Article

Effects of abstinence from tobacco: Etiology, animal models, epidemiology, and significance: A subjective review

Department of Psychiatry, University of Vermont, Burlington, VT 05401-1419, USA.
Nicotine & Tobacco Research (Impact Factor: 2.81). 04/2007; 9(3):329-39. DOI: 10.1080/14622200701188927
Source: PubMed

ABSTRACT This article updates a 1990 review of the effects of tobacco abstinence by reviewing (a) the etiology, (b) animal models, (c) the epidemiology, and (d) the clinical significance of tobacco abstinence effects. The author searched several databases to locate more than 3,500 citations on tobacco abstinence effects between 1990 and 2004. For brevity, the review does not evaluate these effects in regard to craving, hunger, or performance. Data collection and study conclusions were based on the author's subjective judgment. The most validated etiological model suggests that withdrawal is related to decreased dopaminergic activity, but how this relates to nicotine receptor changes is unclear. The two most validated animal models describe increases in intracranial self-stimulation thresholds or observable physical signs. Significant withdrawal symptoms occur in at least half of smokers when they try to quit. Withdrawal appears to produce clinically significant distress and impairment. Increases in depression after abstinence, but not other symptoms, prospectively predict relapse. In conclusion, the proposed neurobiological mechanisms by which withdrawal occurs leave several unanswered questions. Although animal models have been developed, how well they mimic withdrawal in humans is unclear. Tobacco withdrawal is common and can be distressing. Withdrawal-induced depression appears to undermine the smoker's ability to remain abstinent.

