Varenicline on Reward Responses and Cognition in Adolescent Smokers

This is a pilot project using functional magnetic resonance imaging (fMRI) to examine the
influence of varenicline on reward processing, cognitive control, and regulation of craving
in adolescent smokers. We hypothesize that adolescent smokers receiving varenicline, when
compared with those receiving placebo, will have increased activation of the ventral
striatum (VS) in response to anticipation of rewards in the Monetary Incentive Delay Task
(MIDT), decreased activation of the dorsolateral prefrontal cortex (dlPFC) during exposure
to incongruent stimuli in the Stroop task, and reduced activation of the ventral striatum in
response to tobacco cues, and increased activation of the dlPFC during regulation of
responses to tobacco cues during the Regulation of Craving (ROC) task. The results of this
pilot project will have important implications regarding the use of varenicline for treating
tobacco dependence and understanding varenicline's neurobiological effects in adolescent
smokers.

Inclusion Criteria:

- Between 16-19 years of age

- Able to read and write English

- Smoking 5 or more cigarettes on a daily basis, for at least one year

- Not seeking smoking cessation treatment

- Weighing > 55 kg (121 lbs)

Exclusion Criteria:

- Current criteria for abuse or dependence on another psychoactive substance.

- Current diagnosis of any clinical significant psychiatric disease like major
depressive disorder, panic or anxiety disorder, psychosis, schizophrenia, bipolar
disorder.

- Those with a prior suicide attempt or with active suicidal ideation at baseline

- Any regular use of any psychoactive drugs including anxiolytics and antidepressants

- Pregnant or lactating girls: females of childbearing potential who are unwilling or
unable to use an acceptable method of contraception from at least 14 days prior to
study medication administration until 30 days after the last dose of study
medication. Acceptable methods of contraception are: abstinence; any form of hormonal
contraception such as Depo-Provera, daily oral contraceptive, transdermal patch, or
Nuva-ring; intra-uterine device, sterilization; or double barrier contraception which
is a combination of any two of the following methods: condoms, spermicide, diaphragm.

- Evidence or history of clinically significant neurological, hematological, renal,
endocrine, pulmonary, gastrointestinal, cardiovascular, hepatic, or allergic disease.

- History of prior use of or sensitivity to varenicline.

- Color-blindness

- History of significant head trauma

- Metal in body

- Other medical conditions contra-indicated for MRI

- Past history of marked irritability or agitation when attempting to quit smoking,
determined by the Minnesota Nicotine Withdrawal Questionnaire.