Tobacco Withdrawal Symptoms Research Articles

Tobacco withdrawal in women and menstrual cycle phase.

Because negative mood is a characteristic of both tobacco withdrawal and menstrual discomfort, withdrawal may vary by menstrual cycle phase. Tobacco withdrawal, mood, and menstrual discomfort were assessed in premenopausal women who quit smoking during either the follicular (Days 1-14 postmenstrual onset; n = 41) or luteal (Day 15 or longer postmenstrual onset; n = 37) phase of the menstrual cycle and maintained biochemically verified smoking abstinence during the postquit week. Women quitting during the luteal phase reported significantly greater increases in tobacco withdrawal and self-reported depressive symptoms than women quitting during the follicular phase. These results indicate that selecting a quit-smoking day early in the follicular phase may attenuate withdrawal and negative affect in premenopausal female smokers.

Tobacco withdrawal signs and symptoms among women with and without a history of depression.

Tobacco withdrawal signs and symptoms among women with and without a history of depression.

Predictors and timing of adverse experiences during trandsdermal nicotine therapy.

Difficulty sleeping is a recognised tobacco withdrawal symptom, but sleep problems, like application site reactions, are commonly reported as adverse reactions to transdermal nicotine therapy. However, no studies have examined potential predictive factors associated with the occurrence of expected adverse experiences during transdermal nicotine therapy. The subject of skin tolerability among patients with a history of eczema, psoriasis or other skin disorders is of particular interest, as are the relationships between plasma concentrations of nicotine, concurrent smoking, sleep problems and nausea. The cohort study involving 1392 participants was designed to assess the timing, severity and predictive factors of adverse experiences reported during 24-hour transdermal nicotine therapy. Data were collected on patients aged 18 to 70 years old who were smokers and who had expressed a strong desire to stop smoking. The intervention consisted of brief behavioural counselling, a booklet containing smoking cessation advice and instructions for use of the patches, and a 12-week course of decreasing transdermal nicotine doses. Follow-up was available on 1392 out of 1481 study participants. The majority of adverse experiences were mild. Sleep problems occurred in 669 out of 1392 (48%) participants and most often commenced on the day of smoking cessation. Application site reactions occurred in 478 out of 1392 (34%) participants and most often occurred after 6 days of therapy. No predictor had an adjusted hazard ratio above 2. Statistically significant (p < 0.05) predictors of sleep problems were successfully quitting smoking and female gender. Predictors of application site reactions were psoriasis or eczema, other skin conditions, age <40 years, female gender, place of birth outside Australasia, and trade or university education level. Substantially increased nicotine intake during therapy compared with baseline smoking occurred in 8% of participants who smoked concurrently, and 4% of participants who did not (p = 0.1). Increased nicotine intake was associated with a modest increase in the overall rate of adverse experiences (89% vs 63%, p = 0.04) and dizziness/lightheadedness (17% vs 3%, p = 0.03), but not with sleep problems or cardiovascular events. Transdermal nicotine therapy appears to be well tolerated, even if the user smokes concurrently. Sleep disturbance during therapy appeared to be primarily associated with tobacco withdrawal rather than with nicotine excess from treatment with transdermal nicotine. Study participants with pre-existing skin disorders were somewhat more likely to report mild application site reactions than other participants.

Endocrine effects of nicotine administration, tobacco and other drug withdrawal in humans.

The focus of this manuscript is on the effects of smoking and tobacco withdrawal on the hypothalamic-pituitary axis (HPA). A variety of studies have shown that nicotine administered intravenously or through intense cigarette smoking can induce changes in hormones associated with the HPA. Administration of, and abrupt cessation from, other drugs of abuse has also been shown to affect levels of these hormones. Additionally, many of the symptoms of stress and tobacco withdrawal overlap suggesting that the hormonal changes seen during periods of stress may be observed during tobacco abstinence. These findings led to a study of the effects of tobacco withdrawal on plasma ACTH, cortisol, and prolactin levels. The results indicated tobacco cessation caused small and transient effects on plasma hormone levels which were not significantly influenced by nicotine replacement and were not related to other signs of withdrawal.

