Pre-abstinence smoke intake and smoking motivation as predictors of severity of cigarette withdrawal symptoms

Twenty-nine cigarette smokers completed a smoking motivation questionnaire and had expired-air carbon monoxide (CO) and plasma nicotine concentrations measured prior to abstaining from smoking for 24 h. Before and after the abstinence period, the subjects rated mood and physical symptoms known to be affected by cigarette abstinence (e.g. irritability, restlessness). Scores on the dependent smoking subscale of the smoking motivation questionnaire correlated significantly with overall withdrawal severity, craving, and increased irritability. Indulgent smoking scores correlated positively with increased hunger. Pre-abstinence plasma nicotine concentration significantly pedicted craving, hunger, restlessness, inability to concentrate and overall withdrawal severity, while expired-air CO predicted craving and restlessness only. Usual daily cigarette consumption did not significantly predict any withdrawal effects. The data indicate that pre-abstinence measures of smoking motivation and smoke intake may provide a guide to withdrawal severity on smoking cessation and that smokers with a high pre-abstinence nicotine intake experience the greatest discomfort.     

Reports of smoking withdrawal symptoms over a 21 day period of abstinence

This paper presents results from a study which examined the occurrence and time course of smoking withdrawal symptoms in a group of 33 smokers followed over a 21 day period of abstinence. Smoking withdrawal symptoms examined included: irritability, feeling sleepy, sleeplessness, dizziness, coughing, tightness in the chest, constipation, mouth sores, and cravings for a cigarette. Findings showed a fairly consistent pattern of reduction across days of abstinence for six of the nine symptoms examined--irritability, feeling sleepy, dizziness, coughing, tightness in the chest, and cravings. Most symptoms decreased sharply during the first few days of cessation followed by a continued, but slower rate of decline in the second and third week of abstinence. Heavy smokers tended to report more withdrawal symptoms than light smokers, although the difference between heavy and light smokers was statistically significant only with respect to irritability. The implications of these findings for relapse prevention are discussed.     

Physiological and psychological symptoms and predictors in early nicotine withdrawal

The present study assessed the structure and intensity of the nicotine withdrawal syndrome in 30 (22 male, 8 female) heavy smokers across three experimental conditions: smoking, brief abstinence (3.5 h), and extended abstinence (18 h). Physiological variables (heart rate and blood pressure) and psychological variables (anxious and depressed mood) were examined in terms of symptom validity and as predictors of nicotine withdrawal intensity. As length of abstinence increased, heart rate and blood pressure decreased, and anxious and depressed mood increased. Only anxious and depressed mood were significant individual predictors of withdrawal intensity. The symptom structure of withdrawal did not change over time as abstinence levels increased; each symptom's contribution to nicotine withdrawal intensity remained stable throughout the first 18 h of abstinence.     

The effects of a prison smoking ban on smoking behavior and withdrawal symptoms

This study investigated symptoms of distress and nicotine dependence as predictors of nicotine withdrawal symptoms among 188 incarcerated male smokers during a mandated smoking ban. Participants completed a smoking history questionnaire and measures of nicotine dependence, withdrawal, cravings, and distress before the ban and two follow-up times. The majority of smokers (76%) continued to smoke following the smoking ban. Smokers after the ban were more nicotine dependent than were the participants who reported quitting. Smokers also reported more withdrawal symptoms than did participants who quit, even when accounting for nicotine dependence and baseline withdrawal scores. An interaction was found such that distressed smokers had the highest level of nicotine withdrawal. These results have implications for how smoking bans are instituted in prison settings.     

The early time course of smoking withdrawal effects

RATIONALE: There has been little study of the very early time course of the smoking withdrawal syndrome, despite its relevance to the maintenance of both smoking and postcessation abstinence. The literature contains a range of estimates about the early appearance of withdrawal symptoms, but without reference to empirical data. OBJECTIVES: The study aim was to conduct a comprehensive, multimodal assessment of the early time course of the symptoms associated with smoking withdrawal among cigarette smokers. METHODS: Participants were 50 smokers randomly assigned to either abstain or smoke at their own pace during 4 h in the laboratory. Dependent measures included resting heart rate, sustained attention (Rapid Visual Information Processing task; RVIP), selective attention to smoking stimuli (an emotional Stroop task), and self-report (Wisconsin Smoking Withdrawal Scale; WSWS). After baseline assessment, participants were assigned to the two conditions and the dependent measures were collected every 30 min. RESULTS: Generalized estimating equations revealed that abstaining participants displayed greater withdrawal than smoking participants on all measures with the exception of the Stroop task. Statistically significant differences in withdrawal were found within 60 min on heart rate, within 30 min on the RVIP, and between 30 and 180 min postcessation on the various subscales of the WSWS. CONCLUSIONS: These findings provide the first evidence of the early time course of smoking withdrawal symptoms, although further research is needed to distinguish withdrawal from drug offset effects. Implications for understanding the maintenance of daily smoking and for the treatment of tobacco dependence are discussed.     

