1990; Pritchard et al.,1992; Schori & Jones, 1975) used some form ofreinforcement contingency to maintain optimalperformance, and none compared behavior undervarying reinforcement schedules or under contin-gent versus noncontingent conditions. With so fewstudies using an explicit schedule of reinforce-ment, any conclusion concerning the effectivenessto maintain stable performance would be prema-ture. Future studies should compare performancewith and without reinforcement contingencies andincorporate such schedules of reinforcement when-ever possible.

Nature and Demands of the Performance Test

Studies have shown that performance tests aredifferentially sensitive to the effects of drugs. Forexample, ethanol and several benzodiazepines im-paired performance to a greater extent and for alonger time on difficult versions of a tracking taskand Digit Symbol Substitution Test compared witheasier versions of the tests (Linnoila et al., 1990;Nikaido, Ellinwood, Heatherly, & Gupta, 1990).Using the repeated acquisition of behavioral chainstest, which allows a separate analysis of learningand performance, Higgins and colleagues (Bickel,Hughes, & Higgins, 1990; Higgins et al., 1992;Higgins, Woodward, & Henningfield, 1989) re-ported that ethanol, atropine, and benzodiaz-epines impaired acquisition of novel responseswithout adversely affecting repeated performanceof the same response. These studies suggested thatdifficult versions of a test or aspects of tests

requiring greater cognitive processing (learning vs.performance) were more sensitive to the impairingeffects of various drugs.

The effects of smoking or nicotine have beenassessed in several studies that varied test diffi-culty. In 15 studies (16 experiments), test difficultywas directly manipulated or allowed to vary accord-ing to accuracy of performance (Dunne et al.,1986; Hasenfratz & Battig, 1992; Hasenfratz, Ja-quet, Aeschbach, & Battig, 1991; Hasenfratz,Michel, et al., 1989; Hasenfratz, Pfiffner, et al.,1989; Knott, 1985a; Kucek, 1975; Michel & Battig,1989; Michel et al., 1988; Nil et al., 1988; Rusted &Warburton, 1992; Schori & Jones, 1974, 1975;Spilich et al., 1992, Experiments 1 & 3; West &Hack, 1991). In 6 of the 9 experiments in whichlevel of difficulty was manipulated, smoking ornicotine condition did not interact with test diffi-culty (Dunne et al., 1986; Knott, 1985a; Kucek,1975; Rusted & Warburton, 1992; Spilich et al.,1992, Experiments 1 & 3). In 2 of the other 3studies, smoking produced faster reaction time indifficult compared with easy test versions (Hasen-fratz & Battig, 1992; West & Hack, 1991), whereas1 study found slower responding after smoking inthe less complex test (Schori & Jones, 1974). Of 6studies using a modified version of the RVIP test,which increased in difficulty as performance accu-racy increased, 2 reported that smoking enhancedperformance (Hasenfratz et al., 1991; Hasenfratz,Michel, et al., 1989), 1 showed smoking producedless of a decline in performance than not smoking(Nil et al., 1988), and three reported no effect(Hasenfratz, Pfiffner, et al., 1989; Michel & Battig,1989; Michel et al., 1988). Schori & Jones (1975)found that smoking had no effect on level ofdifficulty attained on a divided attention test.Thus, although nicotine effects can vary accordingto task difficulty, the majority of studies did notindicate that difficult tests were more sensitivethan easier tests to the effects of smoking ornicotine.

Comparing across and within studies in Tables1-4, there is no evidence that tests demandingcognitive abilities are more sensitive to the effectsof nicotine compared with those measuring motoror attentional behavior. For example, of the 13studies assessing cognitive and motor or atten-tional abilities in the same study (Carter, 1974;Elgerot, 1976; Heishman et al., 1993; Hindmarchet al., 1990; Jones et al., 1992; Kerr et al., 1991;


Landers et al., 1992; Morris & Gale, 1993; Parrott& Winder, 1989; Sherwood et al., 1992; Snyder &Henningfield, 1989; Spilich et al., 1992; Williams,1980), none reported that smoking or nicotinealtered performance on the cognitive test and noton the motor or attentional test. Additionally,there is little evidence that nicotine differentiallyaffects cognitive versus motor abilities when bothare required in the same test. For example, theRVIP test involves some degree of cognitive pro-cessing to detect a target stimulus, as do allattentional tests, and a timed motor response. Ofthe 19 experiments using the RVIP test in healthysubjects (Table 3, Sustained attention), only 5reported that smoking or nicotine affected accu-racy and not reaction time.

