The DOI matches its Crossref record; 140 of the 177 references it cites were found in a registry or an index.
Effects of abstinence from tobacco: Valid symptoms and time course
Abstract
This article updates a 1990 review of the effects of tobacco abstinence by reviewing (a) which symptoms are valid indicators of tobacco abstinence and (b) the time course of tobacco abstinence symptoms. The author searched several databases to locate more than 3,500 citations on tobacco abstinence effects between 1990 and 2004; 120 of these were used in this review. Data collection and interpretation were based solely on the author's subjective judgments. For brevity, the review does not evaluate craving, hunger, performance, and several other possible outcomes as withdrawal symptoms. Anger, anxiety, depression, difficulty concentrating, impatience, insomnia, and restlessness are valid withdrawal symptoms that peak within the first week and last 2-4 weeks. Constipation, cough, dizziness, increased dreaming, and mouth ulcers may be abstinence effects. Drowsiness, fatigue, and several physical symptoms are not abstinence effects. In conclusion, no major changes are suggested for DSM-IV criteria for tobacco/nicotine withdrawal, but some deletions are suggested for ICD-10 criteria. Future studies need to investigate several possible new symptoms of withdrawal and to define more clearly the time course of symptoms.
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In the citing paper
“Aside from urges to smoke, the most common symptoms involve emotional dysregulation and cognitive deficits (13, 14).”
From Varenicline improves mood and cognition during smoking abstinence (2009) · cites this paper as [13]
In the citing paper
“Seven nicotine withdrawal symptoms were validated in a recent comprehensive review on the topic [119] and appear in the DSM-IV-TR [120]. The symptoms are irritability/anger/frustration, anxiety, depression/negative affect, concentration problems, impatience, insomnia, and restlessness.”
From Mechanistic insights into nicotine withdrawal (2011) · cites this paper as [119]
In the citing paper
“Nicotine withdrawal symptoms are typically reported to reach a peak within the first week of abstinence and taper off for the next 3–4 weeks [119, 124]. However, some reports indicate that symptoms can subside within 10 days [125], while others indicate that withdrawal symptoms may persist past 31 days [126, 127].”
From Mechanistic insights into nicotine withdrawal (2011) · cites this paper as [119]
In the citing paper
“In addition to this, chronic changes in the CNS lead to unpleasant withdrawal symptoms (irritability, depressed mood, anxiety, restlessness, difficulty concentrating and increased appetite) that make the experience of not smoking aversive and generate the need to smoke (19,20).”
From The Multiple Facets of Cigarette Addiction and What They Mean for Encouraging and Helping Smokers to Stop (2009) · cites this paper as [20]
In the citing paper
“Nicotine administration also increases the extracellular noradrenaline in various parts of the brain (32–35);”
From Tobacco addiction (2008) · cites this paper as [35]
In the citing paper
“Most nicotine withdrawal symptoms in adults peak at one week.18”
From Maternal Smoking during Pregnancy and Newborn Neurobehavior: Effects at 10 to 27 Days (2009) · cites this paper as [18]
In the citing paper
“These symptoms include difficulty concentrating, increased craving, depressed mood, and increased anxiety (Hughes, 1992(Hughes, , 2007)).”
From Activation of α4β2*/α6β2* nicotinic receptors alleviates anxiety during nicotine withdrawal without upregulating nicotinic receptors (2014) · cites this paper as Hughes, 2007
In the citing paper
“This is in line with evidence from ex-smokers who report that withdrawal symptoms abate a few weeks after smoking cessation (Hughes, 2007).”
From An application of the stress-diathesis model: A review about the association between smoking tobacco, smoking cessation, and mental health (2023) · cites this paper as Hughes, 2007
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“Besides a craving for tobacco, nicotine withdrawal can induce not only dysphoria, fear, anhedonia, irritability, restlessness, and increased appetite, but often also remarkable sleep disturbances [4,5].”