Relationship of perceived risks of smoking cessation to symptoms of withdrawal, craving, and depression during short-term smoking abstinence

The current study examined the relationship between perceived risks of quitting smoking and the self-reported experience of risks (e.g., cravings) during short-term abstinence. Participants (n=55) were daily smokers enrolled in a study of contingency management for smoking cessation with biochemically confirmed abstinence for 1 week. Participants were divided into groups of higher and lower perceived risk of quitting. There were no differences by risk group in demographics or baseline smoking, nicotine dependence, cravings, withdrawal, and depression. Although participants with higher levels of perceived risks reported a similar pattern of cravings and withdrawal symptoms during abstinence, they experienced higher levels of cravings, withdrawal symptoms, and depression than participants with lower risk beliefs. There were no differences in the relationship of risk to withdrawal symptoms by gender. Smokers with higher levels of perceived risk may find it more difficult to quit and remain abstinent due to higher levels of anticipated or experienced withdrawal symptoms and may benefit from targeted behavioral interventions with regard to risk perception and enhanced coping with withdrawal and other effects of smoking cessation.     

Smoking withdrawal symptoms in two weeks of abstinence

In order to study trends in smoking withdrawal symptoms, 35 participants in a smoking cessation clinic completed four questionnaires daily for 2 weeks. The questionnaire dealt with a variety of symptoms which a factor analysis showed could be grouped into four factors: stimulation, desire to smoke, and physical and psychological symptoms. Changes were observed in reports of symptoms over days. Trend analyses found that each symptom group except stimulation showed significant patterns or changes as a function of days in abstinence. These symptom clusters were all found to have U-shaped functions. In addition, desire to smoke and psychological symptoms showed linear decreases as abstinence proceeded. Light and heavy smokers were found to differ in the pattern of reported stimulation.Ss who were totally abstinent reported less severe craving overall for cigarettes than those who only reduced their cigarette consumption by an average of 60%. Also, the craving of totally abstinentSs dropped off more sharply as abstinence proceeded. The import of these patterns and trends in withdrawal symptoms as a function of time is discussed.     

Effects of tryptophan depletion on acute smoking abstinence symptoms and the acute smoking response

Given the putative role of serotonin in the modulation of smoking withdrawal and the central actions of nicotine, this study examined the affective and neuroelectric correlates of smoking abstinence and cigarette smoking following depletion of the serotonin precursor, tryptophan. In a randomized, double-blind two session (tryptophan depletion [TD] vs. nondepletion), placebo-controlled design, spectrally analyzed electroencephalogram (EEG), self-ratings of withdrawal symptoms and mood states were assessed in 18 male cigarette smokers before smoking abstinence, 5 h postsmoking abstinence and again following sham smoking and the smoking of one cigarette. Compared to a nutritionally balanced amino acid (AA) mixture containing tryptophan (i.e., placebo mixture), oral ingestion of a similar mixture devoid of tryptophan resulted in a 70% reduction of plasma tryptophan but failed to alter the appearance or reversal (by acute cigarette smoking) of withdrawal symptoms, negative mood states and increased slow wave EEG in male smokers deprived of cigarettes. These results, although not supporting a role for the serotonergic system in acute smoking and early smoking abstinence symptoms, are discussed in relation to the neuropharmacology of smoking behavior and suggestions for future work.     

The effects of controlled deep breathing on smoking withdrawal symptoms in dependent smokers

This study was designed to assess the effect of controlled deep breathing on smoking withdrawal symptoms. In two laboratory sessions, dependent smokers refrained from smoking for 4 h. During a deep breathing session, participants were instructed to take a series of deep breaths every 30 min. During a control session, participants sat quietly. Controlled deep breathing significantly reduced smoking withdrawal symptoms, including craving for cigarettes and negative affect (tense, irritable), while resulting in the maintenance of baseline arousal (wide awake, able to concentrate) levels. Furthermore, a history of heavy smoking was associated with greater increases in arousal during the deep breathing session. The results of this preliminary study suggest that controlled deep breathing may be useful for relieving symptoms of smoking withdrawal.     

