Evaluation of the mood and physical symptoms scale (MPSS) to assess cigarette withdrawal

Rationale The mood and physical symptoms scale (MPSS) was developed in the early 1980s to assess cigarette withdrawal symptoms, and variants of it have been used for 20 years. To date, no paper has been published on the properties of the scale.Objectives To evaluate psychometric properties of MPSS and the interrelationship between the key tobacco withdrawal symptoms.Methods The core elements of the MPSS involve 5-point ratings of depressed mood, irritability, restlessness, difficulty concentrating and hunger and 6-point ratings of strength of urges to smoke and time spent with these urges. The data set chosen for analysis was well suited to the task in that it involved a relatively large sample, abstinence was defined as not a puff for 24 h biochemically verified, participants were not using any medication that would have reduced withdrawal discomfort (e.g. nicotine patch), the abstinence rate was very high resulting in minimal bias due to attrition, and ratings were provided on three occasions prior to abstinence. The study involved 111 smokers setting a target quit date of whom 106 attempted abstinence and 96 achieved it.Results The MPSS items were stable prior to abstinence and sensitive to abstinence. Post-abstinence increases in mood and physical symptoms demonstrated a high level of internal coherence. Ratings of urges to smoke correlated highly with changes in mood and other symptoms. Ratings of hunger correlated less well with the scale as a whole and may involve some distinct processes.Conclusions The MPSS meets the key requirements of a cigarette withdrawal scale. Although urge to smoke/craving was not included in the list of DSM-IV withdrawal symptoms, it should be regarded as forming part of the withdrawal syndrome.     

The effect of abstinence on cigarette consumption upon the resumption of smoking

To study the impact of abstinence on the number of cigarettes smoked per day upon the resumption of smoking, adult current smokers completed retrospective surveys in two studies. The consumption rate demonstrated at the resumption of smoking fell with progressively longer abstinence periods out to 6 months, showing little further reduction even after years of abstinence. Subjects in Study 1 (n=848) resumed smoking at 34% of their lifetime peak rate of consumption, accelerating to 58% at 2 weeks, to 64% at 1 month, and to 68% at 6 months. Subjects in Study 2 (n=803) resumed smoking at 48% of their pre-quit peak rate of consumption, accelerating to 69% at 1 week, to 78% at 2 weeks, and to 88% at 6 months. The trajectory of consumption with the resumption of smoking differs from that in novice smokers, suggesting that some impact of nicotine persists during abstinence. The shapes of the observed trajectories suggest that more than one process may be at work. Prospective studies are needed to confirm these findings.     

Separate effects of cigarette smoke yield and smoke taste on smoking behavior

The purpose of this experiment was to compare independently the influence of different cigarette smoke taste categories and different machine standard smoke yield values on cigarette smoking behavior and related subjective measures. In six separate sessions 15 regular smokers were presented with a medium and a low smoke yield cigarette of each of the three taste categories, mentholated, dark (Gauloises) and blond (Muratti) tobacco. Each session, included a natural and a forced smoking procedure of one cigarette type only. Forced smoking consisted of smoking 30 puffs whereby a new half-length cigarette was presented after every third puff. During the seventh session, habitual brand cigarettes were smoked as a reference. The sessions followed in weekly intervals, and the subjects became familiar with the test cigarettes during the last 5 days preceding each test session. Although general acceptability of the cigarettes, smoking satisfaction and pleasantness of taste were clearly lower for all test cigarettes as opposed to the habitual brand reference, cigarettes, these measures remained unaffected by taste or smoke yield of the test cigarettes. Harshness of smoke was higher in the dark tobacco category and generally decreased with the lower smoke yield cigarettes. Independent effects of taste and smoke yield were obtained for total puff volume, inhalation time and CO absorption, suggesting a compensatory intensification of smoking behavior for low yield cigarettes and an independent increase of smoking intensity from mentholated to dark tobacco to blond tobacco. The results suggest therefore that factors which affect cigarette smoke taste have effects on smoking behavior which are separate from those obtained by comparing smoke yields.     

