Smoking Withdrawal Dynamics: III. Correlates of Withdrawal Heterogeneity.

Five parameters of postcessation smoking withdrawal variability derived from clinical data (T. M. Piasecki, D. E. Jorenby, S. S. Smith, M. C. Fiore, & T. B. Baker, 2003a, 2003b) were predicted from baseline measures and pharmacotherapy assignment. Smokers who were more dependent, older, and high in negative affect reported more severe withdrawal. Women, heavier smokers, and those with a history of depression reported more variable symptoms. Smokers treated with nicotine patch, bupropion, or both reported less severe withdrawal than did those given placebo, but medication did not affect the slope of symptoms over time, day-to-day variability of symptoms, or the size of acute changes in symptoms associated with lapses to smoking. Prior research has shown that these symptom facets predict later relapse: thus, current pharmacotherapies may aid cessation by diminishing withdrawal severity, but they do not affect all clinically important aspects of withdrawal. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smoking withdrawal dynamics: II. Improved tests of withdrawal-relapse relations.

In this article, the authors assessed whether continuously scaled symptom parameters derived from growth models (T. M. Piasecki et al., 2003) are linked to smoking at long-term follow-up by using data from a large-scale clinical trial (N=893). Results revealed that higher withdrawal intercepts, positive linear slopes, and greater volatility were all positively associated with relapse, and cigarette coefficients (indicating smoking-induced withdrawal reduction) were negatively related to relapse. In models keyed around the first lapse to smoking, those destined to lapse reported more severe withdrawal during abstinence, and withdrawal patterns discriminated groups defined according to lapse duration. The findings complement earlier heterogeneity studies in implicating the pattern of changing withdrawal symptoms over time as a factor strongly associated with smoking relapse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Olanzapine reduces urge to smoke and nicotine withdrawal symptoms in community smokers.

Olanzapine (OLAN), an atypical antipsychotic medication with mixed 5-HT2/DA antagonist properties, was predicted to dose-dependently decrease urge to smoke, withdrawal, and cigarette reinforcement in smokers without psychosis. A double-blind placebo-controlled within-subjects cross-over trial investigated the acute effects of OLAN (0, 2.5, and 5.0 mg; counterbalanced order) in 24 community smokers who underwent 10-hr smoking deprivation. Urge to smoke, tobacco withdrawal, and cigarette reinforcement were assessed with cue reactivity and behavioral choice procedures. OLAN (2.5 mg) reduced withdrawal symptoms before and during cue exposure and decreased urge associated with anticipated positive affect from smoking before and during cue exposure; 5.0 mg OLAN decreased withdrawal only when cues were included. OLAN did not affect preference for cigarette puffs versus money, smoke intake, or urge to smoke associated with negative affect relief. The results indicate a potentially beneficial effect of 2.5 mg OLAN on tobacco withdrawal and urge to smoke. Combined 5HT/DA antagonists should be considered for future development of pharmacotherapies for smoking cessation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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

A past history of depression is associated with a decreased likelihood of quitting smoking. Tobacco withdrawal may be a mechanism through which depression history impedes smoking cessation. This research examined the influence of depression history on unmedicated tobacco withdrawal signs (polysomnographic measures of sleep) and symptoms (self-reported urge, negative affect, hunger, and sleep) among women (N/& =/&13). Depression history was associated with differential withdrawal-induced changes in several REM sleep parameters. Self-report and other polysomnography (sleep fragmentation, slow-wave sleep) measures displayed statistically significant withdrawal effects but did not discriminate between depression history groups. These results suggest that REM sleep parameters may be sensitive to differential tobacco withdrawal responses that are not readily apparent through self-reported symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cigarette smoking and chewing gum: Response to a laboratory-induced stressor.

The current study examined the anxiolytic effects of cigarette smoking and chewing gum on urge to smoke, withdrawal, and anxiety in response to a public speaking task in 45 undergraduate smokers. Participants were asked to smoke, chew gum, or do nothing in response to the stressor. Participants completed measures of anxiety, withdrawal symptoms, and urge to smoke pre- and poststressor. The smoke group reported fewer urges to smoke pre- and poststressor than the other groups. The smoke and gum groups reported fewer withdrawal symptoms than did the control group poststressor. Chewing gum was helpful in managing levels of withdrawal symptoms compared with the control group. Groups did not differ on measures of anxiety. Results suggest that smoking in response to a stressor may not reduce levels of affective stress. Furthermore, chewing gum may be helpful in managing withdrawal symptoms in response to a stressor. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender differences in acute tobacco withdrawal: Effects on subjective, cognitive, and physiological measures.