Nicotine-Containing Versus De-Nicotinized Cigarettes: Effects on Craving and Withdrawal

Nicotine exposure levels and subjective effects from smoking a de-nicotinized cigarette (Next) were examined under controlled conditions. Ten tobacco smokers smoked 20 puffs from their own brand (1.1 mg nicotine delivery, commercial cigarettes), a 0.7 mg nicotine “light” cigarette, or the Next de-nicotinized cigarette (< 0.1 mg nicotine) during independent experimental test sessions. The Next cigarette did not deliver any appreciable nicotine, did not elevate heart rate during smoking, and was rated as less satisfying than the smokers' own brand. Subjective ratings of cigarette craving and tobacco withdrawal symptoms increased during a 90 min post-smoking abstinence period. However, there were no measurable differences on these subjective ratings across the three cigarette test brands. It is concluded that nicotine can be removed from cigarettes without affecting the onset time course or intensity of cigarette cravings and other tobacco withdrawal symptoms in an acute abstinence model. Further studies to determine the subjective and physiological effects of nicotine-free cigarettes would contribute to a greater understanding of tobacco withdrawal and the processes involved in smoking maintenance.

Effects of Mecamylamine on Spontaneous EEG and Performance in Smokers and Non-Smokers

In a previous study, mecamylamine, a centrally active nicotine antagonist, exacerbated EEG signs of tobacco abstinence in abstinent smokers. In the present study, the effects of mecamylamine were compared in non-smokers and nondeprived smokers. Mecamylamine (0, 5 and 10 mg, p.o.) was administered to six smokers and six non-smokers; eight of these subjects were also given a 20 mg dose. Before drug administration, resting EEG was similar in both groups. In both groups, mecamylamine caused dose-related decreases in alpha frequency and increases in delta frequency; beta frequency was increased by the 5 and 10 mg doses. The similarity of effects in smokers and non-smokers suggests a direct pharmacological action rather than precipitated nicotine withdrawal. Significant baseline differences existed between smokers and non-smokers in systolic blood pressure, pulse rate, skin temperature and pupil diameter. Response time slowed in both vigilance and distractibility tasks and delayed recall was impaired. Mecamylamine increased ratings of: “relaxed,” “nodding,” “sleepy” and “coasting.” This small-sample study tentatively suggests that nicotinic cholinergic mechanisms modulate brain electrical activity and cognitive function in smokers and non-smokers. Disruption of these neural systems could mediate the symptoms of tobacco withdrawal and be involved in the pathophysiology of Alzheimer's disease. Published by Elsevier Science Inc., 1997

Occupational factors, smoking habits and tobacco withdrawal symptoms among male Japanese employees.

The aim of the study is to know the effects of occupational factors and smoking habits on tobacco withdrawal symptoms among male Japanese employees. A total of 2,862 male employees in a company in Japan completed questionnaires concerning tobacco withdrawal symptoms, occupational factors (occupation, shift work, work stress) and smoking habits. Data from 1,443 male ever-quitters were analyzed. Among male ever-quitters, 67% had ever experienced tobacco withdrawal symptoms. Significantly higher age-adjusted rates of tobacco withdrawal symptoms were found in those who experienced frequent exhaustion after work, current smokers, those who smoked 20 or more cigarettes per day, smoked for 20 years or longer and tried to quit smoking twice or more (p < 0.05). Multiple logistic regression analysis indicated that younger age, technical/clerical occupation, exhaustion after work, number of cigarettes smoked per day, duration of smoking, currently smoking and number of trials to quit smoking, were significantly associated with tobacco withdrawal symptoms (p < 0.05). It is suggested that younger age, technical/clerical occupation, exhaustion after work, number of cigarettes smoked and duration of smoking are risk factors of tobacco withdrawal symptoms in male Japanese employees.