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Varenicline improves mood and cognition during smoking abstinence
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“It also leads to several unpleasant withdrawal symptoms including irritability, depressed mood, anxiety, restlessness, difficulty concentrating, sleep disturbance and increased appetite (Hughes 2007; Hughes et al. 1991, 1994; Hughes and Hatsukami 1986).”
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“, 2007), withdrawal symptoms typically peak within a week of cessation and subside over the following 3–4 weeks (Hughes, 2007).”
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Self-citationAbuse Liability Assessment of Tobacco Products Including Potential Reduced Exposure Products
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“Behavioural intervention Background Smoking cessation is associated with tobacco withdrawal symptoms (TWS) such as sleep disturbance, irritability, poor concentration, and depressed mood, as well as intense craving for a cigarette (Hughes 2007).”
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“Smoking is prohibited during fasting hours, therefore limiting the number of cigarettes per day might be related to weight gain among smokers in Ramadan((56)).”
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“Somatic symptoms include bradycardia, insomnia, and gastrointestinal discomfort, whereas negative affective symptoms include anger, anxiety, craving, depression, difficulty concentrating, impatience, insomnia, and restlessness (Hughes, 2007a).”
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“For instance, withdrawal symptoms such as craving, negative affect, inability to concentrate, hunger, and insomnia all seem to index decreased tobacco intake amongst dependent smokers (Dawkins et al. 2009; Hughes 2007a, b; Leventhal et al. 2010).”
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InfluentialClickotine, A Personalized Smartphone App for Smoking Cessation: Initial Evaluation
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Smoking Behaviour and Mental Health Disorders—Mutual Influences and Implications for Therapy
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“During abstinence, withdrawal symptoms such as depressed mood, insomnia, and irritability [30] are hypothesized to occur because target nAChRs are either no longer occupied by nicotine or change from the desensitized to the active state and become responsive to nicotine, once more causing a strong urge to resume smoki…”
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“In women and men, craving was significantly lower at 7 to 9 days of abstinence than before quitting, in keeping with data suggesting withdrawal symptoms that drive craving peak within the first week of quitting and decline by 7 to 9 days of abstinence.(49) In addition, smokers were helped to remain abstinent using con…”
DAT Genotype Modulates Brain and Behavioral Responses Elicited by Cigarette Cues
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“Nicotine withdrawal symptoms abate within 1 month of quitting (Hughes, 2007).”
BackgroundAnxiolytics for smoking cessation
Hughes, J. R., Stead, L. F., & Lancaster, T. (2000) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002849 · Cited by 101
Self-citationMaternal Smoking during Pregnancy and Newborn Neurobehavior: Effects at 10 to 27 Days
Stroud, L. R., Paster, R. L., Papandonatos, G. D., Niaura, R., Salisbury, A. L., Battle, C., Lagasse, L. L., & Lester, B. (2009) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2008.07.048 · Cited by 102
McClernon, F. J., Kollins, S. H., Lutz, A. M., Fitzgerald, D. P., Murray, D. W., Redman, C., & Rose, J. E. (2007) · Psychopharmacology · doi:10.1007/s00213-007-1009-3 · Cited by 101
“Significant increases in craving for cigarettes, while not considered a withdrawal symptom in most nosologies, is reported by a majority of smokers (Hughes 2007).”
BackgroundChange in anxiety following successful and unsuccessful attempts at smoking cessation: cohort study
McDermott, M. S., Marteau, T. M., Hollands, G. J., Hankins, M. C., & Aveyard, P. N. (2013) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.112.114389 · Cited by 101
“quit attempt due to withdrawal from nicotine (14), it remains unclear what happens in the longer term once the initial withdrawal phase has ended (normally after 2-4”
Varenicline and bupropion sustained-release combination therapy for smoking cessation
Ebbert, J. O., Croghan, I. T., Sood, A., Schroeder, D. R., Hays, J. T., & Hurt, R. D. (2009) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntn031 · Cited by 98
Influence of Neuronal Nicotinic Receptors over Nicotine Addiction and Withdrawal
De Biasi, M., & Salas, R. (2008) · Experimental Biology and Medicine · doi:10.3181/0712-mr-355 · Cited by 95
“In humans, cessation of tobacco intake precipitates both somatic and affective symptoms of withdrawal which may include severe craving for nicotine, irritability, anxiety, loss of concentration, restlessness, decreased heart rate, depressed mood, impatience, insomnia, and increased appetite and weight gain (21, 22).”
