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: 3.3). 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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    • "Such tasks have shown correlations with relevant smoking measures. Models of early lapse posit that it is not just the severity of tobacco withdrawal but also how an individual responds to discomfort and distress that predicts early smoking lapses (Brown et al., 2005; Hughes, 2007). A number of studies have provided data consistent with a distress tolerance perspective on early lapse but experimental research is still limited. "
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    ABSTRACT: The relationship between nicotine abstinence and panic onset is still not well understood and the role of catastrophic misinterpretation, as possible moderator or mediator of this relationship, is unknown. We tested whether nicotine abstinence influences the response to a CO2 panic challenge and whether catastrophic misinterpretation (measured via the Anxiety Sensitivity [ASI] and the SomatoSensory Amplification Scale [SSAS]) exerts a moderating or mediating effect on the relationship between nicotine abstinence and panic. Eighty regular smokers underwent a 35% CO2 challenge after the transdermal administration of nicotine or placebo. Physiological and psychological variables were measured at baseline, directly before and after the challenge. Fear reactivity to the challenge was similar in both conditions. ASI (post-Test Visual Analogous Scale of Fear: ΔR2 = 0.043, p < .05) and SSAS (post-Test Visual Analogous Scale of Anxiety: ΔR2 = 0.036, p < .05; post-Test Panic Symptom List: ΔR2 = 0.035, p < .05) influenced anxiety as response to the challenge. We found no support for the moderational and the mediational hypotheses. The findings regarding fear reactivity when group status is considered partly confirm the literature. The positive findings observed for ASI and SSAS as factors influencing the response to the challenge, together with the lack of evidence for a moderational and a mediational hypothesis, confirm that anxiety sensitivity and somatosensory amplification are independent constructs and suggest that they directly influence the response to the challenge. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Full-text · Article · Aug 2015 · Experimental and Clinical Psychopharmacology
    • "Such tasks have shown correlations with relevant smoking measures. Models of early lapse posit that it is not just the severity of tobacco withdrawal but also how an individual responds to discomfort and distress that predicts early smoking lapses (Brown et al., 2005; Hughes, 2007). A number of studies have provided data consistent with a distress tolerance perspective on early lapse but experimental research is still limited. "

    No preview · Article · Dec 2013 · European Psychiatry
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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.
    Full-text · Article · Dec 2013 · Nicotine & Tobacco Research
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