Gender and the effects of different doses of nicotine gum on tobacco withdrawal symptoms.

Gender and the effects of different doses of nicotine gum on tobacco withdrawal symptoms.

Gender and the effects of different doses of nicotine gum on tobacco withdrawal symptoms.

Gender and the effects of different doses of nicotine gum on tobacco withdrawal symptoms.

Two Studies of the Clinical Effectiveness of the Nicotine Patch With Different Counseling Treatments

To assess the effectiveness of transdermal nicotine therapy for smoking cessation and suppression of withdrawal severity in conjunction with two different adjuvant counseling treatments. Two independent randomized placebo-controlled double-blind trials. Smoking cessation clinic. Eighty-eight (study 1) and 112 (study 2) adult volunteers motivated to quit smoking. Eight weeks of 22-mg transdermal nicotine therapy with group counseling (study 1); 4 weeks of 22 mg followed by 2 weeks of 11-mg transdermal nicotine therapy with brief individual counseling (study 2). Modified point prevalence (7 consecutive days of nonsmoking) at the end of patch treatment and 6 months after treatment initiation was assessed by self-report and biochemically confirmed; survival analyses were also conducted for both studies to compare treatment efficacy. Also, we examined the impact of the nicotine patch on specific withdrawal symptoms (anger, anxiety, awakening, difficulty concentrating, depression, hunger, impatience, and craving). Transdermal nicotine treatment produced higher cessation rates at the end of treatment than did placebo with both adjuvant counseling interventions: 59 percent vs 40 percent (p < 0.05 in study 1) and 37 percent vs 20 percent (p < 0.05 in study 2), respectively. Smoking cessation efficacy was maintained 6 months after initiation of treatment: 34 percent vs 21 percent (p = 0.08 in study 1) and 18 percent vs 7 percent (p = 0.05 in study 2). Survival analyses also revealed significant group differences in efficacy in both studies. Nicotine patches also suppressed a variety of withdrawal symptoms, including craving in the first weeks after patients quit smoking. Transdermal nicotine effectively augments smoking cessation rates with two different types of counseling treatment. Overall, the nicotine patch approximately doubles the sustained rate of smoking cessation. Additionally, the nicotine patch provides relief from some tobacco withdrawal symptoms.

Tobacco withdrawal symptoms: an experimental analysis

Tobacco withdrawal symptoms: an experimental analysis

Randomised controlled trial of nasal nicotine spray in smoking cessation

Studies with nicotine chewing gum and nicotine skin patches indicate that nicotine replacement can help people to give up smoking. The rapidity with which nicotine is absorbed when given as a nasal spray suggests that it might be effective for those for whom the other means of replacement are too slow. The efficacy and safety of a nasal nicotine spray as an adjunct to group treatment for stopping smoking were assessed in a randomised, double-blind, placebo-controlled trial in which 227 cigarette smokers attending the Maudsley Hospital Smokers Clinic received 4 weeks of supportive group treatment plus active nicotine (0·5 mg per shot) or placebo nasal spray. The main end-point was biochemically validated complete abstinence from smoking from the third week of group treatment until the 12-month follow-up. Side-effects were assessed by self-reports and, where necessary, by physical examination. Of subjects assigned to active treatment 26% (n=30) were validated abstinent throughout the year, compared with 10% (n = 11) of those assigned to placebo (relative abstinence rate 2·6, 95% Cl 1·5-4·5, p<0·001). The advantage of the active spray was greatest in the heaviest smokers. Plasma nicotine concentrations from the spray were typically between one-half and three-quarters of baseline smoking levels. Tobacco-withdrawal symptoms, craving for cigarettes, and weight gain in abstinent subjects were reduced by the active spray. Minor irritant side-effects were frequent in both active and placebo sprays, but only 2 subjects had the spray discontinued as a result. No serious adverse effects were encountered. Nasal nicotine spray combined with supportive group treatment is an effective aid to smoking cessation.