A decrease in the plasma DHEA to cortisol ratio during smoking abstinence may predict relapse: a preliminary study

Rationale Increases in depressive symptoms during smoking cessation have been associated with risk for relapse. Several studies have linked plasma levels of cortisol and dehydroepiandrosterone (DHEA) or DHEA-sulfate (DHEAS) to depressive symptoms.Objectives To determine whether changes in plasma cortisol, DHEA, or DHEAS levels and emergence of depressive symptoms during smoking cessation are associated with smoking relapse.Materials and methods Subjects were healthy non-medicated men and women, aged 39±12 years, who smoked, on average, 22 cigarettes per day. Depressive symptoms, smoking withdrawal symptoms, and plasma steroid levels were measured before and after 8 days of verified smoking abstinence. Relapse status at day 15 was then determined.Results In the full sample (n=63), there was a trend for changes in depressive symptoms to be associated with relapse. In the subset of 25 subjects with plasma neuroactive steroid data, there was a significant interaction between the change in the plasma DHEA/cortisol ratio from day 0 to day 8 and relapse status at day 15. This ratio was similar before abstinence, but lower at day 8 in relapsed, compared to abstinent, subjects. Changes in the DHEA/cortisol ratio tended to predict changes in depressive symptoms in the women only.Conclusion A decrease in the plasma DHEA/cortisol ratio during 8 days of smoking abstinence was associated with relapse over the following week. Further research is needed to fully characterize sex-specific relationships between abstinence-induced changes in neuroactive steroid levels, depressive or withdrawal symptoms, and relapse. Such research may lead to new interventions for refractory smoking dependence.     

Time course of smoking withdrawal symptoms as a function of nicotine replacement

Subjects (N = 32) provided morning, afternoon, and evening data for week-1 withdrawal from smoking. Withdrawal symptoms were measured using Schneider's Smoker Complaint Scale. Twenty subjects received nicotine gum and 12 subjects received placebo gum. Carbon monoxide levels verified smoking abstinence. Results showed significantly less withdrawal for nicotine gum subjects compared to the placebo group. A significant treatment- x -time of day interaction was also observed: Placebo subjects reported increased withdrawal in the evenings compared to their morning and afternoon scores, and in contrast to nicotine-group responses. The results provide evidence for nicotine withdrawal and its alleviation by nicotine gum.     

Social learning predictors of the avoidance of smoking relapse

The concepts of health valuing, multidimensional locus of control, and self-efficacy were conceptualized to represent related but distinct factors which are strongly associated with health-promoting behavior. The predictive power of this model was tested by following 75 smokers quitting through formal treatment programs and 75 smokers who quit by treating themselves for three months. Discriminant Function Analysis displayed significant predictive power from the model. Self-efficacy was the strongest predictor of abstinence versus relapse, but more accurately for self-treatment than for program treatment groups. Persons attributing greater power to health professionals were more likely to relapse. Health valuing displayed a diminished return curve. Results suggest that the enhancement of self-efficacy may be the most important task of treatment.     

Space-based abstinence: alleviation of withdrawal symptoms in combinative cocaine-phencyclidine abuse

Twenty male combinative cocaine free-base/phencyclidine (space-base) abusers were studied for forty-five days, in a double-blind design. Treatment with desipramine was significantly more effective than placebo in alleviating abstinence symptoms. This study tends to support the catecholamine-depletion hypothesis of cocaine and phencyclidine withdrawal.     

Cognitive and psychological correlates of smoking abstinence, and predictors of successful cessation

The neural circuitry implicated in addictive drug use, which appears to be down-regulated in early abstinence, corresponds closely with brain reward pathways. A literature review suggests that responses to incentive stimuli and the ability to inhibit reflexive responses, both of which have been associated with normal functioning in these pathways, might be weakened during acute abstinence from chronic drug use. In an ongoing study, 82 smokers, abstinent overnight before two separate testing occasions, have been assessed after administration of nicotine and placebo lozenges (order of sessions counterbalanced). Nicotine administration is associated with a significant reduction in anhedonia, a near-significant increase in response to financial incentive, enhanced ability to inhibit reflexive eye movements, and increased attentional bias to words with appetitive significance. Fifty-nine participants then initiated a quit attempt and 19 reported relapsing within 7 days. Comparing their performance in the two prequit lozenge assessment sessions, relapsers showed a stronger effect of nicotine on enhancing their ability to inhibit reflexive eye movements and a near-significant trend towards greater nicotine-induced increases in attentional bias toward appetitive words.     

