Article

Nicotine withdrawal symptoms and psychiatric disorders: Findings from an epidemiologic study of young adults

May 1992
American Journal of Psychiatry 149(4):464-9

DOI:10.1176/ajp.149.4.464

Source
PubMed

Authors:

Naomi Breslau

Michigan State University

Marlyne Kilbey

Wayne State University

Earlier, the authors reported on the association of nicotine dependence with major depression and anxiety disorders in a group of young adults. This report describes the occurrence of withdrawal symptoms and their sociodemographic and psychiatric correlates in persons in that group who tried unsuccessfully to abstain from smoking. A random sample of 1,007 members of a health maintenance organization, 21-30 years old, were interviewed with a revised version of the NIMH Diagnostic Interview Schedule. Data on nicotine withdrawal came from a subset of 239 smokers who had tried unsuccessfully to quit or cut down on smoking. With two exceptions, each of the DSM-III-R nicotine withdrawal symptoms was reported by more than one-half of these smokers. Withdrawal symptoms were more severe in white than in black smokers but were unrelated to sex, educational level, or marital status. Persons with histories of major depression or any anxiety disorder reported more severe withdrawal symptoms than persons with neither of these disorders. Severity of withdrawal, or any specific symptom, did not account for the association between major depression and continued smoking. Furthermore, severity of withdrawal was unrelated to continued smoking. While the long-term clinical significance of nicotine withdrawal is unclear, the evidence indicates that in the general population, abstinence from smoking is associated with a variety of disturbances, including a craving for cigarettes, dysphoria, and symptoms of irritability or nervousness. In this study disturbances were more severe in persons with histories of major depression or anxiety disorders.

Patterns of Change in Depressive Symptoms During Smoking Cessation: Who's at Risk for Relapse?

Article

Full-text available

Apr 2002

The authors examined patterns of change in depressive symptoms during smoking cessation treatment in 163 smokers with past major depressive disorder (MDD). Cluster analysis of Beck Depression Inventory (A. T. Beck, C. H. Ward, M. Mendelson, J. Mock, & J. Erbaugh, 1961) scores identified 5 patterns of change. Although 40% of participants belonged to clusters characterized by increasing depressive symptoms during quitting (rapid increasers, n = 31, and delayed increasers, n = 35), almost 47% were in clusters characterized by decreasing symptoms (delayed decreasers, n = 24, and rapid decreasers, n = 52). Both rapid and delayed increasers had especially poor smoking cessation outcomes. Results suggest that among smokers with an MDD history there is substantial heterogeneity in patterns of depressive symptoms during quitting and that patterns involving increased symptoms are associated with low abstinence rates.

Depression and Nicotine Withdrawal Associations with Combustible and Electronic Cigarette Use

Article

Full-text available

Dec 2020
Int J Environ Res Publ Health

Depression is a risk factor for nicotine use and withdrawal. Population level epidemiologic studies that include users of either combustible or electronic cigarette (NICUSER) could inform interventions to reduce nicotine dependence in vulnerable populations. The current study examined the relationship between depression diagnosis (DEPDX), NICUSER, and lifetime rates of DSM-V nicotine withdrawal (NW) symptoms in a nationally representative sample of US adults (N = 979), who answered related questions in surveys administered through GfK’s KnowledgePanel. Over 42% of the sample reported lifetime ever combustible cigarette use, 15.6% electronic-cigarette use, and 45.9% either (NICUSER). Weighted logistic regression analyses (controlling for age and gender) found that DEPDX was associated with 2.3 times increased odds (ratio (OR); 95% Confidence Interval (CI): 1.5–3.5) of being a NICUSER. Regarding risks of NW symptoms among NICUSER, models that additionally controlled for frequency of nicotine use found that DEPDX was significantly associated with increased odds of concentration problems (OR = 2.4; 95% CI: 1.3–4.5) and depressed mood (OR = 2.2; 95% CI: 1.1–4.1) when quitting or cutting down on nicotine use. Results highlight the consistent comorbidity between depression, nicotine use, and symptomatic nicotine withdrawal in a population-based sample of combustible and electronic cigarette users.

Prenatal Tobacco Smoking is associated with Postpartum Depression in Japanese Pregnant Women: The Japan Environment and Children's Study

Article

Full-text available

Nov 2019
J AFFECT DISORDERS

Introduction: Previous studies in Western countries have examined the association between prenatal smoking and risk for Postpartum depression (PPD). However, evidence from Japan is lacking, despite the high prevalence of smoking among pregnant women. Therefore, we examined the association between prenatal smoking and PPD among pregnant Japanese women. Methods: We analyzed data for up to 1 month after childbirth from the Japan Environment and Children's Study (JECS), a nationwide birth cohort study. Among the 103,070 pregnant women recruited, 80,872 eligible participants were included in the analysis. PPD was defined as a score of ≥9 on the Edinburgh Postnatal Depression Scale (EPDS). Prenatal smoking and length of smoking cessation among ex-smokers were obtained using self-administered questionnaires at second/third trimester. Results: Among 80,872 pregnant women, 9.0% reported PPD. Multivariable-adjusted odds ratios (OR) (95% confidence intervals) for PPD (reference: never smoked) were 1.24 (1.12-1.37) for women who quit smoking after becoming pregnant, and 1.38 (1.21-1.56) for those who smoked during pregnancy. Compared with women who had never smoked, those who quit smoking ≤5 years before childbirth had a higher occurrence of PPD, with a multivariable-adjusted OR of 1.10 (1.00-1.22). Limitations: Questionnaire data was self-reported by participants, thus smoking status might be under-reported. Conclusions: Women who smoked during pregnancy, quit smoking after becoming pregnant, and quit smoking ≤5 years before childbirth are more likely to experience PPD than those who had never smoked.

Individual differences in emotion dysregulation and trajectory of withdrawal symptoms during a quit attempt among treatment-seeking smokers

Article

Oct 2018
BEHAV RES THER

Objective: Cigarette smoking remains the leading preventable cause of death in the United States, and withdrawal symptoms are central to the maintenance of tobacco use. Previous research suggests that individual differences in the propensity to experience negative affect may be related to more severe withdrawal symptoms. However, little research has examined how individual differences in the ability to regulate affect (emotion dysregulation) may impact withdrawal symptoms over time. Method: Therefore, the current study examined the effects of emotion dysregulation on change in tobacco withdrawal symptoms over 12 weeks following a cigarette quit attempt among 188 (Mage = 38.52, SD = 14.00, 46.8% male) treatment seeking smokers. Results: Results from the study indicated greater emotion dysregulation was associated with greater quit day withdrawal symptoms as well as with as slower decline in withdrawal symptoms over the 12-week period (B = -0.001, SE = 0.001, p = .046). Conclusion: The current study offers novel evidence into the role of emotion dysregulation in relation to withdrawal symptoms during a quit attempt. Assessing and reducing heightened emotion dysregulation prior to a quit attempt may be a potentially important therapeutic tactic for helping smokers achieve greater success in managing tobacco withdrawal. Public health significance statement: This study emphasizes the ways in which emotional dysregulation may affect tobacco withdrawal symptoms. This study can be utilized to further target smoking cessation programs for those attempting to quit smoking.

Different Effects of Cigarette Smoking on Neuropsychological Performance in Psychiatric Disorders

Chapter

Mar 2016

Smoking rates are significantly higher in the psychiatric population than in the general population. However, the prevalence of smokers is not homogeneous across different psychiatric disorders. Exceptionally high smoking rates have been found in patients suffering from schizophrenia (SZ), with high rates in bipolar disorder (BD) and in major depressive disorder (MDD); however, patients with obsessive-compulsive disorder (OCD) smoke less than both patients with other psychiatric disorders and the general population. Distinct cognitive effects of smoking among the different psychiatric populations may in part explain this variation. Some data suggest that smoking may exert beneficial effects on some cognitive functions of subjects with SZ, MDD, or BD, whereas it may have detrimental cognitive effects in healthy subjects and, to a greater extent, in subjects with OCD. In this chapter, we discuss the potential neurobiological mechanisms of smoking. Pharmacological interventions on the cholinergic system and/or cognitive remediation training may contribute to improve cognitive deficits and to promote smoking cessation in individuals with SZ, MDD, and BD.

Do Antidepressants Worsen COPD Outcomes in Depressed Patients with COPD?

Article

Full-text available

Nov 2024

Alan G. Kaplan

The coexistence of depression with chronic obstructive pulmonary disease (COPD) has been associated with poorer outcomes. Studies have questioned the safety of antidepressants in patients with COPD. This review shows the potential relationships and the possible mechanisms and gives us good warnings on how to approach this problem. Treatment should be both non-pharmacological and pharmacological, but importantly tailored to the individual patient.