CLONIDINE PATCH FAILS TO INCREASE SMOKING CESSATION.

At least nine small studies have examined whether clonidine blocks tobacco-withdrawal symptoms and promotes smoking cessation, but these studies have not consistently found a benefit. This multicenter, double-blind trial involving 213 smokers is the …

Effects of caffeine on tobacco withdrawal

Smoking cessation increases caffeine blood levels, and this has been hypothesized to cause some of the symptoms of tobacco withdrawal (e.g., anxiety and insomnia). To test this hypothesis, 10 coffee drinkers who smoked cigarettes were entered into a completely within-subjects experimental design in which the effects of caffeine dose (0, 50, and 100 mg/coffee serving) and smoking status (smoking versus abstinence) were examined over a 4-day period. Self-reported and observed measures of tobacco withdrawal, caffeine withdrawal, and intoxication, as well as psychomotor tasks and vital signs, were completed daily; blood was drawn at the end of each period. Temporary abstinence produced typical withdrawal symptoms but did not significantly increase caffeine blood levels. Caffeine did not increase the severity of symptoms but did decrease the severity of withdrawal-induced hunger. These findings suggest that, in the absence of increased blood levels, caffeine does not increase the severity of tobacco withdrawal.

Effect of Transdermal Nicotine Delivery as an Adjunct to Low-Intervention Smoking Cessation Therapy

To assess the smoking cessation efficacy of transdermal nicotine patches as an adjunct to low-intervention therapy, we conducted a double-blind, placebo-controlled trial in 158 smokers. Participants were randomly assigned to one of the following three study regimens that required daily application of two 15-cm2 patches: (1) 24-hour nicotine delivery, (2) nicotine delivery during wakeful hours only, and (3) placebo. The impact of the three regimens on smoking cessation rates and tobacco withdrawal symptoms was examined. During the last 2 weeks of the trial, 39% of the 24-hour nicotine regimen delivery group, 35% of those on wakeful hour nicotine regimens, and 13.5% of the placebo treatment group achieved abstinence. Self-reported quit rates for the two nicotine patch-wearing regimens, as compared with that for the placebo group, continued to be significantly higher at 6 months. Moreover, compared with placebo, the transdermal nicotine patches significantly reduced tobacco withdrawal symptoms during the first few weeks of quitting. The differences in quit rates and tobacco withdrawal symptoms between the two active groups were not statistically significant. The patches were well tolerated both topically and systemically. We concluded that transdermal nicotine, when used as an adjunct to low-intervention therapy, significantly reduced tobacco withdrawal symptoms and enhanced smoking cessation rates.

Buspirone effect on tobacco withdrawal symptoms: a pilot study.

Tobacco withdrawal symptoms hamper smoking cessation. This was a pilot study of buspirone, a new azapirone anxiolytic, for tobacco withdrawal. Thirteen smokers entered an open clinical trial. Smokers were titrated to 30 mg/day of oral buspirone for 2 weeks prior to cessation. Tobacco withdrawal and Spielberger state-anxiety scales were used at baseline, on the quit date, and then at 24 hours, 48 hours, 1 week, and 2 weeks after abrupt cessation. At the final visit, smokers compared their withdrawal experience with previous cessation attempts. Two patients (15 percent) could not tolerate the medication and did not attempt smoking cessation. Of the remaining 11 smokers, 3 (27 percent) rated withdrawal relief "very definite," 6 (55 percent) "moderate," and 2 (18 percent) "slight." More than two-thirds of the smokers believed that their difficulty concentrating, craving, restlessness, and anxiety were improved compared with earlier tobacco withdrawal attempts. Five patients (46 percent) reported decreased smoking urges during the 2-week medication titration period. Tobacco withdrawal symptoms and state-anxiety scores changed significantly during the study (P less than 0.05). These results are encouraging, but they should be interpreted with caution because of the small sample size and lack of placebo control. Buspirone effect on tobacco withdrawal symptoms should be studied in a randomized, controlled clinical trial.