Comparative analysis of waterpipe and cigarette suppression of abstinence and craving symptoms

This study's objective is to examine the relative effectiveness of cigarettes and waterpipe (WP) in reducing tobacco abstinence symptoms in dual cigarette/WP smokers. Sixty-one dual cigarette/WP smokers participated (mean age±SD 22.0±2.6 year; mean cigarettes/day 22.4±10.1; mean WPs/week 5.2±5.6). After 12-hour abstinence participants completed two smoking sessions (WP or cigarette), while they responded to subjective measures of withdrawal, craving, and nicotine effects administered before smoking and 5, 15, 30 and 45 min thereafter. For both tobacco use methods, scores on measures of withdrawal and craving were high at the beginning of session (i.e., before smoking) and were reduced significantly and comparably during smoking. Analysis of smoking and recovery (post-smoking) phases showed similarity in the way both tobacco use methods suppressed withdrawal and craving, but the recovery of some of these symptoms can be faster with cigarette use. This study is the first to show the ability of WP to suppress abstinence effects comparably to cigarettes, and its potential to thwart cigarette cessation.     

Comparison of cannabis and tobacco withdrawal: severity and contribution to relapse

This naturalistic telephone survey study compared perceptions of withdrawal severity in 67 daily cannabis users and 54 daily tobacco cigarette smokers who made quit attempts during the prior 30 days. A Withdrawal Symptom Checklist assessed the severity of abstinence symptoms and a Likert scale assessed perceived relations between abstinence symptoms and relapse. A composite Withdrawal Discomfort Score did not differ significantly between groups (M = 13.0 for cannabis, vs. M = 13.2 for tobacco). Individual symptom severity ratings were also of similar magnitude, except craving and sweating were slightly higher for tobacco. Both groups reported that withdrawal contributed substantially to relapse, and the strength of these ratings was similar across groups. The diverse convenience sample examined in this study adds external validity and generalizability to prior studies that included only users not planning to quit or excluded many common types of cannabis users. The comparable withdrawal experience from these heterogeneous cannabis and tobacco users supports previous findings from controlled laboratory studies and indicates that real-world, frequent cannabis users perceive that withdrawal symptoms negatively affect their desire and ability to quit.     

Signs and symptoms from nicotine gum abstinence

This study examined and compared withdrawal signs and symptoms from cessation of 0, 2 and 4 mg nicotine gum. In addition, a comparison was made between nicotine gum versus cigarette withdrawal symptoms. Smokers first underwent cigarette deprivation for 4 days and then were randomly assigned to 0 (N=16), 2 (N=25), and 4 (N=21) mg gum. They were asked to chew the gum for 1 month and then to undergo a 4-day nicotine gum deprivation period. The results showed a number of significant changes occurring after deprivation from 4 mg gum, one change from 2 mg gum, and no changes from 0 mg gum. There were no significant differences in severity of withdrawal among the various doses of nicotine gum. There were more severe symptoms of withdrawal from cigarette as opposed to 4 mg nicotine gum deprivation.     

Nicotine self-administration and withdrawal: modulation of anxiety in the social interaction test in rats

RATIONALE: Most smokers report smoking has an anxiolytic effect, which may contribute to nicotine dependence. OBJECTIVE: To examine effects in the social interaction test (SI) of anxiety after 4 weeks' self-administered nicotine (15 infusions of 0.03 mg/kg, totalling 0.45 mg/kg per day), and after 24 and 72 h of withdrawal. The effect of exposure to the operant chamber on withdrawal responses was also examined. METHODS: Animals were trained to self-administer saline or nicotine and after 4 weeks they were tested in SI after their daily self-administration session. Animals were retested after 24 and 72 h withdrawal, when they were either taken directly from the home cage or were tested 5 min after a 30-min exposure to the operant chamber. RESULTS: Compared with the saline control group, the animals that had been self-administering nicotine for 4 weeks showed decreased social interaction with no decrease in locomotor activity, indicating a significant anxiogenic effect of the nicotine infusions. There was no change in social interaction after 24 and 72 h withdrawal from chronic nicotine, regardless of whether or not the rats were exposed to the operant chamber just prior to being tested. CONCLUSIONS: Nicotine self-administration is not maintained because of its anxiolytic effect, but despite, or because of, its anxiogenic effect. There was no evidence of an anxiogenic response after either 24 or 72 h of withdrawal and thus increased anxiety on withdrawal from nicotine does not seem to contribute to nicotine self-administration.     

