The impact of cumulative vulnerabilities on the valuation of cigarettes among veterans seeking to quit smoking.

Military veterans in the United States often face significant obstacles or vulnerabilities known to maintain cigarette smoking including trauma exposure, Post-traumatic Stress Disorder (PTSD), chronic pain, nicotine dependence, withdrawal symptoms, and psychological distress. Behavioral economic principles, including delay discounting and demand, provide a novel framework for understanding the relation between these vulnerabilities and the reinforcement value of cigarettes, a novel potential therapeutic target. This study examined the cumulative effect of multiple vulnerabilities on the reinforcement value of cigarettes among the veterans enrolled in a remotely delivered smoking cessation treatment study. Participants (n = 104) were primarily middle-aged men (52 years old (SD = 10), 89% male). About half (52%) reported high levels of nicotine dependence; nearly all reported exposure to trauma (92%); 29% met criteria for possible PTSD; 52% reported elevated pain levels; and 21% reported severe psychological distress. The number of vulnerabilities was linearly associated with higher delay discounting rates in a cigarette-money cross commodity task, F(1,101) = 4.78, p = 0.031; greater demand intensity, F(1,102) = 14.11, p < 0.001; and lower demand elasticity, F(1,102) = 8.2, p = 0.005, in a cumulative manner, but unrelated to monetary discounting. These findings suggest that the selected vulnerabilities demonstrate a cumulative impact on the reinforcement value of cigarettes. This relation might help to explain the difficulties veterans encounter achieving long-term abstinence from smoking and underscore the need for novel treatment approaches that target the reinforcement value of cigarettes in the context of multiple vulnerabilities.