Patterns of change in withdrawal symptoms, desire to smoke, reward motivation and response inhibition across 3 months of smoking abstinence

Lynne Dawkins,John Powell,Alan Pickering,Robert West,Jane H Powell

doi:10.1111/j.1360-0443.2009.02522.x

Abstract

We have demonstrated previously that acute smoking abstinence is associated with lowered reward motivation and impaired response inhibition. This prospective study explores whether these impairments, along with withdrawal-related symptoms, recover over 3 months of sustained abstinence. Participants completed a 12-hour abstinent baseline assessment and were then allocated randomly to quit unaided or continue smoking. All were re-tested after 7 days, 1 month and 3 months. Successful quitters' scores were compared with those of continuing smokers, who were tested after ad libitum smoking. Goldsmiths, University of London. A total of 33 smokers who maintained abstinence to 3 months, and 31 continuing smokers. Indices demonstrated previously in this cohort of smokers to be sensitive to the effect of nicotine versus acute abstinence: reward motivation [Snaith-Hamilton pleasure scale (SHAPS), Card Arranging Reward Responsivity Objective Test (CARROT), Stroop], tasks of response inhibition [anti-saccade task; Continuous Performance Task (CPT)], clinical indices of mood [Hospital Anxiety and Depression Scale (HADS)], withdrawal symptoms [Mood and Physical Symptoms Scale (MPSS)] and desire to smoke. SHAPS anhedonia and reward responsivity (CARROT) showed significant improvement and plateaued after a month of abstinence, not differing from the scores of continuing smokers tested in a satiated state. Mood, other withdrawal symptoms and desire to smoke all declined from acute abstinence to 1 month of cessation and were equivalent to, or lower than, the levels reported by continuing, satiated smokers. Neither group showed a change in CPT errors over time while continuing smokers, but not abstainers, showed improved accuracy on the anti-saccade task at 3 months. Appetitive processes and related affective states appear to improve in smokers who remain nicotine-free for 3 months, whereas response inhibition does not. Although in need of replication, the results suggest tentatively that poor inhibitory control may constitute a long-term risk factor for relapse and could be a target for intervention.

Highlights

Acute abstinence from regular smoking is associated with somatic symptoms, low mood [1,2] motivational and cognitive disturbance [3,4,5,6,7] and impaired inhibitory control [8,9,10]
The groups did not differ in sex ratio, age, years of education, number of cigarettes smoked per day, dependence (FTND), pre-baseline salivary cotinine levels, or any of the experimental variables
Consistent with previous reports [17,18,19], self-reported withdrawal symptoms, anxiety and depression steadily improved over one month, whilst in continuing smokers they remained relatively stable across three months

Summary

Introduction

Acute abstinence from regular smoking is associated with somatic symptoms, low mood [1,2] motivational and cognitive disturbance [3,4,5,6,7] and impaired inhibitory control [8,9,10]. Which of these dysfunctions develop as a consequence of smoking, or are constitutional deficits that predate regular smoking, remains uncertain. Gilbert and colleagues [12] noted reduced accuracy on the rapid visual information processing (RVIP) task and EEG deactivation in abstinent smokers which failed to return to either pre-quit baseline, or smoking control levels after 31 days

Methods

Results

Conclusion