Varenicline and counseling for vaping cessation: a double-blind, randomized, parallel-group, placebo-controlled trial

Article

Full-text available

Jul 2023
BMC MED

Background Vaping cessation is virtually unexplored. The efficacy and safety of varenicline for vaping cessation has not been studied and rigorous research is required to advance best practice and outcomes for people who use electronic cigarettes (EC) and want to quit. The objective is to evaluate the efficacy and safety of varenicline (1 mg BID, administered for 12 weeks, with follow-up to week 24) combined with vaping cessation counseling in exclusive daily EC users intending to quit vaping. Methods Design: Double-blind, randomized, parallel-group, placebo-controlled trial. Setting: The study took place at a University-run smoking cessation center. Participants: People who exclusively use ECs daily and intend to quit vaping. Intervention: A total of 140 subjects were randomized to either varenicline (1 mg, administered twice daily for 12 weeks) plus counseling or placebo treatment (administered twice daily, for 12 weeks) plus counseling. The trial consisted of a 12-week treatment phase followed by a 12-week follow-up, nontreatment phase. Main outcomes and measures: The primary efficacy endpoint of the study was biochemically validated continuous abstinence rate (CAR) at weeks 4 to 12. Secondary efficacy end points were CAR at weeks 4 to 24 and 7-day point prevalence of vaping abstinence at weeks 12 and 24. Results CAR was significantly higher for varenicline vs placebo at each interval: weeks 4–12, 40.0% and 20.0%, respectively (OR = 2.67, 95% CI = [1.25–5.68], P = 0.011); weeks 4–24, 34.3% for varenicline with counseling and 17.2% for placebo with counseling (OR = 2.52, 95% CI = [1.14–5.58], P = 0.0224). The 7-day point prevalence of vaping abstinence was also higher for the varenicline than placebo at each time point. Serious adverse events were infrequent in both groups and not treatment-related. Conclusions The findings of the present RCT indicate that inclusion of varenicline in a vaping cessation program for people who use electronic cigarettes and intending to quit may result in prolonged abstinence. These positive findings establish a benchmark of intervention effectiveness, may support the use of varenicline combined with counseling in vaping cessation programs, and may also help guiding future recommendations by health authorities and healthcare providers. Trial registration The study has been registered in EUDRACT with Trial registration ID: 2016-000339-42.

The effects of reduced nicotine content cigarettes in smokers with mood or anxiety disorders: a double-blind randomized trial

Preprint

Full-text available

May 2022

BACKGROUND The U.S. Food and Drug Administration and the government of New Zealand have proposed a reduction of the nicotine content in cigarettes to very low levels. This study examined the likely effects of this regulation in smokers with affective disorders. METHODS In a randomized controlled trial conducted at two sites (Penn State Hershey and Massachusetts General Hospital, Boston) 188 adult smokers with a current or lifetime anxiety or unipolar mood disorder, not planning to quit in the next 6 months, were randomly assigned to smoke either Usual Nicotine Content (UNC) (11.6 mg nicotine/cigarette) cigarettes, or Reduced Nicotine Content (RNC) cigarettes where the nicotine content per cigarette was progressively reduced to 0.2 mg in five steps over 18 weeks. Participants were then offered the choice to either receive assistance to quit smoking, receive free research cigarettes, or resume using their own cigarette brand during a 12-week follow-up period. Main outcomes were biomarkers of nicotine and toxicant exposure, smoking behavior and dependence and severity of psychiatric symptoms. RESULTS After switching to the lowest nicotine content cigarettes, compared to smokers in the UNC group, the RNC group had significantly lower plasma cotinine (metabolite of nicotine), urine NNAL (metabolite of NNK, a lung carcinogen), exhaled carbon-monoxide, cigarette consumption, and cigarette dependence. There were no significant effects on psychiatric symptoms. At the end of the 12-week treatment choice phase, those randomized to the RNC group were more likely to have quit smoking (18% RNC v 4% UNC, p=0.004). CONCLUSION Reducing nicotine content in cigarettes to very low levels reduces toxicant exposure and cigarette addiction and increases smoking cessation in smokers with mood and/or anxiety disorders, without worsening mental health. Trial registration TRN: NCT01928758 , registered August 21, 2013

A Double-Blind, Randomized, Controlled Phase III Trial Investigating Efficacy and Safety of Varenicline for Vaping Cessation in Adult Users

Preprint

Full-text available

Dec 2022

Background: Vaping cessation is virtually unexplored. The efficacy and safety of varenicline for vaping cessation has not been studied and rigorous research is required to advance best practice and outcomes for e-cigarettes users who want to quit. Methods: Eligible patients were randomized to either varenicline (1 mg, administered twice daily for 12 weeks) or placebo treatment (administered twice daily, for 12 weeks) combined with vaping cessation counseling. The trial consisted of a 12-week treatment phase followed by a 12-week follow-up, nontreatment phase. The primary efficacy endpoint of the study was biochemically validated continuous abstinence rate (CAR) at weeks 4 to 12. Secondary efficacy end points were the CAR at weeks 4 to 24 and 7-day point prevalence of vaping abstinence at weeks 12 and 24. Results: CAR was significantly higher for varenicline vs placebo at each interval: weeks 4-12, 40.0% and 20.0%, respectively (OR = 2.67, 95% CI = [1.25 - 5.68], P = 0.011); weeks 4-24, 34.3% for varenicline and 17.2% for placebo (OR = 2.52, 95% CI = [1.14 - 5.58], P = 0.0224). The 7-day point prevalence of vaping abstinence was also higher for the varenicline than placebo at each time point. Serious adverse events were infrequent in both groups and not treatment-related. Conclusions: Inclusion of varenicline and counseling in a vaping cessation program for EC users intending to quit may result in prolonged abstinence. These positive findings may also help guiding future recommendations for vaping cessation by health authorities and healthcare providers.

The effects of reduced nicotine content cigarettes on biomarkers of nicotine and toxicant exposure, smoking behavior and psychiatric symptoms in smokers with mood or anxiety disorders: A double-blind randomized trial

Article

Full-text available

Nov 2022
PLOS ONE

Background The U.S. Food and Drug Administration and the government of New Zealand have proposed a reduction of the nicotine content in cigarettes to very low levels. This study examined the potential effects of this regulation in smokers with affective disorders. Methods In a randomized controlled parallel group trial conducted at two sites in the USA (Penn State University, Hershey, PA and Massachusetts General Hospital, Boston, MA) 188 adult smokers with a current (n = 118) or lifetime (n = 70) anxiety or unipolar mood disorder, not planning to quit in the next 6 months, were randomly assigned (1:1) to smoke either Usual Nicotine Content (UNC) (11.6 mg nicotine/cigarette) research cigarettes, or Reduced Nicotine Content (RNC) research cigarettes where the nicotine content per cigarette was progressively reduced to 0.2 mg in five steps over 18 weeks. Participants were then offered the choice to either receive assistance to quit smoking, receive free research cigarettes, or resume using their own cigarette brand during a 12-week follow-up period. Main outcomes were biomarkers of nicotine and toxicant exposure, smoking behavior and dependence and severity of psychiatric symptoms. The pre-registered primary outcome was plasma cotinine. Results A total of 143 (76.1%) randomized participants completed the randomized phase of the trial, 69 (73.4%) in the RNC group and 74 (78.8%) in the UNC group. After switching to the lowest nicotine content cigarettes, compared to smokers in the UNC group, at the last randomized visit the RNC group had significantly lower plasma cotinine (metabolite of nicotine): difference between groups, -175.7, 95% CI [-218.3, -133.1] ng/ml. Urine NNAL (metabolite of NNK, a lung carcinogen), exhaled carbon-monoxide, cigarette consumption, and cigarette dependence were also significantly lower in the RNC group than the UNC group. No between-group differences were found on a range of other biomarkers (e.g. 8-isoprostanes) or health indicators (e.g. blood pressure), or on 5 different psychiatric questionnaires, including the Kessler K6 measure of psychological distress. At the end of the subsequent 12-week treatment choice phase, those randomized to the RNC group were more likely to have quit smoking, based on initial intent-to-treat sample, n = 188 (18.1% RNC v 4.3% UNC, p = 0.004). Conclusion Reducing nicotine content in cigarettes to very low levels reduces some toxicant exposures and cigarette addiction and increases smoking cessation in smokers with mood and/or anxiety disorders, without worsening mental health. Trial registration TRN: NCT01928758, registered August 21, 2013.

Facilitating Smoking Cessation in Primary Care Settings

Article

May 2022

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

Impact of the Psychiatric Comorbidities in Chronic Obstructive Pulmonary Disease

Article

Full-text available

Mar 2022

Chronic obstructive pulmonary disease (COPD) is one of the main causes of death with a significant impact on the quality of life and mental health of the patients as well as on the health system. The social costs of COPD are significant, because this pathology has a negative impact on patients's professional performance and daily activity. The major risk factors for COPD are age and smoking. Extrapulmonary comorbidities are frequently associated with COPD and may have an influence on the symptoms severity, and the frequency of the exacerbations, hospitalizations and mortality. Psychiatric disorders, especially anxiety and depression, have been observed in clinical trials with an increased prevalence of COPD. The relationship between anxiety, depression and COPD is complex. Psychiatric pathology is involved in influencing the pathophysiology of COPD with a proven impact on the patient's prognosis. COPD sleep disorders can aggravate pre-existing psychiatric pathology, the relationship between the two pathologies being bidirectional. The aim of this paper is to review the latest clinical trials on the existing evidence of psychiatric comorbidities impact on the evolution and prognosis of COPD and the therapeutic alternatives for their improvement. The conclusion of the present study is that anxiety and depression should be periodically assessed by a multidisciplinary team in order to provide a complete management (pharmacological, pulmonary rehabilitation and cognitive-behavioral therapy), improving the patient's quality of life and prognosis.

