How do electronic cigarettes affect cravings to smoke or vape? Parsing the influences of nicotine and expectancies using the balanced-placebo design

J Consult Clin Psychol. 2018 May;86(5):486-491. doi: 10.1037/ccp0000303.


Objective: Although electronic cigarettes (e-cigarettes) are frequently initiated for smoking cessation, results from the first two clinical trials testing this suggest that the perceived benefits of vaping may be influenced by non-nicotine factors, including cognitive outcome expectancies. The current study investigated the separate and combined effects of nicotine delivery and outcome expectancies on cravings for cigarettes and e-cigarettes using a balanced-placebo experiment.

Method: Drug dosage (contains nicotine or not) was crossed with instructional set (told nicotine or non-nicotine) during ad lib e-cigarette use sessions by 128 current e-cigarette users (52 identifying as current cigarette smokers or "dual users"). It was hypothesized that reduction in craving for both cigarettes and e-cigarettes following e-cigarette administration would be driven primarily by the instructional set manipulation, reflecting the influence of outcome expectancies.

Results: As hypothesized, among dual users, a main effect of instructional set emerged on reductions in craving to smoke cigarettes, with participants who were told that their e-cigarette contained nicotine reporting greater craving reduction (p = .046). With respect to reduced cravings for e-cigarettes, we found an interaction between drug dose and instructional set (p = .02) such that nicotine e-cigarettes reduced cravings more than non-nicotine e-cigarettes only among participants told to expect nicotine.

Conclusions: Findings suggest that cognitive expectancies contribute to the acute effects of e-cigarettes on craving, which may provide guidance for their potential as smoking cessation aids. (PsycINFO Database Record

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Craving*
  • Double-Blind Method
  • Electronic Nicotine Delivery Systems*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nicotine / administration & dosage*
  • Smoking / psychology*
  • Smoking Cessation / methods
  • Smoking Cessation / psychology
  • Tobacco Use Disorder / psychology
  • Vaping / psychology*
  • Young Adult


  • Nicotine