Comparison of the behavioral effects of cigarette smoke and pure nicotine in rats

Animal models of tobacco dependence typically rely on parenteral administration of pure nicotine. Models using cigarette smoke inhalation might more accurately simulate nicotine exposure in smokers. The primary goal of this study was to validate methods for administering cigarette smoke to rats using exposure conditions that were clinically relevant and also produced brain nicotine levels similar to those produced by behaviorally active doses of pure nicotine. A secondary goal was to begin examining the behavioral effects of smoke. Nose-only exposure (NOE) to smoke for 10-45 min or whole-body exposure (WBE) to smoke for 1-4 h produced serum nicotine concentrations similar to those in smokers (14-55 ng/ml), without excessive carbon monoxide exposure. Daily nicotine (0.1 mg/kg, s.c.) induced locomotor sensitization whereas 45-min NOE producing brain nicotine levels within the same range did not. Nicotine 0.125 mg/kg s.c. reversed withdrawal from a chronic nicotine infusion as measured by elevations in intracranial self-stimulation thresholds whereas 4-h WBE producing similar brain nicotine levels did not. These data demonstrate the feasibility of delivering cigarette smoke to rats at clinically relevant doses, and provide preliminary evidence that the behavioral effects of nicotine delivered in smoke may differ from those of pure nicotine.     

The electronic-cigarette: effects on desire to smoke, withdrawal symptoms and cognition

Electronic cigarettes (e-cigarettes) are battery operated devices that deliver nicotine via inhaled vapour. Few studies have evaluated acute effects on craving and mood, and none have explored effects on cognition. This study aimed to explore the effects of the White Super e-cigarette on desire to smoke, nicotine withdrawal symptoms, attention and working memory. Eighty-six smokers were randomly allocated to either: 18 mg nicotine e-cigarette (nicotine), 0mg e-cigarette (placebo), or just hold the e-cigarette (just hold) conditions. Participants rated their desire to smoke and withdrawal symptoms at baseline (T1), and five (T2) and twenty (T3) minutes after using the e-cigarette ad libitum for 5 min. A subset of participants completed the Letter Cancellation and Brown-Peterson Working Memory Tasks. After 20 min, compared with the just hold group, desire to smoke and some aspects of nicotine withdrawal were significantly reduced in the nicotine and placebo group; the nicotine e-cigarette was superior to placebo in males but not in females. The nicotine e-cigarette also improved working memory performance compared with placebo at the longer interference intervals. There was no effect of nicotine on Letter Cancellation performance. To conclude, the White Super e-cigarette alleviated desire to smoke and withdrawal symptoms 20 min after use although the nicotine content was more important for males. This study also demonstrated for the first time that the nicotine e-cigarette can enhance working memory performance. Further evaluation of the cognitive effects of the e-cigarette and its efficacy as a cessation tool is merited.     

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.     

Cigarette withdrawal symptoms in adolescent smokers

One hundred and sixteen female adolescent smokers were asked about withdrawal symptoms experienced during past attempts to give up smoking for good. Sixty-three percent reported difficulties during abstinence of the kind experienced by adult smokers. Daily smokers were more likely to report withdrawal effects than non-daily smokers (74% versus 47%, P<0.005). Reported experience of withdrawal symptoms was positively related to self-reports of cigarette consumption and depth of inhalation and nicotine intake as indexed by salivary cotinine concentrations. Reported occurrence of at least one withdrawal effect correlated positively with nicotine intake after controlling for behavioural variables. Our results indicate that teenage smokers are likely to suffer withdrawal symptoms when they try to give up. Behavioural factors and expectations based on observations of adults may have played a part in their experience of withdrawal, but it is also likely that pharmacological factors are implicated even at this early stage.     

Effects of oral pH on cigarette smoking.

Permeability of nicotine across the oral mucosa had been shown to be a direct linear function of alkalinity in the oral cavity. Here, oral pH in cigarette smokers was manipulated from pH 5 to 8 by rinses with Sorenson's and McIlvaine's buffers. As a alkalinity increased, cigarette taste was perceived as stronger, more bitter, and, in some cases, more upleasant; and heart-rate accelerated slightly. Nicotine self-administration and blood pressure were not influenced. Differential absorption of nicotine and cross-adaptation of sour to bitter taste are both discussed as explanations for the results.     