Impact of a soft tip nicotine-free harmless cigarette as part of a smoking cessation program with psychological support and varenicline: an integrated workplace smoking cessation intervention

Article

Full-text available

Jun 2021

Cigarette consumption in the general population has shown a sustained decline over the past 20 years, but despite this, it is essential to monitor consumption among smokers at their workplace. There is an association between cigarette addiction and work-related stressors, with high prevalence rates for smokers, at least double those of other adults. This two-group randomized clinical trial compared the 12-week combined effect of psychological support and varenicline associated with the use or not of a nicotine-free inhaler with a soft mouthpiece (QuitGo™) on the 4 to 24-week cessation rate in enrolled smokers to a smoking cessation program promoted by our research group. The results of the logistic model analysis showed that the likelihood of quitting successfully at week 24 was significantly higher in the QuitGO™ group than in the control group for participants with high behavioral dependence as assessed by Glover-Nilsson Smoking Behavioral Questionnaire-GN-SBQ (OR = 8.55; CI at 95% = 1.75-43.20). The data presented suggest that the soft tip nicotine-free harmless cigarette may be helpful for smokers and those with work-related stress symptoms who recognize the need to have a gesture in the traditional cigarette smoking ritual.

Cap libro- Cigarros con cápsulas de sabor - 2021

Chapter

Full-text available

Apr 2021

Los cigarros con cápsulas han experimentado un crecimiento exponencial a nivel mundial, con especial énfasis en varios países de Latinoamérica, entre ellos México donde casi la mitad de la población fumadora las prefiere. El propósito del capítulo es mostrar la evidencia científica sobre los cigarros con cápsulas, qué son; cuáles son los sabores más comunes; su marketing y empaquetado; las prevalencias y factores asociados al consumo; las políticas e implicaciones de la cápsula de sabor; y las necesidades de investigación futura, en el contexto mexicano. Actualmente, los cigarros contienen hasta tres cápsulas en el filtro y se ofrecen en diversidad de sabores, incluso dentro de una cajetilla pueden contener hasta cinco sabores diferentes, siendo los más comunes una variedad de combinación con el sabor a menta y otros inspirados en frutas. Los diseños del empaquetado de las cajetillas son un medio importante para atraer a consumidores, modificar las preferencias del producto, haciéndolos más atractivos y con menor percepción de daño a la salud en comparación con los cigarros de combustión sin cápsulas, lo que ha contribuido a socavar los esfuerzos del control del tabaco en México. Se debe alentar a promover políticas públicas de prohibición de cápsulas de sabor.

Tobacco Withdrawal Symptoms Before and After Nicotine Deprivation in Veteran Smokers with Posttraumatic Stress Disorder and with Major Depressive Disorder

Article

Nov 2020
NICOTINE TOB RES

Introduction The high smoking prevalence amongst individuals with psychiatric disorders constitutes a major public health disparity. Negative reinforcement models of addiction posit that severe tobacco withdrawal symptoms, related to the affective vulnerabilities of these smokers, may thwart their quitting smoking successfully. However, relatively few studies have prospectively examined the effects of nicotine deprivation on withdrawal symptoms in these groups. Method This study compared the level of withdrawal symptoms both before and after nicotine deprivation in those diagnosed with posttraumatic stress disorder (PTSD) or major depressive disorder (MDD) and in those without psychiatric diagnoses. Participants were US veterans who smoked (>10 cigarettes/day) and met diagnostic criteria for PTSD (n= 38), MDD (n=43), or no psychiatric diagnosis (‘controls’ n=44). Participants attended study visits before and during 48-hour nicotine deprivation to report tobacco withdrawal symptoms. Analyses evaluated withdrawal symptom levels (baseline and during nicotine deprivation) and the change in symptoms related to nicotine deprivation and compared 1) participants with a psychiatric diagnosis versus controls, and 2) participants with PTSD versus MDD. Results Contrary to hypotheses, nicotine deprivation produced greater increases in most withdrawal symptoms amongst controls than in those with psychiatric diagnoses. Compared with controls, those with PTSD or MDD reported elevated symptom levels both before and after tobacco deprivation for most withdrawal symptoms. Conclusions These findings suggest that chronically high levels of distress and craving, rather than acute increases in withdrawal symptoms due to nicotine deprivation, may account for the quitting difficulties of those with comorbid conditions such as PTSD and MDD. Implications Severe tobacco withdrawal may account for the higher quitting difficulties of smokers with either posttraumatic stress disorder (PTSD) or major depressive disorder (MDD). Paradoxically, this study showed that individuals with no psychiatric diagnosis had greater increases in tobacco withdrawal severity due to nicotine deprivation than did those with either PTSD or MDD. Those with either PTSD or MDD showed high stable levels of withdrawal symptom severity both before and during 2 days of abstinence, suggesting that their quitting difficulties may be related to their chronically high levels of distress rather than nicotine deprivation per se.

Short- and Mid-term Effects of Acute Coronary Syndromes on Smoking Behaviour, Factors Affecting Smoking Status and the Family Physicians’ Role After Discharge

Article

Full-text available

Nov 2020

Introduction:Cigarette smoking is one of the most important preventable risk factors for atherosclerotic diseases. This study aims to assess the smoking behaviour after acute coronary syndrome (ACS) and aims to delineate the factors affecting smoking status after discharge.Methods:The Fagerström Test for Nicotine Dependence score, the sociodemographic status of patients, types of ACS and applied treatment methods were recorded. The Gensini scoring system was used to evaluate the extent and severity of coronary artery disease. Patients were reached via phone calls in the first, third and sixth month after discharge to assess their smoking status, their reasons for relapse and any recurrences of their diseases.Results:Forty-five percent of patients were treated for ST-elevated myocardial infarction, and 43.2% (n=48) had high or very high levels of dependence. Patients who had early symptoms had a higher rate of quitting smoking (p=0.009). Only 78.4% had thought of quitting smoking after discharge. Seventy-four (66.6%) patients underwent catheter-based interventions. The rates of relapse were 20.8% (n=15), 42.6% (n=32) and 53.9% (n=41) at the end of the first, third and sixth month after discharge, respectively. Gensini scores seemed to be higher among patients who had quit smoking (p

Association of smoking status and health-related quality of life: difference among young, middle-aged, and older adults in Shandong, China

Article

Full-text available

Feb 2021
QUAL LIFE RES

Purpose: Few studies explored the relationship between smoking status and health-related quality of life (HRQOL) among adults in China. This study aims to explore the relationship between smoking status and HRQOL among adults (18 +) and examine whether there is a difference in this relationship among young, middle-aged, and older adults in China. Methods: A total of 23,021 respondents were included in this study. The HRQOL is measured by EQ-5D-3L. The smoking status is divided into never smokers, current smokers, and former smokers. Tobit regression and Logistic regression are employed to explore the association between smoking status and HRQOL. The interaction term is included to explore the difference among young, middle-aged, and older adults. Results: This study finds smoking status is significantly associated with HRQOL. An interaction analysis shows that the association between smoking status and HRQOL is significantly different among young, middle-aged, and older adults (P < 0.05). The smoking status is only significantly associated with HRQOL in middle-aged and older adults, but not for young adults. Compared with never smokers, former smokers report significantly lower EQ-5D-3L utility value in middle-aged adults (coefficient = - 0.089; 95%CI - 0.128 to - 0.050), current smokers report significantly higher EQ-5D-3L utility value in older adults (coefficient = 0.041; 95%CI 0.005 to 0.076). Conclusions: This study demonstrates a significant association between smoking status and HRQOL among adults in China, and there is a difference in this relationship among young, middle-aged, and older adults. The government should take efforts to formulate a variety of measures to control tobacco use among adults.

Nicotine Effects, Body Weight Concerns and Smoking: A Literature Review

Article

Mar 2020
CURR PHARM DESIGN

Antonio Cepeda-Benito

How people become addicted to cigarette smoking and remain addicted despite repeated attempts to quit requires piecing together a rather complex puzzle. The present review contextualizes the role of nicotine and smoking sensory stimulation on maintaining smoking, describe nicotine's effects on feeding behavior and body weight, and explore the impact of smoking outcome expectancies, including the belief that nicotine suppresses appetite and body weight on the decision to smoke or vape (use of e-cigarettes). The analysis concludes with a review of rat models of human nicotine intake that attempt to isolate the effects of on appetite and weight gain. This research replicates with relative closeness phenomena observed in smokers, but the rat model falls short of replicating the long-term weight gain observed postsmoking cessation.

Investigating Tobacco Withdrawal in Response to Reduced Nicotine Cigarettes Among Smokers With Opioid Use Disorder and Other Vulnerabilities

Article

Full-text available

Feb 2020

Individuals with opioid use disorder (OUD) have high prevalence of smoking and poor cessation outcomes. Data suggest that smokers with OUD may experience heightened nicotine reinforcement and more severe tobacco withdrawal compared to smokers without OUD. The Food and Drug Administration is currently considering reducing the nicotine content of cigarettes to reduce smoking prevalence and smoking-related disease. It is critical to understand the effects of reduced nicotine content cigarettes (RNCCs) on tobacco withdrawal in this subgroup. In this secondary analysis, we investigated the ability of RNCCs to attenuate acute tobacco withdrawal and craving severity in smokers with OUD versus those without substance use disorders (SUDs). Smokers maintained on methadone or buprenorphine (opioid-maintained [OM]; n = 65) versus without other SUDs (i.e., non-SUD; n = 135) completed 5 laboratory sessions wherein they smoked their usual brand (UB) or a research cigarette varying in nicotine content (0.4, 2.4, 5.2, 15.8 mg/g of tobacco) under double-blind, acute abstinence conditions. Participants completed the Minnesota Tobacco Withdrawal Scale, including a desire to smoke (craving) item, before and every 15 min for 1 hr following smoking each cigarette. Tobacco withdrawal and craving did not differ significantly by OM status in response to UB or RNCCs. In addition to the Dose × Time interaction, greater depression and cigarette dependence consistently predicted withdrawal and craving (ps < .05). Across all cigarettes, tobacco withdrawal and craving did not significantly differ by OM status, suggesting that smokers receiving opioid agonist treatment may respond favorably to RNCCs. Additional studies with larger and more diverse samples are needed to address this question more definitively. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

The Implication of the Corticotropin-Releasing Factor in Nicotine Dependence and Significance for Pharmacotherapy in Smoking Cessation

Article

Full-text available

Mar 2019

Vasileia Karasavva

Smoking represents one of the greatest preventable causes of death globally, and pharmacological treatments of higher efficacy targeting smoking cessation are necessary. Current drug interventions show only modest success rates and do not adequately address nicotine withdrawal-induced anxiety that is heavily implicated in relapse and failed quit attempts. The purpose of this paper is to highlight that nicotine dependence is at least partially maintained through the negative reinforcing effect of avoiding abstinence-induced anxiety. This paper presents findings which suggest that this effect is mediated by the activation of the Corticotropin-Releasing Factor (CRF) system are presented and the implications of a therapeutic agent containing a CRF_1 antagonistare discussed. Specifically, CRF_1 blockers are highlighted as alternatives for individuals with multiple failed quit attempts because they target the abstinence-induced increased anxiety that seems to lie at the core of failed cessation attempts.