BackgroundWithdrawal: Expanding a Key Addiction Construct
Piper, M. E. (2015) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntv048 · Cited by 99
McClure, J. B., Swan, G. E., Jack, L. M., Catz, S. L., Zbikowski, S. M., McAfee, T. A., Deprey, M., Richards, J. A., & Javitz, H. S. (2009) · Journal of General Internal Medicine · doi:10.1007/s11606-009-0926-8 · Cited by 94
Ratschen, E., Britton, J. R., Doody, G. A., Leonardi‐Bee, J., & McNeill, A. D. (2009) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2009.08.003 · Cited by 92
Weight change during and after Ramadan fasting
Hájek, P., Myers, K., Dhanji, A., West, O., & McRobbie, H. J. (2011) · Journal of Public Health · doi:10.1093/pubmed/fdr087 · Cited by 91
Lerner, A., & Klein, M. (2019) · Brain Communications · doi:10.1093/braincomms/fcz025 · Cited by 89
“Tobacco/nicotine withdrawal usually begins within 24– 72 h of stopping or decreasing tobacco use, peaks at 2– 3 days after abstinence, and lasts 2–4 weeks (Hughes, 2007; New South Wales Government, 2008; APA, 2013; Jackson et al., 2015) and label Nicotrol 2010, Table 1.”
BackgroundRodent models of nicotine withdrawal syndrome
Malin, D. H., & Goyarzu, P. (2009) · Handbook of experimental pharmacology · doi:10.1007/978-3-540-69248-5_14 · Cited by 89
“Signs and symptoms include irritability, agitation, anxiety, sleep disturbances, difficulty concentrating, depression, weight gain, and craving for tobacco (Hughes 2007b).”
InfluentialSmoking cessation in pregnancy: a continuing challenge in the United States
Scherman, A. J., Tolosa, J. E., & McEvoy, C. T. (2018) · Therapeutic Advances in Drug Safety · doi:10.1177/2042098618775366 · Cited by 85
Smoking by people with mental illness and benefits of smoke-free mental health services
Campion, J., Checinski, K., Nurse, J., & McNeill, A. D. (2008) · Advances in Psychiatric Treatment · doi:10.1192/apt.bp.108.005710 · Cited by 86
“Nicotine withdrawal symptoms related to decreased dopaminergic activity cause significant distress and impairment in at least half of smokers when they quit (Hughes, 2007a).”
BackgroundNicotine withdrawal and agitation in ventilated critically ill patients
Lucidarme, O., Seguin, A., Daubin, C., Ramakers, M., Terzi, N., Beck, P., Charbonneau, P., & du Cheyron, D. (2010) · Critical Care · doi:10.1186/cc8954 · Cited by 85
“These symptoms peak during the first week of abstinence but sometimes are persistent for several weeks or months, and then gradually decrease to baseline levels [4,5].”
BackgroundShort-term abstinence effects across potential behavioral addictions: A systematic review
Fernandez, D. P., Kuss, D. J., & Griffiths, M. D. (2020) · Clinical Psychology Review · doi:10.1016/j.cpr.2020.101828 · Cited by 92
Walker, N. K., Howe, C., Bullen, C., Grigg, M., Glover, M., McRobbie, H. J., Laugesen, M., Parag, V., & Whittaker, R. (2012) · Addiction · doi:10.1111/j.1360-0443.2012.03906.x · Cited by 85
Stoker, A. K., Semenova, S., & Markou, A. (2008) · Neuropharmacology · doi:10.1016/j.neuropharm.2008.03.013 · Cited by 85
“Finally, in humans, the nicotine withdrawal syndrome is also characterized by ‘physical’ or somatic signs that include bradycardia, insomnia, gastrointestinal discomfort, and increased appetite (Hughes, 2007; Hughes et al., 1991b).”