Effects of cigarette nicotine content and smoking pace on subsequent craving and smoking

Abstract Rationale. The relative contribution of sensory and pharmacological variables in regulating craving and smoking remains unclear. Rapid smoking procedures and denicotinized cigarettes can be used to further disentangle these factors, and to explore the relationship between craving and smoking. Objective. The present study examined the role of nicotine and sensory cues in mediating craving and smoking, and the relationship between craving and smoking. Methods. Participants (n=15) engaged in one session each of rapid smoking (up to nine cigarettes with puffs taken every 6 s) and normal paced smoking with nicotinized and denicotinized cigarettes (total of four sessions). During the next 3 h, craving and withdrawal assessments and smoking opportunities were scheduled every 15 min. Plasma nicotine levels were measured at baseline, immediately and 15 min after the smoking interventions, and subsequently at the time when the participant first chose to smoke. Results. Craving ratings were equally suppressed immediately after all conditions. After self-paced conditions, both types of cigarettes produced equivalent effects on latency to smoke. Latency to smoke was significantly longer after rapid smoking of nicotinized cigarettes compared to all other conditions. Finally, changes in craving were associated with choices to smoke. Conclusions. The sensory cues associated with smoking suppressed craving ratings regardless of the smoking pace or nicotine content. Only at high doses did nicotine levels play an additional role in acutely suppressing smoking behavior. Small elevations in craving ratings were associated with choices to smoke. Electronic Publication     

Fruit and vegetable intake as a moderator of the association between depressive symptoms and cigarette smoking

ABSTRACT

Background: Studies have consistently reported associations among depression, cigarette smoking, and fruit and vegetable intake (FVI). This study evaluated FVI as a moderator of the association between depressive symptoms and smoking. Methods: The authors analyzed data from the National Longitudinal Survey of Youth 1979: Child and Young Adult. The study sample was adults aged 19–33 years at baseline in the year 2004 from the Young Adult Survey portion. Moderation analyses were performed using the Johnson-Neyman technique to assess whether baseline FVI moderated the association between depressive symptoms and smoking status cross-sectionally and as a predictor of smoking cessation longitudinally at 4-year follow-up. Results: Cross-sectionally, at lower levels of FVI (<4.9 times/day), there was a significant association between smoking and depressive symptoms (P < .05), but not at higher levels of FVI (≥4.9 times/day; P > .05). Longitudinally, there was an inverse association between depressive symptoms and quitting smoking at FVI <1.2 times/day (P < .05), but there was not a significant association at FVI ≥1.2 times/day (P ≥ .05). Conclusions: FVI moderated the association between depressive symptoms and cigarette smoking cross-sectionally and longitudinally. The cross-sectional findings might be partially explained by the longitudinal findings paired with prior research; there might be fewer smokers with high FVI because depressive symptoms are removed as an impediment to cessation. Further experimental research is warranted to test the efficacy of increased FVI as an adjunct to smoking cessation, with a possible mechanism of action being reduced depressive symptoms during quit attempts.     

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 mecamylamine on human cigarette smoking and subjective ratings

Multiple measures of cigarette smoking, subjective effect and physiological effect were collected during 90-min test sessions in normal volunteers. Before sessions subjects received oral doses of mecamylamine (2.5, 5.0, 10, 20 mg) or placebo. Each dose and placebo was given three times in a randomized block sequence. Mecamylamine increased several measures of cigarette smoking, including number of cigarettes, number of puffs per cigarette, and expired air carbon monoxide level. Mecamylamine also produced modest, dose-related decreases in standing blood pressure and increases in standing heart rate. The subjective effects produced by mecamylamine were not characteristic of those of psychoactive drugs. Mecamylamine appears to have increased cigarette smoking by decreasing the effective dose level of nicotine available from cigarette smoking.     