Concluding Comments

The purpose of this review was to examine theeffects of nicotine administration and cigarettesmoking on human performance to clarify the roleof nicotine-induced effects as determinants of theinitiation and maintenance phases of smokingbehavior. The distinction between studies con-ducted with nonabstinent smokers or nonsmokersand those conducted with abstinent smokers canprovide some insight.

In nonabstinent smokers and nonsmokers, nico-tine produced absolute enhancement of finger-tapping rate and motor responses in brief tests ofattention. All other aspects of performance, includ-ing cognitive functioning, were not reliably en-hanced. These enhancing effects do not appear tobe of sufficient generality or magnitude to explainwhy people find cigarette smoking highly reinforc-ing during the initiation phase of tobacco depen-dence.

In contrast, studies with abstinent smokers re-ported a greater frequency of nicotine enhance-ment. Although critical predeprivation baselinedata was missing from the majority of such studies,these positive effects indicated that nicotine canreverse deprivation-induced deficits in sensory abili-ties, finger tapping, and selective and sustainedattention. These data support the conclusion thatnicotine deprivation is a condition that controlsthe maintenance of cigarette smoking in nicotine-dependent persons and that one mechanism of thisbehavioral control is that nicotine functions to

restore deprivation-induced deficits in perfor-mance (USDHHS, 1988).

The methodological problems inherent in muchof this literature limit the extent to which firmconclusions can be drawn. Placebo control condi-tions were used in only 24% of experiments andsingle- or double-blind testing conditions weremaintained in 26% of experiments. An imprecisemethod of nicotine dosing, ad lib cigarette smok-ing, was used in 70% of studies, and smokers whowere tobacco deprived for more than 4 hr weretested in at least 65% of experiments. Studies inwhich an unknown dose of nicotine is administeredto individuals in withdrawal who know they aresmoking contribute little to our understanding ofthe performance effects of nicotine.

Although it appears that studies with smallsample sizes did not result in a disproportionatenumber of null outcomes, it should be noted thatour emphasis was on the overall tests of signifi-cance and not on the effect size of the independentvariable and the power of the statistical test todetect that effect. Determining the average statisti-cal power of a research domain can provide insightinto a pattern of significant results. For example, ifpower is around .50, some studies will reportsignificance and others will not (Rossi, 1990). Suchinconsistency is clearly evident in the nicotine andperformance literature and may be due to mar-ginal statistical power. It seems appropriate tofurther the critical analysis of this literature byconducting a meta-analysis, in which effect size iscalculated for each study and close attention ispaid to study characteristics (moderating vari-ables) that may be associated with effect size. Sucha research synthesis provides a systematic meansfor determining the presence or absence of aneffect, the magnitude and directionality of theeffect, and the specific conditions under which theeffect is likely to occur (Cooper & Hedges, 1994).We plan to conduct a research synthesis on thisliterature to enhance the discussion of researchissues in the present review.

To delineate more clearly the conditions underwhich nicotine functions to enhance or impairperformance will require more research on theinteractive influences of nicotine dose and route ofadministration, state of the individual, reinforce-ment contingencies maintaining performance, andthe nature of the performance test. Specifically,future research should attempt to (a) use nicotine


delivery systems other than tobacco cigarettes tocontrol dosage more effectively; (b) measure nico-tine plasma concentrations, especially if cigarettesare used, to verify delivered dose; (c) compare theperformance of smokers in nicotine-deprived andnondeprived states; (d) test nonsmokers to exam-ine nicotine effects in the absence of chronictolerance and dependence; (e) manipulate rein-forcement contingencies under which subjects per-form to examine potential interactive motivationaleffects with nicotine; and (f) use a variety of teststhat span the range of human abilities to furtherour understanding of the effects of nicotine onhuman performance.

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Received September 27,1993Revision received April 14,1994

Accepted April 16,1994 •

New Editors Appointed, 1996-2001

The Publications and Communications Board of the American Psychological Associationannounces the appointment of two new editors for 6-year terms beginning in 1996. As ofJanuary 1, 1995, manuscripts should be directed as follows:

• For Behavioral Neuroscience, submit manuscripts to Michela Gallagher, PhD,Department of Psychology, Davie Hall, CB# 3270, University of North Carolina,Chapel Hill, NC 27599.

• For the Journal of Experimental Psychology: General, submit manuscripts to NoraS. Newcombe, PhD, Department of Psychology, Temple University, 565 Weiss Hall,Philadelphia, PA 19122.

Manuscript submission patterns make the precise date of completion of 1995 volumesuncertain. The current editors, Larry R. Squire, PhD, and Earl Hunt, PhD, respectively, willreceive and consider manuscripts until December 31, 1994. Should either volume becompleted before that date, manuscripts will be redirected to the new editors for consider-ation in 1996 volumes.

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