Acute exercise effects on smoking withdrawal symptoms and desire to smoke are not related to expectation

Rationale Recent research has shown that 10 min of moderate intensity exercise reduce smoking withdrawal symptoms and desire to smoke in acutely abstinent smokers. The aim of the current study was to determine whether the reductions are related to participant expectation of these effects. Materials and methods Forty-five sedentary participants who had smoked ten or more cigarettes per day for at least 3 years reported their expectation of the effects of exercise on smoking withdrawal symptoms. Approximately 1 month later, participants were randomly assigned to one of three groups after 11–15 h of overnight smoking abstinence. Each group read either a positive, negative or neutral statement concerning exercise effects on smoking withdrawal symptoms. They rated their expectation again and then completed 10 min of moderate intensity exercise on a stationary bicycle ergometer. Using standardised scales, participants rated smoking withdrawal symptoms and desire to smoke at 10, 5 and 0 min before exercise, then at 5 and 10 min during exercise and 15 and 20 min post-exercise. Results Expectation of exercise effects on withdrawal were manipulated in the predicted directions. No significant group main effects were found for any symptom. Significant reductions in symptoms and desire to smoke occurred during and after exercise regardless of participant expectation. Conclusions Ten minutes of moderate intensity exercise can lead to reductions in desire to smoke and smoking withdrawal symptoms, which are not due to the participant’s expectation of exercise effects. These findings support the use of short periods of exercise as an aid to smoking cessation.     

Acute effects of nicotine and mecamylamine on tobacco withdrawal symptoms, cigarette reward and ad lib smoking

Separate and combined effects of nicotine and the nicotinic antagonist mecamylamine were studied in 32 healthy volunteer smokers after overnight abstinence from smoking. Subjects participated in three sessions (3 h each), during which they wore skin patches delivering either 0 mg/24 h, 21 mg/24 h or 42 mg/24 h nicotine. Thirty-two subjects were randomly assigned to two groups receiving oral mecamylamine hydrochloride (10 mg) vs. placebo capsules. Two and one-half hours after drug administration, subjects were allowed to smoke ad lib, rating the cigarettes for rewarding and aversive effects. Transdermal nicotine produced a dose-related reduction in the subjective rewarding qualities of smoking. Nicotine also reduced craving for cigarettes and this effect was attenuated, but not eliminated, by mecamylamine. Mecamylamine blocked the discriminability of high vs. low nicotine puffs of smoke, and increased nicotine intake substantially during the ad lib smoking period. Some of the psychophysiological effects of each drug (elevation in blood pressure from nicotine, sedation and decreased blood pressure from mecamylamine) were offset by the other drug. The results supported the hypothesis that nicotine replacement can alleviate tobacco withdrawal symptoms even in the presence of an antagonist such as mecamylamine. Mecamylamine did not precipitate withdrawal beyond the level associated with overnight cigarette deprivation, suggesting its effects were primarily due to offsetting the action of concurrently administered nicotine as opposed to blocking endogenous cholinergic transmission.     

The effects of cigarette smoking and abstinence on auditory verbal learning

Smoking has been associated with both enhanced and impaired cognitive performance; across a variety of domains, but there is limited evidence demonstrating the effects on verbal learning. The current study assessed the effect of smoking and abstinence on verbal learning, immediate memory and retention using the Auditory Verbal Learning Test (AVLT). Three groups: 20 smokers, 20 abstaining smokers and 20 non-smoking adults were assessed on the AVLT on two occasions. At session one, abstaining smokers refrained from smoking for 12 h (pre-cigarette), whilst smokers had continued to smoke to satiety. Session two commenced after a 15-min break when both smoking groups were instructed to smoke a cigarette, followed by administration of the second version of the AVLT (post-cigarette). Abstaining smokers showed significant deficits in learning compared to smokers during the pre-cigarette session. Following re-initiation of smoking in the abstaining smokers, these learning decrements were no longer evident. There were trends towards significant group findings in immediate memory and retention during the pre-cigarette session, which again were no longer evident in the post-cigarette session. These findings provide further evidence that smoking abstinence affects verbal learning and furthermore smoking simply restores cognitive performance to pre-abstinence levels.