Gender differences in tobacco withdrawal are of considerable clinical importance, but research findings on this topic have been mixed. Methodological variation in samples sizes, experimental design, and measures across studies may explain the inconsistent results. The current study examined whether male (n = 101) and female (n = 102) smokers (≥15 cigarettes/day) differed in abstinence-induced changes on a battery of self-report measures (withdrawal, affect, craving), cognitive performance tasks (attention, psychomotor performance), and physiological responses (heart rate, blood pressure, brain electroencephalogram). Participants attended 2 counterbalanced laboratory sessions, 1 following 12 hr of abstinence and the other following ad libitum smoking. Results showed that women reported greater abstinence-induced increases in negative affect, withdrawal-related distress, and urge to smoke to relieve withdrawal distress. In contrast, both genders reported similar abstinence-induced changes in positive affect and urge to smoke for pleasure. Men and women exhibited generally similar abstinence-induced changes in physiological and cognitive performance measures. In addition, gender did not moderate the association between withdrawal symptoms and baseline measures of smoking behavior and dependence. Abstinence-induced changes in withdrawal distress mediated the effect of gender on latency until the 1st cigarette of the day at trend levels ( p     

Predicting relapse back to smoking: Contrasting affective and physical models of dependence.

Traditional models of physical dependence suggest that nicotine dependence should be reflected by the extent of drug exposure (e.g., smoking rate) and by evidence of physiological adaptation (e.g., withdrawal severity). An affective model suggests that nicotine dependence should be related to an individual's tendency to experience negative affect and expectations that nicotine use would ameliorate such affect. This research investigated the ability of these 2 models to predict relapse back to smoking at 6 months postquit, Logistic regression models were developed and tested in 505 heavy smokes participating in nicotine patch clinical trials. Results supported both models, but the most potent predictor of outcome was postquit negative affect, which accounted for much of the predictive validity of traditional measures of nicotine dependence. Affective reactivity appears to be a core constituent of dependence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early cessation success or failure among women attempting to quit smoking: Trajectories and volatility of urge and negative mood during the first postcessation week.

Aversive symptoms of abstinence from nicotine have been posited to lead to smoking relapse and research on temporal patterns of abstinence symptoms confirms this assumption. However, little is known about the association of symptom trajectories early after quitting with postcessation smoking or about the differential effects of tonic (background) versus phasic (temptation-related) symptom trajectories on smoking status. The current study examined trajectories of urge and negative mood among 300 women using the nicotine patch during the first postcessation week. Ecological momentary assessments collected randomly and during temptation episodes were analyzed using hierarchical linear modeling yielding four individual trajectory parameters: intercept (initial symptom level), linear slope (direction and rate of change), quadratic coefficient (curvature), and volatility (scatter). Early lapsers, who lapsed during the first postcessation week, exhibited more severe tonic urge and phasic negative mood immediately after quitting, and more volatile tonic and phasic urge compared to abstainers. Late lapsers, who were abstinent during the first week but lapsed by 1 month, exhibited more severe tonic urge immediately after quitting compared to abstainers. These results demonstrate the importance of early postcessation urge and negative affect and highlight the value of examining both tonic and phasic effects of abstinence from nicotine. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

High-dose transdermal nicotine and naltrexone: Effects on nicotine withdrawal, urges, smoking, and effects of smoking.