Off-label uses of drugs for depression

Article

Oct 2019
EUR J PHARMACOL

The prescription of drugs for depression is rising rapidly. One of the reasons for this trend is their many off-label uses. Up to one third of all prescriptions are for non-indicated use, which in addition to drug repurposing includes different dosing or duration than those recommended. In this review, we elaborate on what antidepressants can treat besides depression. The five classes of drugs for depression are introduced, and their mechanisms of action and serious side effects are described. The most common off-label uses of antidepressants are discussed, with a special focus on treating eating disorders, sleep problems, smoking cessation and managing chronic pain. Depression is often a comorbidity when antidepressants are chosen as therapy, but good therapeutic effects have been observed for other conditions also when depression is not involved. Finally, a new type of antidepressant developed from the hallucinogenic "party drug" ketamine is briefly introduced. This recent development suggest that antidepressants will keep playing a central role in medicine for years to come.

Safety and efficacy of first-line smoking cessation pharmacotherapies in bipolar disorders: Subgroup analysis of a randomized clinical trial

Article

Jun 2019
J AFFECT DISORDERS

Objectives: Post hoc analyses of EAGLES data to examine safety and efficacy of first-line smoking cessation pharmacotherapies in smokers with bipolar disorders (BD). Methods: Smokers with BD I/II (n = 285; 81.4% with BD I) and a comparison nonpsychiatric cohort (NPC; n = 2794) were randomly assigned to varenicline, bupropion, nicotine replacement therapy (NRT), or placebo for 12 weeks, plus weekly counseling. Primary outcomes were occurrence of moderate to severe neuropsychiatric adverse events (NPSAEs) and Weeks 9-12 biochemically-confirmed continuous abstinence (CA) rates. Results: For BD smokers, NPSAE risk differences versus placebo were: varenicline, 6.17 (95% CI: -7.84 to 20.18); bupropion, 4.09 (-8.82 to 16.99); NRT, -0.56 (-12.34 to 11.22). ORs for Weeks 9-12 CA, comparing active medication to placebo among BD smokers were: varenicline, 2.61 (0.68-9.95); bupropion, 1.29 (0.31-5.37), NRT, 0.71 (0.14-3.74). Pooling across treatments, NPSAE occurrence was higher (10.7% versus 2.3%; P < 0.001) and CA rates were lower (22.8% versus 13.3%; P = 0.008) in BD than NPC. Limitations: Study not powered to detect differences in safety and efficacy in the BD subcohort; generalizability limited to stably treated BD without current substance use disorders. Conclusions: Smokers with BD had higher risk of NPSAEs and were less likely to quit overall than NPC smokers. Among smokers with BD, NPSAE risk difference estimates for active treatments versus placebo ranged from 1% lower to 6% higher. Efficacy of varenicline in smokers with BD was similar to EAGLES main outcomes; bupropion and NRT effect sizes were descriptively lower. Varenicline may be a tolerable and effective cessation treatment for smokers with BD. Trial registration: ClinicalTrials.gov identifier (https://clinicaltrials.gov/): NCT01456936.

Quit rates at 6 months in a pharmacist-led smoking cessation service in Malaysia

Article

Full-text available

Aug 2016

Sui Chee Fai

Smoking cessation clinics have been established in Malaysia since 2004, but wide variations in success rates have been observed. This study aimed to evaluate the proposed pharmacist-led Integrated Quit Smoking Service (IQSS) in Sabah, Malaysia, and identify factors associated with successful smoking cessation.

The effect of implementing a tobacco treatment service on adherence to evidence-based practice in an inpatient state-owned psychiatric hospital: Tobacco Treatment in a State Psychiatric Facility

Article

May 2018

Background and Objectives The Centers for Medicare and Medicaid Services (CMS) requires reporting of specific tobacco treatment (TT) measures. We examined compliance to these measures before and after initiation of a specialized TT service in a state‐psychiatric hospital. Methods Using a retrospective analysis, patient records (N = 3669) were examined, using one‐way ANOVAs, for changes in rates of tobacco use screening and treatment between September–December 2015 (pre‐implementation of CMS requirements), and January–April, May–August, and September–December 2016 (post‐implementation of the CMS requirements). Results We found significant increases, between Sep–Dec 2015 and Sep–Dec 2016, in the rates of tobacco use screening (93.4–95.3%, F [3, 12] = 7.39, p = .005), offering TT counseling (68.1–76.5%, F [1] = 18.59, p = .001) and medications (71.7–76.5%, F [1] = 5.86, p = .032). Conclusions and Significance Our findings can provide guidance to enhance compliance with TT measures in psychiatric settings. (Am J Addict 2018;XX:1–4)

Depressive symptomatology in smokers with personality disorders who participated in a psychological treatment programe for smoking cessation / Sintomatología depresiva en fumadores con trastornos de la personalidad que participaron en un programa (...)

Article

Full-text available

Jun 2010

El presente estudio analiza la presencia de sintomatología depresiva en una muestra de 202 fumadores con y sin trastornos de personalidad que acuden a un tratamiento psicológico para dejar de fumar.Los resultados encontrados indican que el grupo de fumadores con trastornos de personalidad presentó más síntomas depresivos que el grupo de fumadores sin trastornos de personalidad, tanto al inicio del tratamiento como al finalizar el mismo. Este hallazgo confirmaría la frecuente asociación entre trastornos del Eje II y malestar emocional, producto del deterioro del funcionamiento general del sujeto por causa de los patrones de comportamiento inflexibles característicos de los trastornos de personalidad. AbstractThe present study analyzes the presence of depressive symptomatology in a sample of 202 smokers with and without personality disorders who participate in a psychological treatment programme for giving up smoking. The results indicate that the group of smokers with personality disorders presented more depressive symptoms than the group of smokers without personality disorders, both at the start and at the end of the treatment. This finding would confirm the widely found association between Axis II disorders and emotional distress, resulting from the deterioration of the individual’s general functioning due to the inflexiblebehaviour patterns characteristic of personality disorders.

Why are Antidepressant Drugs Effective Smoking Cessation Aids?

Article

Full-text available

Sep 2017
CURR NEUROPHARMACOL

Background: Before the advent of varenicline, antidepressant drugs were reported to exhibit better clinical efficacy than nicotine replacement therapy as smoking cessation aids. The most studied is bupropion, a clinically-effective antidepressant, the first to be marketed throughout Europe for smoking cessation. Since depression and tobacco smoking have a high incidence of cooccurrence, this would implicate an underlying link between these two conditions. If this correlation can be confirmed, then by treating one condition the related state would also be treated. Objectives: This review article will evaluate the various theories relating to the use of antidepressant drugs as smoking cessation aids and the underlying mechanisms link tobacco smoking and depression to explain the action of antidepressants in smoking cessation. One plausible theory of self-medication which proposes that people take nicotine to treat their own depressive symptoms and the affective withdrawal symptoms seen with abstinence from the drug. If the depression can instead be treated with antidepressants, then they may stop smoking altogether. Another theory is that the neurobiological pathways underlying smoking and depression may be similar. By targeting the pathways of depression in the brain, antidepressants would also treat the pathways affected by smoking and ease nicotine cravings and withdrawal. The role of genetic variation predisposing an individual to depression and initiation of tobacco smoking has also been discussed as a potential link between the two conditions. Such variation could either occur within the neurobiological pathways involved in both disorders or it could lead to an individual being depressed and selfmedicating with nicotine.

