Childhood maltreatment and stress reactivity in cigarette users: Evidence from the Addiction Neuroclinical Assessment (ANA) framework.

Stress is a key mechanism underlying cigarette smoking, yet little is known about how childhood maltreatment (CM) shapes stress-related responses across core addiction domains. Guided by the Addiction Neuroclinical Assessment (ANA) framework, this study examined whether CM exposure moderated within-person changes in negative affect, urge to smoke, and working memory during an acute laboratory stress task in daily smokers (N = 56). Generalized estimating equation results indicated significant main effects of time (β = 0.063, 95 % CI [0.003, 0.123], p = 0.038) and CM exposure (β = 0.217, 95 % CI [0.011, 0.423], p = 0.039) on negative affect, such that higher CM predicted sustained elevations in negative affect across the session. The CM × Time interaction was non-significant. A significant main effect of time on urge to smoke was observed (β = 0.246, 95 % CI [0.168, 0.325], p < 0.001). The main effect of CM on urge to smoke was just above the traditional threshold of significance (β = -0.282, 95 % CI [-0.581, 0.017], p = 0.064) and the primary CM × Time interaction was not significant. However, supplementary analyses treating time categorically indicated a significant CM × Time interaction (p = 0.040), suggesting that the association between CM and urge to smoke differed across phases of the stress protocol. No association was observed between CM exposure and working memory. These findings suggest that CM may be particularly relevant to negative emotionality among cigarette users, while its associations with stress-related changes across other ANA domains warrant further investigation.