Although treatment with transdermal nicotine replacement (TNR) has improved smoking abstinence rates, higher doses of TNR could improve effects on urge to smoke, nicotine withdrawal, and reinforcement from smoking, and naltrexone might further reduce reinforcement and urges. A laboratory investigation with 134 smokers using a 3 × 2 parallel-group design evaluated the effects of TNR (42-mg, 21-mg, or 0-mg patch) as crossed with a single dose of naltrexone (50 mg) versus placebo on urge to smoke, withdrawal, and responses to an opportunity to smoke (intake, subjective effects) after 10 hr of deprivation. Urge and withdrawal were assessed both prior to and after cigarette cue exposure. Only 42 mg TNR, not 21 mg, prevented urge to smoke, heart rate change, and cue-elicited increase in withdrawal. Both 21 and 42 mg TNR blocked cue-elicited drop in heart rate and arterial pressure. Naltrexone reduced cue-elicited withdrawal symptoms but not urges to smoke or deprivation-induced withdrawal prior to cue exposure. Neither medication significantly affected carbon monoxide intake or subjective effects of smoking except that 42 mg TNR resulted in lower subjective physiological activation. No interaction effects were found, and no results differed by gender. Results suggest that starting smokers with 42 mg TNR may increase comfort during initial abstinence, but limited support is seen for naltrexone during smoking abstinence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does reducing withdrawal severity mediate nicotine patch efficacy? A randomized clinical trial.

Nicotine replacement therapy (NRT) repeatedly has been shown to improve smoking treatment outcome. The major mechanism posited for this improvement in outcome is that NRT reduces nicotine craving and withdrawal. The authors tested this hypothesized mechanism of action using real-time data on craving and withdrawal, collected by ecological momentary assessments administered on a palm-top computer. Smokers (N = 324) were randomized to receive either active high-dose (35 mg) 24-hr patches or placebo. Increases in positive affect and decreases in craving, negative affect, and attention disturbance severity were related to lower risk of lapsing. Although NRT treatment did significantly decrease withdrawal and craving severity, these reductions only partially accounted for NRT's impact on time to first lapse: The results from a mediation analysis showed that the hazard ratio for NRT, when controlling for withdrawal and craving severity, was only a third to a half lower than the uncontrolled hazard ratio for NRT alone. This suggests that other mechanisms for the effectiveness of NRT need to be examined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Affect, expectancies, urges, and smoking: Do they conform to models of drug motivation and relapse?

Social-learning models of drug motivation and relapse often include the constructs of affect and drug expectancies. Most research has taken a molar approach to examining relations between these constructs and level of drug use. An experiment examined the roles of affect and expectancies in multiple measures of situation-specific motivation to smoke tobacco. Undergraduate smokers (n?=?101) received either a positive or negative mood manipulation (false feedback on an intelligence test). Self-reported urge was influenced by both negative affect and expectancies for positive reinforcement from smoking. Actual consumption was related only to smoking expectancies and only among abstaining smokers. affect by expectancy interactions were also found. Findings support a limited role of affect and expectancies in smoking motivation. Poor coherence among the motivational indexes challenges the assumptions of existing models of drug motivation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smoking withdrawal dynamics: I. Abstinence distress in lapsers and abstainers.

Smoking withdrawal reports from a clinical trial (n=893) were submitted to hierarchical linear modeling as a cross-method replication of a heterogeneity approach to withdrawal measurement and to clarify the influence of postcessation smoking on symptom reports. Five individual difference parameters tapping distinct facets of withdrawal were derived: intercepts (mean severity), linear slope (direction and rate of change), quadratic trend (curvature), volatility (scatter) and, among lapses, a cigarette coefficient (smoking-related deflections of symptoms). All parameters were highly variable across persons. Lapsers had more aversive symptom patterns than abstainers, and symptoms tended to be higher than otherwise predicted on lapse days. These results reinforce the conclusion that withdrawal symptoms are highly variable and argue against discarding withdrawal data from participants who lapse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of body image threat on smoking motivation among college women: Mediation by negative affect.

A recent experimental study found that activation of negative body image cognitions produced urges to smoke in young women (E. N. Lopez, D. J. Drobes, J. K. Thompson, & T. H. Brandon, 2008). This study intended to replicate and extend these experimental findings by examining the role of negative affect as a mediator of the relationship between body dissatisfaction and smoking urges. Female college smokers (N = 133) were randomly assigned to a body image challenge (trying on a bathing suit) or a control condition (evaluating a purse). State levels of urge to smoke, mood, and body dissatisfaction were assessed both pre- and postmanipulation. Trying on a bathing suit increased body dissatisfaction and reported urges to smoke, particularly those urges related to reducing negative affect. Additionally, state negative affect mediated the relationship between the body image manipulation and smoking urge. This study provides additional support, through an experimental design, that situational challenges to body image influence smoking motivation and that this effect occurs, at least in part, through increases in negative affect. Theoretical and applied implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relation between self-reported affect and drug urges and cravings in continuing and withdrawing smokers.