Symptoms of Tobacco Withdrawal

Smokers (n = 315) who wished to quit were randomly assigned in a double-blind manner to groups using either nicotine or placebo gum. Self-reported and observed symptoms of tobacco withdrawal were collected before cessation and at follow-ups of 1 to 2 weeks, 1 month, and 6 months. Self-reported and/or observed anger, anxiety, craving, difficulty concentrating, hunger, impatience, and restlessness were the most prominent symptoms of tobacco withdrawal. These symptoms had returned to precessation levels by 1 month except increased weight, hunger, and craving continued for 6 months in many smokers. Nicotine gum decreased most symptoms, including craving and hunger but not weight. Abstinent smokers with more intense withdrawal were not more likely to relapse. Abstinent smokers who gained more weight were less likely to relapse.

Dream of absent-minded transgression: An empirical study of a cognitive withdrawal symptom.

Among 293 smokers abstinent for between 1 and 4 weeks, 33% reported having at least 1 dream about smoking. In most dreams, subjects caught themselves smoking and felt strong negative emotions, such as panic and guilt. Dreams about smoking were the result of tobacco withdrawal, as 97% of subjects did not have them while smoking, and their occurrence was significantly related to the duration of abstinence. They were rated as more vivid than the usual dreams and were as common as most major tobacco withdrawal symptoms. In subjects abstinent for 1 year, 63% recalled having dreams about smoking. They had on average 5 of them, and about a quarter occurred after the 6th month of abstinence. Having dreams about smoking was prospectively positively related to maintenance of abstinence. An explanation of this finding based on the association of smoking in dreams with aversive emotions is offered.

Antismoking products

Nicotine is the addictive substance in tobacco and its withdrawal is responsible for a range of unpleasant symptoms after smoking cessation. Although it produces acute physiological effects, nicotine alone is not carcinogenic and does not appear to cause the vascular disease associated with smoking. Nicotine replacement has been shown to be a safe and effective pharmacological treatment for tobacco dependence in certain smokers. Its efficacy is greatest when prescribed for those who are motivated and highly nicotine-dependent. It is probably not indicated for smokers with a low degree of nicotine dependence. Studies of nicotine chewing gum conducted in special referral clinics have generally produced positive results, whereas those conducted in community practice settings have shown a smaller benefit when compared with placebo. When the results of all published placebo-controlled trials are pooled the typical improvement in smoking cessation rate is 40% (odds ratio continued smoking 0.6; 95% confidence interval 0.5-0.71; P less than 0.00001). The best results with nicotine chewing gum have been obtained with multicomponent programmes which have included some counselling and ongoing follow up and support. Early reports of success with a transdermal nicotine preparation suggest that it may have similar efficacy to nicotine gum. Clonidine administered orally or transdermally has also been shown to reduce tobacco withdrawal symptoms but requires more convincing evidence of long-term efficacy before it can be recommended for routine use. Currently available over-the-counter products, apart from nicotine chewing gum, have not been shown to be effective.

Smoking cessation in the workplace: Evaluation of relapse factors

Relapse factors associated with a well-supported worksite smoking cessation program were examined in a prospective study. Of 104 employee-participants, 81 (78%) were confirmed as abstinent at 8 days after quit day. Forty-six employees (44%) continued to report total abstinence at 1 year. Stepwise regression analysis of baseline variables found two significant, but weak, predictors of 1-year smoking status: Fagerstrom score and number of other smokers residing in the home. Analysis of tobacco withdrawal symptom data of confirmed abstainers found only self-reported anxiety scores to be predictive of smoking status at 1 year. Early abstainers with elevated anxiety scores appear to be at high risk for smoking relapse.