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Extinction Burst after Varenicline Titration: A Case Report

Published online by Cambridge University Press:  10 April 2013

Marc L. Steinberg  and
Jill M. Williams
Marc L. Steinberg*
Affiliation:
Robert Wood Johnson Medical School, New Brunswick, NJ, USA
Jill M. Williams
Affiliation:
Robert Wood Johnson Medical School, New Brunswick, NJ, USA
*
Address for correspondence: Marc L. Steinberg, Ph.D., Department of Psychiatry, Robert Wood Johnson Medical School, New Brunswick, NJUSA. Email: [email protected]
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Abstract

Background: The mechanism of action of varenicline as a partial agonist may make it useful for cigarette reduction as smokers experience reduced craving and withdrawal at the same time their cigarettes provide reduced reinforcement value.

Case Description: The current case report describes a 51-year-old African American woman using varenicline to reduce her cigarette use. After making a substantial reduction in cigarettes per day (from 25 to 8), the patient unexpectedly began smoking considerably more (from 8 to 20) after 11 days treatment with varenicline.

Conclusions: The temporary increase in smoking while taking varenicline was likely the result of an ‘extinction burst’ where the extinction of a reward (e.g., nicotine's rewarding effects after smoking a cigarette) was temporarily associated with an increase in the behaviour usually associated with the reward (e.g., smoking a cigarette). Once explaining to her that no amount of cigarettes would overcome the feeling of reduced reward she likely felt while taking varenicline, she was able to reduce her smoking again.

Keywords

vareniclinetobaccocigarettecessationextinction burst
Type
Articles
Information
Journal of Smoking Cessation , Volume 8 , Issue 2 , December 2013 , pp. 115 - 118
Copyright
Copyright © The Author(s), published by Cambridge University Press on behalf of Australian Academic Press Pty Ltd 2013 

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