Investigated, in 2 experiments, the effects of withdrawal and stress on the affective correlates of urges to smoke. In both, habitual cigarette smokers were divided into continuing and withdrawing smoker groups. In the 1st study, 44 adults reported current mood, urge, and expectations over a 24-hr period. In the 2nd, a controlled laboratory study, urge, affect, and physiological data were obtained from continuing and withdrawing groups (N?=?64) exposed to high- or low-stress conditions. Urges among withdrawing smokers were positively associated with negative affect and negatively associated with positive affect; continuing smokers reported urges that were directly associated with positive affect and unrelated to negative affect. Stress and withdrawal produced urge and self-reports that were related to negative affect. Moreover, Ss who smoked after exposure to withdrawal and stress reported greater pleasure and arousal than did other Ss. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An Experimental Examination of the Initial Weeks of Abstinence in Cigarette Smokers.

Gaining experimental control over abstinence may help define processes that change during abstinence that may be related to the association between initial abstinence and relapse risk often noted in clinical trials. Adult smokers (n = 34) were randomly assigned to receive monetary incentives contingent on abstinence (CO ± 4 ppm) or noncontingent for 12 days. Carbon monoxide (CO) tests were conducted 3 times per day, saliva samples were collected on Days 5 and 12, and all other measures were collected 1 time per day. In the contingent group, 59% of participants abstained throughout the study versus 0% in the control condition. Abstinence was associated with increases in participant-rated ease of abstaining and confidence in abstinence; nicotine withdrawal severity and craving decreased over time. Results indicate that it is feasible to experimentally manipulate smoking abstinence and that doing so can enhance understanding of the relationship between early abstinence and relapse risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of nicotine dose and administration method on withdrawal symptoms and side effects during short-term smoking abstinence.

The effects of using several different nicotine replacement treatments on self-reported withdrawal symptoms and side effects during 2-day periods of smoking cessation, with 5 days of ad lib smoking between cessation days, were evaluated. Participants (N ?=?18) experienced the following conditions: nicotine gum, 24-hr patch, 16-hr patch, 24-hr patch plus gum, double 24-hr patch, and no nicotine replacement. The present study found morning urge to smoke was greater during the 16-hr than during the 24-hr patch condition. Double-patch use resulted in significantly greater insomnia than the smoking baseline and 16-hr patch conditions. The no medication and gum alone conditions resulted in similar withdrawal symptoms, and both tended to result in greater reported withdrawal symptoms than the smoking baseline condition. There were no significant withdrawal symptom differences between the 24-hr, patch-gum, and double-patch conditions. The 24-hr and double-patch conditions were preferred by two thirds of the participants (6 each). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological and pharmacological influences in cigarette smoking withdrawal: Effects of nicotine gum and expectancy on smoking withdrawal symptoms and relapse.

To determine the relative effects of expectancy and nicotine depletion on aversive withdrawal symptoms, we gave 109 smokers attempting to quit either nicotine gum or placebo within a balanced placebo design and monitored their withdrawal symptoms and smoking for 2 weeks. Subjects who believed they were getting nicotine gum reported less physical symptoms of withdrawal, showed less arousal, and smoked fewer cigarettes during the first week of quitting when compared with those who thought they were receiving placebo gum. The actual nicotine content of gum had no effect on withdrawal or relapse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acute nicotine reinforcement, but not chronic tolerance, predicts withdrawal and relapse after quitting smoking.

Little research has examined the association of tobacco dependence with nicotine tolerance or reinforcement in a clinical sample. Smokers preparing to quit smoking participated in laboratory sessions to assess nicotine tolerance on subjective, cardiovascular, and performance measures and to assess nicotine reinforcement using a choice procedure. Participants were then provided with individual counseling (but no medication), made a quit attempt, and were followed for 1 year to determine clinical outcome, as determined by postquit withdrawal and days to relapse. Nicotine tolerance was unrelated to either withdrawal or relapse. However, acute nicotine reinforcement was significantly related to both greater withdrawal and faster relapse. Results challenge the common assumption that nicotine tolerance is closely related to dependence but suggest that nicotine reinforcement may have theoretical and clinical significance for dependence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)