A two-site, two-arm, 34-week, double-blind, parallel-group, randomized controlled trial of reduced nicotine cigarettes in smokers with mood and/or anxiety disorders: trial design and protocol

Article

Full-text available

Jan 2017
BMC PUBLIC HEALTH

Background The U.S. Food and Drug Administration can set standards for cigarettes that could include reducing their nicotine content. Such a standard should improve public health without causing unintended serious consequences for sub-populations. This study evaluates the effect of progressive nicotine reduction in cigarettes on smoking behavior, toxicant exposure, and psychiatric symptoms in smokers with comorbid mood and/or anxiety disorders using a two-site, two-arm, double-blind, parallel group, randomized controlled trial (RCT) in four phases over 34 weeks. Methods Adult smokers (N = 200) of 5 or more cigarettes per day will be randomized across two sites (Penn State and Massachusetts General). Participants must have not had a quit attempt in the prior month, nor be planning to quit in the next 6 months, meet criteria for a current or lifetime unipolar mood and/or anxiety disorder based on the structured Mini-International Neuropsychiatric Interview, and must not have an unstable medical or psychiatric condition. After a week of smoking their own cigarettes, participants receive two weeks of Spectrum research cigarettes with usual nicotine content (11.6 mg). After this baseline period, participants will be randomly assigned to continue smoking Spectrum research cigarettes that contain either (a) Usual Nicotine Content (11.6 mg); or (b) Reduced Nicotine Content: the nicotine content per cigarette is progressively reduced from approximately 11.6 mg to 0.2 mg in five steps over 18 weeks. At the end of the randomization phase, participants will be offered the choice to either (a) quit smoking with assistance, (b) continue smoking free research cigarettes, or (c) return to purchasing their own cigarettes, for the final 12 weeks of the study. The primary outcome measure is blood cotinine; key secondary outcomes are: exhaled carbon monoxide, urinary total NNAL- 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol and 1-hydroxypyrene, oxidative stress biomarkers including 8-isoprostanes, measures of psychiatric symptoms (e.g., depression, anxiety), smoking behavior and dependence (e.g., cigarette consumption, quit attempts), and health effects (e.g., blood pressure, respiratory symptoms). Discussion Results from this study will inform FDA on the potential effects of regulating the nicotine content of cigarettes and help determine whether smokers with mood and/or anxiety disorders can safely transition to significantly reduced nicotine content cigarettes. Trial registration TRN: NCT01928758, registered August 21, 2013.

Smoking and depression

Article

Jan 2010

Colin P Mendelsohn

COPD’s effects on psychosocial functioning and familial interactions

Chapter

Full-text available

Dec 2015

Cigarette smoking and depression comorbidity: Systematic review and proposed theoretical model

Article

Full-text available

Sep 2016
ADDICTION

Background and aims: Despite decades of research on co-occurring smoking and depression, cessation rates remain consistently lower for depressed smokers than for smokers in the general population, highlighting the need for theory-driven models of smoking and depression. This paper provides a systematic review with a particular focus on psychological states that disproportionately motivate smoking in depression, and frame an incentive learning theory account of smoking-depression co-occurrence. Methods: We searched PubMed, Scopus, PsychINFO, and CINAHL through December 2014, which yielded 852 articles. Using pre-established eligibility criteria, we identified papers focused on clinical issues and motivational mechanisms underlying smoking in established, adult smokers (i.e., maintenance, quit attempts, and cessation/relapse) with elevated symptoms of depression. Two reviewers independently determined whether articles met review criteria. We included 297 articles in qualitative synthesis. Results: Our review identified three primary mechanisms that underlie persistent smoking among depressed smokers: low positive affect, high negative affect, and cognitive impairment. We propose a novel application of incentive learning theory which posits that depressed smokers experience greater increases in the expected value of smoking in the face of these three motivational states, which promotes goal-directed choice of smoking behavior over alternative actions. Conclusions: The incentive learning theory accounts for current evidence on how depression primes smoking behavior and provides a unique framework for conceptualizing psychological mechanisms of smoking maintenance among depressed smokers. Treatment should focus on correcting adverse internal states, and beliefs about the high value of smoking in those states, to improve cessation outcomes for depressed smokers. This article is protected by copyright. All rights reserved.

Racial/Ethnic Differences in Self-reported Withdrawal Symptoms and Quitting Smoking Three Years Later: A Prospective, Longitudinal Examination of US Adults

Article

Aug 2016

Introduction Racial/ethnic groups appear to differ on quit success and withdrawal is a key factor in cessation failure, yet little is known about racial/ethnic differences in withdrawal symptoms. This study of U.S. adults examined racial/ethnic differences in current smokers’ report of withdrawal symptoms and the relationship between withdrawal symptoms and quitting smoking three years later. Methods Using data from the National Epidemiologic Survey on Alcohol and Related Conditions (Wave 1, 2001-2001; Wave 2, 2004-2005), analyses were conducted on participants who identified as Non-Hispanic White, Non-Hispanic Black, or Hispanic; reported current cigarette smoking at Wave 1; and provided smoking status information at Wave 2 (n=7,981). Withdrawal symptoms during past quit attempts were assessed at Wave 1. Results Among Wave 1 current smoking adults, Non-Hispanic White respondents were more likely than Non-Hispanic Black and Hispanic respondents to report experiencing at least one withdrawal symptom, seven out of eight withdrawal symptoms, withdrawal-related discomfort, and withdrawal-related distress (ps<0.0001). While withdrawal symptoms were associated with a lower odds of quitting smoking for all groups, a stronger relationship between number of symptoms and lower odds of quitting was evident among Non-Hispanic White compared to Non-Hispanic Black respondents (interaction beta=0.065, p=0.0001). For Non-Hispanic White participants, each additional withdrawal symptom was associated with a 6% decrease in the odds of quitting. Conclusions Withdrawal symptoms were more commonly reported by Non-Hispanic White adults than Non-Hispanic Black and Hispanic adults and appeared to have a greater impact on failure to quit smoking for Non-Hispanic White compared to Non-Hispanic Black adults. IMPLICATIONS To our knowledge, this is the first study to use prospective, longitudinal data to examine the relationship between race and withdrawal symptoms and the impact of withdrawal symptoms on quitting among adults in the U.S. Non-Hispanic White adults were more likely to report withdrawal symptoms and there was a stronger relationship between greater number of withdrawal symptoms and lower odds of quitting for Non-Hispanic White adults compared to Non-Hispanic Black adults. Developing a better understanding of racial/ethnic differences in withdrawal and cessation can help to tailor efforts to improve outcomes for smokers in various racial/ethnic groups.

Quit rates at 6 months in a pharmacist-led smoking cessation service in Malaysia

Article

Full-text available

Aug 2016

Background: Smoking cessation clinics have been established in Malaysia since 2004, but wide variations in success rates have been observed. This study aimed to evaluate the proposed pharmacist-led Integrated Quit Smoking Service (IQSS) in Sabah, Malaysia, and identify factors associated with successful smoking cessation. Methods: Data from 176 participants were collected from one of the quit-smoking centres in Sabah, Malaysia. Pharmacists, doctors and nurses were involved throughout the study. Any health care provider can refer patients for smoking cessation, and free pharmacotherapy and counselling was provided during the cessation period for up to 3 months. Information on demographic characteristics, smoking behaviours, follow-up and pharmacotherapy were collected. The main outcome measure was the abstinence from smoking, which was verified through carbon monoxide in expired air during the 6-month follow-up. Results: A 42.6% success rate was achieved in IQSS. Smoking behaviour such as lower cigarette intake and lower Fagerström score were identified as factors associated with success. On top of that, a longer duration of follow-up and more frequent visits were significantly associated with success in quitting smoking. Conclusion: Collaboration among health care practitioners should be the main focus, and we need a combination of proven effective modalities in order to create an ideal smoking cessation module.

Gender differences in self-reported withdrawal symptoms and reducing or quitting smoking three years later: A prospective, longitudinal examination of U.S. adults

Article

Jun 2016

Background: Little is known about gender differences in withdrawal symptoms among smokers in the community. This study used longitudinal epidemiologic data to examine gender differences in current smokers' report of withdrawal symptoms during past quit attempts and the relationship between withdrawal symptoms and the odds of reducing or quitting smoking three years later. Methods: Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; Wave 1, 2001-2001, n=43,093; Wave 2, 2004-2005, n=34,653). Analyses were conducted on respondents who reported current daily cigarette smoking at Wave 1 (n=6911). Withdrawal symptoms during past quit attempts were assessed at Wave 1. Current smoking status was assessed at Wave 2. Results: Wave 1 current smoking women, compared to men, were more likely to endorse any withdrawal symptoms, withdrawal-related discomfort, and withdrawal-related relapse (ps<0.0001). Women endorsed a greater number of withdrawal symptoms than men (M=2.37, SE=0.05 versus M=1.78, SE=0.04; p<0.0001). The odds of reducing and quitting smoking were significantly lower for respondents who reported any Wave 1 withdrawal symptoms, withdrawal-related discomfort, and withdrawal-related relapse. These relationships did not differ for women versus men. Among men, the odds of reducing smoking at Wave 2 decreased significantly with each cumulative withdrawal symptom compared to women (β interaction=0.87; p=0.01). Conclusions: Women were more likely to report withdrawal while the relationship between withdrawal symptoms and decreased likelihood of reducing smoking was stronger in men. Identifying gender differences in withdrawal can help develop strategies to help reduce withdrawal for both men and women.

Depression and cigarette smoking behavior: A critical review of population-based studies

Article

Jun 2016
AM J DRUG ALCOHOL AB

Background: Smoking and depression are both leading causes of disability, mortality and morbidity around the world. Using epidemiologic data to study the association between depression and the severity, course, and persistence of smoking in the general population is important for understanding the scope of the problem of smoking among people with depression. Objectives: The current paper aims to critically review existing epidemiologic research on the smoking behaviors of persons with depressive symptoms and disorders and to identify gaps in the literature that warrant further study. Methods: Literature searches of Medline and EMBASE were used to identify articles that analyzed epidemiologic data and examined an aspect of smoking behavior in persons with depressive symptoms or disorders. Six hundred ninety-three abstracts were reviewed and 45 studies met all of the inclusion criteria to be included in the review. Results: Persons with depression, compared to those without depression, are more likely to smoke, and meet criteria for nicotine dependence, are less likely to quit smoking, and are more likely to relapse. Little is known about the association between depression and smoking behavior by age, socioeconomic status, or race/ethnicity or with regard to the use of tobacco products other than cigarettes. Conclusion: Persons with depression are more likely to smoke cigarettes and have greater difficulty quitting smoking. Community-based and public health approaches may need to begin considering the links between depression and smoking in order to best target the current smokers in the population and develop more effective tobacco control campaigns.