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    • "To the best of our knowledge, only two studies have systematically evaluated the early time course of smoking withdrawal effects (Brown et al., 2013; Hendricks, Ditre, Drobes, & Brandon, 2006). However, these studies did not address the clinical significance of these symptoms (e.g., their relationships with quit attempt outcomes such as abstinence or later withdrawal symptoms; Hughes, 2007a), which could serve as predictors of treatment success and provide valuable information for clinicians in designing tailored interventions. Predictors of early withdrawal effects are also unknown. "
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    ABSTRACT: Although the early time course of smoking withdrawal effects has been characterized, the clinical significance of early withdrawal symptoms and their predictors are unknown. This study evaluated the relationships of early smoking withdrawal effects with quit attempt outcomes and the rate of nicotine metabolism. Eleven treatment-seeking smokers abstained from smoking for 4hr in the laboratory, before a quit attempt. Withdrawal measures included heart rate, sustained attention, and self-report. Following baseline assessment, withdrawal measures were administered every 30min. At the conclusion of the 4-hr early withdrawal session, participants received a brief smoking cessation intervention and then returned 1 week and 12 weeks later for outcome assessments that included biochemically confirmed smoking abstinence, cigarettes smoked in the past 24hr, and self-reported withdrawal symptoms. The rate of nicotine metabolism was estimated at intake using the nicotine metabolite ratio (trans-3'-hydroxycotinine/cotinine) measured in saliva. Greater self-reported negative affect and concentration difficulty during early withdrawal, most notably anxiety, were related with poorer quit attempt outcomes. There was some indication that although a faster increase in craving and greater hunger during early withdrawal were associated with more favorable outcomes, a greater decrease in heart rate during this time was associated with poorer outcomes. Faster nicotine metabolism was related to a faster increase in anxiety but a slower increase in craving during early withdrawal. These findings lend support to the clinical significance of early smoking withdrawal effects. The rate of nicotine metabolism may be a useful predictor of early withdrawal symptoms.
    Nicotine & Tobacco Research 12/2013; DOI:10.1093/ntr/ntt204 · 2.81 Impact Factor
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    • "However, it is possible that the use of participants paid to abstain from smoking overnight may have attenuated the relationships between abstinence-related expectancies and withdrawal, as this research paradigm tends to yield muted withdrawal effects (Hughes 2007a). Thus, abstinence-related expectancies may prove even more potent predictors of longer-term withdrawal and withdrawal symptoms among those trying to cease cigarette use. "
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    ABSTRACT: Despite the decades-long emphasis on withdrawal in leading models of addiction, the causal mechanisms driving smoking withdrawal effects are not well known. This gap in the knowledge base has stalled theory and treatment development for smoking dependence. As cognitive factors have been largely neglected as predictors of withdrawal, the current study sought to examine how smokers' abstinence-related expectancies relate to withdrawal symptomatology. Adult smokers (N = 180; ≥10 cigarettes/day) participated in two counterbalanced experimental sessions involving either 16 h of abstinence or smoking as usual. At baseline, participants completed three withdrawal-related scales of the Smoking Abstinence Questionnaire (Withdrawal, Optimistic Outcomes, and Weight Gain scales), a self-report measure of smokers' abstinence-related expectancies. During experimental sessions, participants completed a number of instruments that covered the range of smoking withdrawal effects (i.e., negative affect, urge/craving to smoke, diminished positive affect, concentration difficulty, hunger, and physiological symptoms). Even after controlling for the influence of demographic characteristics and cigarette dependence, smokers' abstinence-related expectancies were meaningful predictors of abstinence-induced changes in various withdrawal symptoms (mean adjusted standardized β = 0.22). Stronger expectancies for withdrawal and weight gain predicted more severe withdrawal effects, whereas stronger expectancies for optimistic outcomes predicted less severe withdrawal effects. These findings are consistent with the notion that expectancies actively shape future experience and are the first to support the suggestion that smokers' abstinence-related expectancies may be causal agents of withdrawal symptomatology. Future research is required to more conclusively determine whether abstinence-related expectancies mold withdrawal effects.
    Psychopharmacology 06/2013; 230(3). DOI:10.1007/s00213-013-3169-7 · 3.99 Impact Factor
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    • "stress reduction, maintenance of mental health and reduction in medication side-effects) appeared to be more important for most. However, while stress-relief and enjoyment are commonly reported reasons for continuing to smoke (in all smokers), evidence suggests that habit and nicotine dependence are, in fact, more influential than most people realise [34,35]. Nicotine acts on the mid-brain, creating impulses to smoke caused by stimuli associated with smoking. "
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    ABSTRACT: Background: Smoking in people with mental health problems (MHPs) is an important public health concern as rates are two to three times higher than in the general population. While a strong evidence base exists to encourage and support smoking cessation in the wider population, there is limited evidence to guide the tailoring of interventions for people with MHPs, including minimal understanding of their needs. This paper presents findings from theoretically-driven formative research which explored the barriers and facilitators to smoking cessation in people with MHPs. The aim, guided by the MRC Framework for the development and evaluation of complex interventions, was to gather evidence to inform the design and content of smoking cessation interventions for this client group. Methods: Following a review of the empirical and theoretical literature, and taking a critical realist perspective, a qualitative approach was used to gather data from key stakeholders, including people with enduring MHPs (n = 27) and professionals who have regular contact with this client group (n = 54). Results: There was a strong social norm for smoking in participants with MHPs and most were heavily addicted to nicotine. They acknowledged that their physical health would improve if they stopped smoking and their disposable income would increase; however, more important was the expectation that, if they attempted to stop smoking, their anxiety levels would increase, they would lose an important coping resource, they would have given up something they found pleasurable and, most importantly, their mental health would deteriorate. Barriers to smoking cessation therefore outweighed potential facilitators and, as a consequence, impacted negatively on levels of motivation and self-efficacy. The potential for professionals to encourage cessation attempts was apparent; however, they often failed to raise the issue of smoking/cessation as they believed it would damage their relationship with clients. The professionals’ own smoking status also appeared to influence their health promoting role. Conclusions: Many opportunities to encourage and support smoking cessation in people with MHPs are currently missed. The increased understanding provided by our study findings and literature review have been used to shape recommendations for the content of tailored smoking cessation interventions for this client group.
    BMC Public Health 03/2013; 13. DOI:10.1186/1471-2458-13-221 · 2.32 Impact Factor
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