Effect of varenicline and bupropion SR on craving, nicotine withdrawal symptoms, and rewarding effects of smoking during a quit attempt

Aims To examine the effect of varenicline, a selective alpha4-beta2 nicotinic acetylcholine receptor (nAChR) partial agonist, on craving and withdrawal symptoms in smokers making a quit attempt and the rewarding effects of smoking during a lapse after the target quit date (TQD). Materials and methods Pooled data were analysed from two identical double-blind, randomised trials comparing varenicline 1 mg BID, bupropion (sustained release) 150 mg BID and placebo using measures of craving and withdrawal in the first week after the TQD (in abstinent [n = 612] and non-abstinent participants [n = 1,155]) and of the rewarding effects of the first cigarette smoked in non-abstinent participants. Results In abstinent and non-abstinent participants combined, varenicline reduced craving more than bupropion (p < 0.01) and placebo (p < .001); the effect did not differ by whether or not subjects were abstinent; bupropion reduced craving more than placebo (p < 0.001). Among abstinent participants, both varenicline and bupropion reduced negative affect more than those receiving placebo (p < 0.005). Neither active drug reduced restlessness, insomnia or appetite vs placebo. Varenicline reduced ratings of satisfaction and psychological reward after the first cigarette smoked after the TQD vs bupropion (p < 0.005) and placebo (p < 0.001); bupropion also reduced these more than placebo (p < 0.05). Conclusions Varenicline significantly reduces craving and the rewarding effects of smoking after the TQD to a greater extent than bupropion, which may contribute to varenicline’s greater efficacy for smoking cessation. Varenicline’s lack of effect in reducing insomnia, restlessness and increased appetite in this analysis suggests that receptors other than the alpha4-beta2 nAChR subtype may be implicated in these withdrawal symptoms.     

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.     

Effects of withdrawal from chronic exposure to cigarette smoke on hypothalamic and preoptic catecholamine nerve terminal systems and on the secretion of pituitary hormones in the male rat

Summary A 48 h but not a 72 h or 7 day withdrawal from chronic exposure to cigarette smoke was associated with increased noradrenaline levels (quantitative histofluorimetry) in the subependymal layer (SEL) of the median eminence, the anterior periventricular hypothalamic region (PV I) and the parvocellular part of the hypothalamic nucleus (PA FP) and an increased noradrenaline utilization (tyrosine hydroxylase inhibition by MT) in the SEL and the PV I. Following a 48 h or 72 h but not a 7 day withdrawal from chronic exposure to cigarette smoke an increased catecholamine utilization was found in the medial palisade zone (MPZ) of the median eminence. Reduced serum prolactin, FSH and corticosterone levels were found following a 48 h withdrawal from chronic exposure to cigarette smoke. Following a 72 h withdrawal from chronic exposure to cigarette smoke a reduced concentration of serum prolactin was noted. Chronic exposure to cigarette smoke reduced serum TSH levels and lead to a tolerance development with regard to noradrenaline levels and utilization within the preoptic region with the exception of the periventricular preoptic region. The finding of special interest in the present study is the demonstration of a highly significant lowering of corticosterone serum levels despite maintained blood levels of ACTH as seen 48 h following withdrawal. It is suggested that this type of endocrine change may lead to changes in fear-motivated behaviour and contribute to behavioural withdrawal reactions. The maintained reductions of serum prolactin levels found after 48 h and 72 h of withdrawal from cigarette smoke exposure (cf. Andersson et al. 1985a) is discussed in terms of an increased catecholamine utilization in the medial palisade zone of the median eminance. This activation is suggested to be caused by the development of a prolactin receptor supersensitivity within the medium eminence. The present evidence indicates withdrawal effects mainly in the noradrenaline nerve terminals of the sub-ependymal layer of the median eminence, the anterior periventricular hypothalamic region and the parvocellular part of the paraventricular hypothalamic nucleus which inter alia are involved in regulation of ACTH secretion (cf. Andersson et al. 1985a).     

Does switching to an ultra-low nicotine cigarette induce nicotine withdrawal effects?

Twenty-six smokers took part in a study which examined subjective and physiological effects of switching to an ultra-low yielding cigarette (0.1 mg nicotine) for 10 days. Subjects were randomly assigned to one of two groups. One group continued smoking their usual brand while the other group switched to the low yielding cigarette. Subjective ratings and physiological measures were taken at baseline, then after 1, 3 and 10 days in the respective conditions. Plasma nicotine concentrations dropped by some 60% after switching. Although substantial, this drop was considerably less than the drop in nominal yield of the cigarettes (around 90%), indicating marked compensation on the part of these smokers. Switching to the low yielding cigarette was accompanied by a significant increase in hunger and a drop in heart rate. These effects typically occur following cigarette withdrawal. However, other common cigarette withdrawal symptoms, such as irritability, depression, and inability to concentrate, were not detected.