The association between workplace smoking bans and self-perceived, work-related stress among smoking workers

Article

Full-text available

Feb 2012
BMC PUBLIC HEALTH

Background: There is substantial empirical evidence on the benefits of smoking bans; however, the unintended consequences of this anti-smoking measure have received little attention. This paper examines whether workplace smoking bans (WSB's) are associated with higher self-perceived, work-related stress among smoking workers.

A global overview of shared genetic architecture between smoking behaviors and major depressive disorder in European and East Asian ancestry

Article

Apr 2025
J AFFECT DISORDERS

Tabac et psychotropes: incidences pharmacologiques et pharmacocliniques

Article

Jan 1995

Differences in biobehavioral measures of cigarette smoking by depression symptomology

Article

Jul 2023
ADDICT BEHAV

Introduction: Research that explores the clinical relevance of subclinical depressive symptoms and smoking is primarily focused on smoking cessation. We examine whether depression symptoms vary across an array of biological (carbon monoxide boost), behavioral (FagerströmTest of Nicotine Dependence, cigarettes per day, smoking topography), and psychological smoking-related outcomes (Questionnaire on Smoking Urges, Withdrawal Symptoms Checklist) in non-treatment-seeking smokers. Methods: Baseline data were pooled from three research trials with identical procedures designed to assess individual smoking behavior using smokers preferred cigarette brands. Depression symptom level (asymptomatic, subsyndromal, syndromal) was defined using established Center for Epidemiological Depression Scale (CES-D) cutpoint criteria. Smokers were instructed to smoke as usual for one-week. At the beginning and end of the baseline period, nicotine dependence, smoking topography, CO boost, desire to smoke, anticipation of positive reinforcement, negative affect, and withdrawal were measured. Results: Ordinary least squares linear regression models were used to test the association between depression symptom level and outcome measures adjusting for sex and education (N = 355). The results revealed no differences in topography measures, cigarettes per day and FTND. Smoking withdrawal and smoking urges were higher among both individuals with subsyndromal symptoms and syndromal depression symptoms compared to those who were asymptomatic. Individuals with subsyndromal depressive symptoms experienced higher smoke exposure and higher relief from negative affect. Conclusion: Increased smoke exposure, greater withdrawal symptoms and urges to smoke, and anticipation of negative affect relief among smokers with subsyndromal depression symptoms suggest that depression symptoms need not reach syndromal levels to alter smoking-related outcomes.

Efficacy and Safety of Combination Behavioral Activation for Smoking Cessation and Varenicline for Treating Tobacco Dependence among Individuals with Current or Past Major Depressive Disorder: A 2x2 Factorial, Randomized, Placebo-Controlled Trial

Article

Apr 2023
ADDICTION

Background and aims: Treatment of depression-related psychological factors related to smoking behavior may improve rates of cessation among adults with major depressive disorder (MDD). This study measured the efficacy and safety of 12 weeks of behavioral activation for smoking cessation (BASC), varenicline, and their combination. Design: Randomized, placebo-controlled, 2x2 factorial design comparing BASC vs. standard behavioral treatment (ST) and varenicline vs. placebo. Setting: Research clinics at two urban universities in the United States. Participants: Three-hundred adult smokers with current or past MDD. Interventions BASC integrated behavioral activation therapy and ST to increase engagement in rewarding activities by reducing avoidance, withdrawal, and inactivity associated with depression. ST was based on the 2008 PHS Clinical Practice Guideline. Both treatments consisted of eight 45-minute sessions delivered between weeks 1 and 12. Varenicline and placebo were administered for 12 weeks between weeks 2 and 14. Measurements: Primary outcomes were bioverified ITT 7-day point-prevalence abstinence at 27 weeks and adverse events (AEs). Findings: No significant interaction was detected between behavioral treatment and pharmacotherapy at 27 weeks (χ2 [1]=0.19, p=.67). BASC and ST did not differ (χ2 [1]=0.43, p=.51). Significant differences in ITT abstinence rates (χ2 [1]=4.84, p=.03) emerged across pharmacotherapy arms (16.2% for varenicline, 7.5% for placebo), with results favoring varenicline over placebo (Rate Ratio=2.16, 95% Confidence Interval=1.08, 4.30). All significant differences in AE rates after start of medication were higher for placebo than varenicline. Conclusion: A randomized trial in smokers with major depressive disorder found that varenicline improved smoking abstinence vs. placebo at 27 weeks without elevating rates of adverse events. Behavioral activation for smoking cessation did not outperform standard behavioral treatment with or without adjunctive varenicline therapy.

The experience of tobacco withdrawal symptoms among current smokers and ex-smokers in the general population: Findings from nationwide China Health Literacy Survey during 2018-19

Article

Full-text available

Jan 2023

Objective To clarify the extent to which smokers in the general population experience tobacco withdrawal symptoms and whether such experience differs in those who continue to smoke and those who stopped smoking. Methods We included relevant questions in the nationally-representative China Health Literacy Survey (CHLS) conducted in 2018–2019. Among 87,028 participants, there were 22,115 ever-smokers aged 20–69 years who provided information on their smoking history and their experience of tobacco withdrawal symptoms. Multivariate logistic regressions were conducted to explore the association between withdrawal symptoms and other variables. Results Among ever-smokers, there were 19,643 (88.8%) current smokers and 2,472 (11.2%) ex-smokers. Among current smokers, 61.3% reported having tried to quit smoking in the past. Overall, 61.1% of current smokers reported experiencing withdrawal symptoms: 69.9% of those who tried to quit smoking in the past and 47.5% of those who did not. A lower proportion of ex-smokers experienced withdrawal symptoms (46.3%) and the difference remained significant after controlling for demographic characteristics (OR = 1.76, 95% CI 1.62–1.93, P < 0.001). The most commonly reported withdrawal symptoms in both current smokers and ex-smokers were craving, restlessness and anxiety. In the multivariable-adjusted analyses, those who experienced withdrawal symptoms when they tried to quit smoking (OR: 2.05, 95% CI: 1.86–2.27) were less likely to successfully quit. Conclusions The clinical picture of the tobacco withdrawal syndrome is the same in current smokers and in ex-smokers, but ex-smokers are less likely to have experienced it. The experience of discomfort when unable to smoke is common and seems likely to be a major factor contributing to maintaining smoking behavior not just among individuals seeking help with quitting smoking, but among smokers generally.

Comparing the Rate of Nicotine Metabolism Among Smokers With Current or Past Major Depressive Disorder

Article

Mar 2021

Background and Objectives Persons with current or past major depressive disorder (MDD) vs those without have higher smoking rates. The nicotine metabolite ratio (NMR) represents variation in the rate of nicotine metabolism and has been associated with smoking behaviors and response to tobacco treatments. We compared NMR between smokers with current or past MDD (MDD+) vs smokers without MDD (MDD−). We also assessed correlates of NMR and compared withdrawal and craving between MDD+ and MDD− smokers. Methods Using baseline data from two clinical trials and propensity score weighting based on sex, race, body mass index, and smoking rate, we compared NMR between MDD+ (N = 279) and MDD− (N = 1575) smokers. We also compared groups on and nicotine withdrawal and craving. Results Mean NMR (β = −.02, 95% confidence interval [CI]: −0.05 to 0.01, P = .13) and the distribution of smokers across NMR quartiles (odds ratio [OR] = 0.76, 95% CI: 0.50 to 1.16, P = .21) were similar between MDD+ and MDD− samples. This relationship was not affected by antidepressant medication. In the MDD+ sample, African Americans had significantly lower mean NMR, while older smokers and smokers with lower education had higher mean NMR (Ps < .05). MDD+ smokers had significantly higher withdrawal and craving than MDD− smokers (Ps < .05). Discussion and Conclusions While variability in NMR may not explain differences in smoking rates between MDD+ and MDD− smokers, MDD+ smokers report increased withdrawal and craving. Scientific Significance In this first study to assess NMR among MDD+ smokers, the findings underscore the need to address withdrawal and craving within smoking cessation treatments for those with MDD. (Am J Addict 2021;00:00–00)

Taking a deep breath

Book

Full-text available

Jun 2007

The evidence examined in this report shows that care is needed to ensure that the smoking ban brings opportunities for people with mental health problems to give up smoking. It also shows that careful monitoring is needed to ensure that imposition of the ban does not cause unnecessary distress and harm in in-patient settings.

Smoking, the Spine, and Spinal Fusion

Chapter

Jan 2005

The Role of Anxiety in Smoking Onset, Severity, and Cessation-Related Outcomes: a Review of Recent Literature

Article

Full-text available

Jun 2020
Curr Psychiatr Rep

Purpose of review: Anxiety is one of the most common mental health conditions globally and co-occurs with smoking at a markedly high rate. The present review offers a narrative overview of the most recent research on the role of anxiety in smoking onset, maintenance, and cessation-related outcomes. Additionally, given the rise in electronic cigarette use, we review the emerging literature on the influence of anxiety on e-cigarette use. Recent findings: Evidence across studies varied as to the role of anxiety or anxiety symptoms in smoking behavior. The most consistent findings suggested that those with anxiety are more likely to be a smoker, supporting a high rate of co-occurrence across these conditions. Less consistent evidence was observed for the association between anxiety and onset, indicators of severity, and cessation outcomes. Although there is robust evidence for an association between smoking and anxiety, there were considerable discrepancies for the precise role of anxiety in smoking onset, severity, and cessation outcomes. Future work utilizing more sophisticated methodologies is needed to identify causal relations as well as putative moderators and mediators of the anxiety-smoking relation.

