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Cited by 193Smoking Behavior and CessationSubstance Abuse Treatment and OutcomesPrenatal Substance Exposure Effects

Prospective examination of effects of smoking abstinence on cortisol and withdrawal symptoms as predictors of early smoking relapse

al’Absi, Mustafa, Hatsukami, Dorothy, Davis, Gary L., Wittmers, Lorentz E.·2004·Drug and Alcohol Dependence
DOI 10.1016/j.drugalcdep.2003.10.014
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Abstract

This study addressed the hypothesis that exaggerated mood and cortisol changes during the first 24h of smoking abstinence are associated with early relapse. Salivary cortisol levels and mood reports were measured during 24-h ad libitum smoking and the first 24-h abstinence period of a quit attempt. Seventy-two habitual smokers (34 women and 38 men) who were interested in smoking cessation participated. Cotinine concentrations in saliva and expired carbon monoxide were measured before and after abstinence and 1 week after the quit date to verify smoking status. Abstinence produced significant withdrawal symptoms in all participants and reduced cotinine and carbon monoxide levels. While participants showed the expected diurnal changes in cortisol levels, those who relapsed within the first week post quitting exhibited a greater drop in morning cortisol concentrations during abstinence relative to their ad libitum smoking levels. Participants who relapsed reported greater withdrawal symptoms, craving for cigarettes, and distress, and they also reported greater reduction in positive affect during the first 24-h period of abstinence than those who maintained abstinence. These results support the hypothesis that early relapse is associated with exaggerated mood and adrenocortical perturbations observed during the first day of abstinence.

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  • Nicotine withdrawal symptoms are a primary reason smokers fail to quit and must be alleviated to prevent early relapse.

    “The symptoms associated with nicotine withdrawal are a primary deterrent to cessation and they need to be quelled to avoid early relapse.”

    From Mechanistic insights into nicotine withdrawal (2011) · cites this paper as [27]

  • Increased severity of nicotine withdrawal predicts increased relapse rates.

    “Nicotine withdrawal symptoms are highly variable between patients and can be quite severe, with increased severity of withdrawal being predictive of increased rates of relapse [25, 27, 128–130].”

    From Mechanistic insights into nicotine withdrawal (2011) · cites this paper as [27]

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Authors
al’Absi, M., Hatsukami, D., Davis, G. L., & Wittmers, L. E.
Affiliations
University of Minnesota (US)
Corresponding author
al’Absi, Mustafa
ORCID
Venue
Drug and Alcohol Dependence
Publisher
Elsevier BV
Published
2004-03
Volume
73
Issue
3
Pages
267-278
ISSN
0376-8716 (ISSN-L)
DOI
10.1016/j.drugalcdep.2003.10.014
OpenAlex
W2072441780
Cited by
193
References
68
Citations by year
2026: 1 · 2025: 6 · 2024: 2 · 2023: 5 · 2022: 7 · 2021: 5 · 2020: 6 · 2019: 5 · 2018: 10 · 2017: 17 · 2016: 7 · 2015: 11 · 2014: 14 · 2013: 12 · 2012: 9
FWCI
6.17
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Drug and Alcohol Dependence (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5p50da013333-10, 1r03da013435-01)
  • National Institute on Drug Abuse (DA013435, DA 013333)
  • National Cancer Institute (R21CA088272, CA88272)
Topics
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
Keywords
smoking abstinence, smoking relapse, salivary cortisol, withdrawal symptoms, mood, adrenocortical function, nicotine craving, positive affect, smoking cessation, cotinine, diurnal cortisol rhythm
MeSH terms
Smoking Prevention, Adolescent, Adult, Affect, Aged, Carbon Monoxide, Circadian Rhythm, Cotinine, Female, Humans, Hydrocortisone, Male, Middle Aged, Saliva, Smoking, Substance Withdrawal Syndrome, Smoking Cessation, Sex Distribution, Area Under Curve, Secondary Prevention

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