A Prospective Investigation of the Synergistic Effect of Change in Anxiety Sensitivity and Dysphoria on Tobacco Withdrawal

Article

Full-text available

Nov 2017

Objective: Prevailing theory and research suggests the psychological and physiological discomfort associated with tobacco withdrawal may play a formative role in the risk of cessation failure. Yet, research elucidating cognitive-affective vulnerability characteristics that contribute to increased tobacco withdrawal severity during periods of planned abstinence is highly limited. In the current study, we explored whether smokers with greater reductions of Anxiety Sensitivity (AS) and dysphoria during a smoking cessation intervention would experience less severe postquit tobacco withdrawal. Method: Specifically, the interactive effect of change (from preintervention baseline to quit day) in AS and dysphoria in relation to postquit withdrawal severity (quit day through 12 weeks postquit) was examined among treatment-seeking adult smokers enrolled in a smoking cessation trial (N = 198; 55.3% female; 86.8% Caucasian; Mage = 38.8, SD = 14.0). Results: Results indicated that the interactive effect of change in AS and dysphoria was related to linear change in postquit withdrawal symptoms. Specifically, larger reductions in AS were associated with a faster decline in the severity of withdrawal symptoms across the 12-week postquit period only for individuals with lower (but not higher) reductions in dysphoria. Additionally, the findings indicated that reducing levels of AS and dysphoria prequit is broadly related to the degree of change in postquit withdrawal symptoms. Conclusion: Collectively, these data suggest there is apt to be clinical merit to employing strategies to address AS and/or dysphoria to more effectively manage emergent withdrawal symptoms following smoking cessation treatment. (PsycINFO Database Record

Direct and Indirect Effects of Psychological Distress on Stress-Induced Smoking

Article

Nov 2017

Objective: Numerous studies have modeled the effects of stress in the laboratory, demonstrating that smokers who are exposed to experimental stressors exhibit significant increases in acute psychological distress. Whether these stress reactions are predictive of stress-induced smoking during an actual quit attempt, however, has not been examined. Furthermore, the possibility that such effects are particularly strong among smokers with higher ambient levels of distress has not been addressed. Method: Nicotine-dependent smokers (N = 60; 40 women, 20 men) completed the Brief Symptoms Index (BSI) and then participated in a laboratory stress task 1 week before a quit attempt. Acute psychological distress was measured immediately before and after exposure to stressful and neutral stimuli. After they quit, participants completed a smoking diary for 14 days in which they recorded the degree to which their smoking was precipitated by emotional stress. Results: Consistent with our hypotheses, BSI scores predicted both exaggerated laboratory stress responses (p < .005) and smoking that was attributable to stress during the 14-day postquit period (p < .01). Laboratory stress reactions were predictive of stress-induced smoking (p < .01), and acute psychological stress reactions mediated the effects of BSI on stress-induced smoking. Conclusions: Acute psychological stress reactivity is a potential mechanism underlying the effect of stress-induced smoking during a quit attempt.

Recent results in women smoking treatment

Article

Full-text available

May 2006

Surgeon General 2001 memorandum showed clearly that smoking is an ever increasing problem in females. Although evidence is contradictory, some authors claim that women have more difficulties and of different type than men when they decide to give up smoking. This paper reviews a number of factors (e.g., surrogate therapy, affective states, concern about weight, menstrual cycle related distress and social support) that affect women smoking cessation so as to guide the most appropriate therapeutic strategies. A review of literature about smoking cessation during pregnancy is also made -during this period a number of motivational, social, medical and cultural factors can make the smoking cessation easier.

A review of epidemiologic research on smoking behavior among persons with alcohol and illicit substance use disorders

Article

May 2016
PREV MED

Persons with alcohol use disorders (AUDs) and substance use disorders (SUDs) appear to be heavily affected by cigarette smoking. In order to address the consequences of smoking in this population, an understanding of the current state of knowledge is needed. Epidemiologic research provides the opportunity to obtain detailed information on smoking behaviors in large community samples. The aim of this paper was to synthesize the epidemiologic evidence on smoking among persons with AUDs/SUDs and suggest directions for future research. Literature searches of Medline and PubMed were used to identify articles and additional articles were elicited from publication reference lists. To be included in the review, papers had to be published in English, analyze epidemiologic data, and examine an aspect of smoking behavior in persons with AUDs/SUDs. Twenty-nine studies met inclusion criteria and were included in the review. In summary, epidemiologic evidence to date suggests greater lifetime and current smoking, nicotine dependence, and non-cigarette tobacco use; lower quitting; and differences in quit attempts and withdrawal symptoms for persons with AUDs/SUDs compared to other people. Most studies examined nationally representative data and were conducted on persons in the United States and Australia. Few publications examined outcomes by demographics (e.g., gender, age) but these studies suggested that specific patterns differ by demographic subgroups. More research is needed on persons with AUDs/SUDs in order to develop the most effective public health and clinical interventions to reduce smoking behaviors, improve cessation outcomes, and reduce the harmful consequences of smoking for those with AUDs/SUDs.

Cigarette Smoking

Chapter

Jan 2010

There are currently about 1 billion cigarette smokers worldwide. Despite legal regulation against the sale of cigarettes to persons under the age of 18 years, smoking among adolescents is nonetheless highly prevalent. Despite significant public health measures focused on reducing adolescent smoking, rates have not significantly declined. These prevalence findings are alarming, as smoking is a leading preventable risk factor for medical illnesses such as heart disease, a variety of pulmonary diseases (e.g., chronic obstructive pulmonary disease) as well as many types of cancer. Thus, there is a pressing need to understand better manage cigarette smoking and related forms of tobacco use. With this background, the purpose of the present chapter is to provide an overview of the prevalence, detection, current theoretical models, and treatment options for cigarette smoking and nicotine dependence.

Psychological and Psychiatric Consequences of Nicotine

Chapter

Jan 1998

Janet Brigham

Most reports about nicotine begin with an explanation of the numerous health risks and horrific death toll of smoking. Perhaps no more powerful statement can be made about the psychoactive and addictive effects of nicotine than a reminder that most of the millions of persons in the United States who use nicotine are aware of the health risks and yet continue to use tobacco. In some populations, notably among adolescents, nicotine use is increasing rather than decreasing, despite legislative, educational, and societal efforts to the contrary. Among U.S. youth, smokeless tobacco use is now so common that one fourth of white high-school-age males report current use (Centers for Disease Control and Prevention [CDC], 1996b). Some factors such as education influence nicotine use; nearly 46% of U.S. males who did not graduate from high school are smokers. Nearly one third of women with comparable education are smokers. Nonetheless, more than 1 in 10 adults with a college education are smokers (CDC, 1996a). Why, when the risks are so great, do so many people start smoking and keep smoking?

Debunking Myths About Self-Quitting

Article

Full-text available

Nov 1989

This article examines data from 10 longterm prospective studies (N > 5,000) in relation to key issues about the self-quitting of smoking, especially those discussed by Schachter. When a single attempt to quit was evaluated, self-quitters’ success rates were no better than those reported for formal treatment programs. Light smokers (20 or less cigarettes per day) were 2.2 times more likely to quit than heavy smokers. The cyclical nature of quitting was also examined. There was a moderate rate (mdn = 2.7%) of long-term quitting initiated after the early months (expected quitting window) of these studies, but also a high rate (mdn = 24%) of relapsing for persons abstinent for six months. The number of previous unsuccessful quit attempts was unrelated to success in quitting. Finally, there were few occasional smokers (slips) among successful long-term quitters. We argue that quitting smoking is a dynamic process, not a discrete event.

Affect Regulation, Tobacco Addiction, and Smoking Cessation

Article

Jul 1989

Timothy P. Carmody

Numerous investigators have examined the role of negative affective states and affect regulation in the initiation and development of cigarette smoking behavior, smoking cessation, and relapse prevention. Affect regulation refers to any attempt to alleviate negative mood states by means of pharmacologic-, cognitive-, behavioral-or environmentalchange methods. The psychological construct/process of affect regulation is examined in relation to (1) the initiation, development, and maintenance of the cigarette smoking habit; (2) the process of quitting smoking; and (3) the long-term maintenance of smoking abstinence versus relapse. Various psychosocial factors and physiological mechanisms are explored that have been hypothesized to be links between negative mood states, nicotine addiction, and smoking cessation. Implications for smoking cessation treatment are discussed in the areas of (1) the use of pharmacologic agents, such as clonidine, in the reduction of nicotine withdrawal symptoms; (2) nicotine replacement therapy; and (3) skills-training approaches to smoking cessation and relapse prevention.

Nicotine Dependence, Major Depression, and Anxiety in Young Adults

Article

Jan 1992
ARCH GEN PSYCHIAT

To determine whether nicotine dependence, classified by level of severity, was associated with other substance dependence, major depression, and anxiety disorders, we studied a random sample of 1007 young adults in the Detroit (Mich) area using the National Institute of Mental Health Diagnostic Interview Schedule, revised according to DSM-III-R. The systematic coverage of DSM-III-R criteria of nicotine dependence provides an unprecedented opportunity to separate persons with nicotine dependence from the larger class of persons with a history of smoking and to examine the prevalence of psychiatric disorders among persons with nicotine dependence and among nondependent smokers. The lifetime prevalence of nicotine dependence was 20%. Nicotine dependence was associated with alcohol, cannabis, and cocaine dependence. Controlling for the effects of other substance dependencies, persons with nicotine dependence had higher rates of major depression and anxiety disorders. The strength of these associations varied by level of severity of nicotine dependence. Nondependent smokers had higher rates of other substance dependencies, but not of major depression or anxiety disorders.

Symptoms of tobacco withdrawal. A replication and extension

Article

Feb 1991
ARCH GEN PSYCHIAT

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.

Depression and depressive symptoms in smoking cessation

Article

Jul 1990
COMPR PSYCHIAT

Previous findings from a smoking cessation trial showed that smokers with a history of major depression had lower success rates than smokers without a depression history. In an attempt to explain the worse outcome observed for smokers with a history of depression, postcessation data obtained from subjects randomly assigned to the placebo condition were examined further. It was observed that in the first week of a behaviorally oriented treatment program, the frequency and intensity of psychological symptoms, particularly depressive mood, were higher among smokers with past depression, and that this discomfort was related to treatment outcome. Interventions designed to prevent dysphoric symptoms during the acute withdrawal period may improve smoking cessation outcome for smokers with a history of major depression.

Smoking, Smoking Cessation, and Major Depression

Article

Oct 1990

A relationship between cigarette smoking and major depressive disorder was suggested in previous work involving nonrandomly selected samples. We conducted a test of this association, employing population-based data (n = 3213) collected between 1980 and 1983 in the St Louis Epidemiologic Catchment Area Survey of the National Institute of Mental Health. A history of regular smoking was observed more frequently among individuals who had experienced major depressive disorder at some time in their lives than among individuals who had never experienced major depression or among individuals with no psychiatric diagnosis. Smokers with major depression were also less successful at their attempts to quit than were either of the comparison groups. Gender differences in rates of smoking and of smoking cessation observed in the larger population were not evident among the depressed group. Furthermore, the association between cigarette smoking and major depression was not ubiquitous across all psychiatric diagnoses. Other data are cited indicating that when individuals with a history of depression stop smoking, depressive symptoms and, in some cases, serious major depression may ensue.

Depression and the Dynamics of Smoking: A National Perspective

Article

Oct 1990

Data from multiple studies suggest that depression plays a role in cigarette smoking. To obtain a national perspective on the role of depression in the dynamics of smoking, we analyzed data from the first National Health and Nutrition Examination Survey and the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. We used the Center for Epidemiologic Studies Depression Scale to assess symptoms of depression and used the standard cutoff (score, ≥16) for defining persons as depressed. The cross-sectional analysis of the first National Health and Nutrition Examination Survey showed that the prevalence of current smokers increased as the Center for Epidemiologic Studies Depression Scale score increased, whereas the quit ratio (former smokers/ever smokers) decreased as the Center for Epidemiologic Studies Depression Scale score increased. Among the cohort of smokers in the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, the estimated incidence of quitting after 9 years of follow-up was 9.9% for depressed smokers and 17.7% for nondepressed smokers. When we adjusted for amount smoked, sex, age, and educational attainment by means of a Cox proportional hazards model, we found that depressed smokers were 40% less likely to have quit compared with nondepressed smokers (relative risk, 0.6). These findings suggest that depression plays an important role in the dynamics of cigarette smoking in the United States. (JAMA. 1990;264:1541-1545)

Nicotine replacement: Ten-week effects on tobacco withdrawal symptoms

Article

Feb 1989

This study examined the long-term effects of nicotine replacement on tobacco withdrawal symptoms. Smokers (N = 40 community volunteers) maintained biologically validated smoking abstinence under closely monitored conditions while chewing 2 mg nicotine gum (Nicorette; average of 6.9 pieces per day) or placebo gum during the first 10 weeks following smoking cessation. During the first postcessation week symptoms of irritability, anxiety, impatience, restlessness, excessive hunger, difficulty concentrating, drowsiness, sleep disturbance and tobacco craving intensity were significantly lower in active as compared with placebo nicotine gum subjects. Symptoms of psychological distress including irritability, anxiety and impatience declined over time in placebo subjects and were suppressed by replacement therapy below placebo treatment levels only during the first 4-5 weeks after smoking cessation. On other items, most notably increased appetite and excessive eating, stable between-group differences persisted over the entire 10-week trial. The data suggest that use of active gum beyond the first 5 weeks post-cessation may be inconsequential as far as suppression of certain key symptoms of psychological disturbance is concerned, but more prolonged use of active gum would be advisable if the long-term nicotine replacement effects observed (e.g. decreased hunger) are relevant to smoking relapse prevention.

Severity of withdrawal symptoms as a predictor of outcome of an attempt to quit smoking

Article

Dec 1989

SYNOPSIS In 227 smokers' clinic clients who managed at least one week of abstinence, ratings of withdrawal symptoms were used to predict subsequent return to smoking. Depression, time spent with urges to smoke, and difficulty not smoking during the first week of abstinence were significantly associated with lapse back to smoking during the second week. Depression and difficulty not smoking during the second week significantly predicted smoking status during the third week. No withdrawal symptoms during the third week were associated with a return to smoking during the fourth week. The predictive power of withdrawal symptoms was over and above that of smoke intake and dependence. The findings provide some support for the view that reduction of withdrawal symptoms may be a worthwhile target in programmes for helping smokers to quit.

Prevalence of smoking among psychiatric outpatients

Article

Sep 1986

The prevalence of smoking among psychiatric outpatients (N = 277) was significantly higher than among either local or national population-based samples (N = 1,440 and 17,000) (52% versus 30% and 33%). The higher prevalence was not associated with the age, sex, marital status, socioeconomic status, alcohol use, coffee use, or institutionalization of the psychiatric patients. Smoking was especially prevalent among patients with schizophrenia (88%) or mania (70%) and among the more severely ill patients. Hypotheses about why psychiatric patients are more likely to smoke and why they do not have a high rate of smoking-induced illnesses are presented.

Prevalence of tobacco dependence and withdrawal

Article

Mar 1987

In a sample of 1,006 middle-aged male smokers drawn from the general population, 90% (N = 905) fulfilled DSM-III criteria and 36% (N = 362) fulfilled Fagerstrom's criteria for tobacco dependence. Among the 875 who had stopped smoking in the past for at least 24 hours, 21% (N = 184) fulfilled DSM-III criteria and 46% (N = 403) fulfilled the authors' own criteria for tobacco withdrawal. Concordance of results among the criteria for diagnosing tobacco dependence and withdrawal was low. These results suggest that the DSM-III criteria for tobacco dependence are overinclusive and that there is little consensus among the definitions of tobacco dependence and withdrawal.

Signs and Symptoms of Tobacco Withdrawal

Article

Apr 1986
ARCH GEN PSYCHIAT

To test the validity, magnitude, and clinical significance of the signs and symptoms of tobacco withdrawal defined by DSM-III, both observed and reported signs and symptoms were measured in 50 smokers during two days of ad lib smoking and then during the first four days of abstinence. Observer and subject ratings of the DSM-III symptoms of craving for tobacco, irritability, anxiety, difficulty concentrating, and restlessness increased after cessation. In addition, bradycardia, impatience, somatic complaints, insomnia, increased hunger, and increased eating occurred after cessation. The frequency and intensity of these symptoms varied across subjects; however, the average distress from tobacco withdrawal was similar to that observed in psychiatric outpatients. Subjects who had more withdrawal discomfort were more tolerant to the cardiovascular effects of nicotine. Subjects who had more withdrawal discomfort did not have a lower rate of smoking cessation.

Pomerleau OF, Pomerleau CS. Neuroregulators and the reinforcement of smoking: towards a biobehavioral explanation. Neurosci Biobehav Rev 8: 503-513

Article

Feb 1984
NEUROSCI BIOBEHAV R

This paper examines findings on the neuroregulatory effects of nicotine in an effort to formulate a unified hypothesis that can explain the remarkable persistence of smoking behavior. Because nicotine alters the bioavailability of several behaviorally active neuroregulators, including acetylcholine, norepinephrine, dopamine, beta-endorphin, and vasopressin, we propose that nicotine is "used" by smokers to produce temporary improvements in performance or affect. Under this formulation, a potential large number of exteroceptive and interoceptive cues unrelated to the nicotine-dependence cycle may serve as discriminative stimuli for smoking, over and above smoking to terminate or avoid withdrawal. The rapid action of nicotine, and its diverse neuroregulatory effects, render it particularly effective as a "coping response" to the demands of daily living. Of special interest in this regard is a biphasic pattern of arousal/catecholaminergic activation followed by cholinergic blockade or beta-endorphin release. Apparently smokers can adjust nicotine intake to enhance these effects selectively, which may add considerably to the appeal of smoking.

Cigarette smoking during anxiety-provoking and monotonous tasks

Article

Feb 1983
ADDICT BEHAV

Cigarette smokers were exposed to three conditions within a single session: stagefright anxiety, monotonous concentration, and a relaxation control. One cigarette was lit during the second 10-minute half of each condition, and smoking topography (number of puffs and cumulative volume smoked) was continuously recorded. Subjects smoked significantly more in the two task conditions than during relaxation, supporting the hypothesis that anxiety-provoking and attention-demanding situations elicit smoking. Younger subjects increased their smoking more than older subjects during stagefright , and females responded more than males to the concentration task.

Nicotine withdrawal symptoms and psychiatric disorders: Findings from an epidemiologic study of young adults

Abstract

No full-text available

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