BackgroundInfluentialInterventions for Tobacco Smoking
Schlam, T. R., & Baker, T. B. (2013) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-050212-185602 · Cited by 85
“These symptoms mount rapidly, within a few hours or less of stopping smoking (Hendricks et al. 2006), and typically—but not always—last two to four weeks (Hughes 2007).”
BackgroundWhy two smoking cessation agents work better than one: Role of craving suppression.
Bolt, D. M., Piper, M. E., Theobald, W. E., & Baker, T. B. (2011) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0026366 · Cited by 84
“…the effects of monotherapies, and (b) empirical evidence and theory suggest that they should be affected by nicotine abstinence and should affect the likelihood of remaining abstinent (Baker, Piper, McCarthy, Majeskie, & Fiore, 2004; D’Souza & Markou, 2010; Hughes, 2007; McCarthy et al., 2008).”
Anxiety and depressive symptoms and affective patterns of tobacco withdrawal
Leventhal, A. M., Ameringer, K. J., Osborn, E., Zvolensky, M. J., & Langdon, K. J. (2013) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2013.06.015 · Cited by 84
“Tobacco withdrawal symptoms, which span various undesirable affective, cognitive, and somatic features (Hughes, 2007), may provoke compulsive motivation to smoke to modulate such symptoms (Baker et al., 2004).”
BackgroundPost, A., Gilljam, H., Rosendahl, I. K., Bremberg, S. G., & Galanti, M. R. (2010) · Addiction · doi:10.1111/j.1360-0443.2009.02852.x · Cited by 84
“In particular, the instrument used in the sixth follow-up survey included selected items for the assessment of nicotine dependence and information on withdrawal symptoms after discontinuation of smoking or snus use [12].”
MethodXu, J., Fregni, F., Brody, A. L., & Rahman, A. S. (2013) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2013.00112 · Cited by 84
Sleep as a Target for Optimized Response to Smoking Cessation Treatment
Patterson, F., Grandner, M. A., Malone, S. K., Rizzo, A., Davey, A., & Edwards, D. G. (2017) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntx236 · Cited by 84
Nicotine and endogenous opioids: neurochemical and pharmacological evidence
Hadjiconstantinou, M., & Neff, N. H. (2011) · Neuropharmacology · doi:10.1016/j.neuropharm.2010.11.010 · Cited by 81
Plaza‐Zabala, A., Flores, Á., Maldonado, R. J., & Berrendero, F. (2011) · Biological Psychiatry · doi:10.1016/j.biopsych.2011.06.025 · Cited by 81
“insomnia, increased appetite and weight gain (3,4).”
Antidepressants for smoking cessation
Hajizadeh, A., Howes, S., Theodoulou, A., Klemperer, E., Hartmann-Boyce, J., Livingstone-Banks, J., & Lindson, N. (2023) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000031.pub6 · Cited by 84
Leventhal, A. M., Waters, A. J., Moolchan, E. T., Heishman, S. J., & Pickworth, W. B. (2010) · Addictive Behaviors · doi:10.1016/j.addbeh.2010.08.007 · Cited by 81
“Numerous studies have documented that statistically significant abstinence effects can be observed for a variety of subjective, cognitive, and physiological measures (for reviews see, Hughes, 2007a,b; Shiffman et al., 2004).”
InfluentialLengsfeld, S., Burkard, T., Meienberg, A., Jeanloz, N., Vukajlovic, T., Bologna, K., Steinmetz, M., Bathelt, C., Sailer, C. O., Vogt, D., et al. (2023) · EClinicalMedicine · doi:10.1016/j.eclinm.2023.101865 · Cited by 90
Garrison, K. A., Pal, P., Rojiani, R., Dallery, J., O’Malley, S. S., & Brewer, J. A. (2015) · BMC Psychiatry · doi:10.1186/s12888-015-0468-z · Cited by 74
“baseline, 1-, 3-, and 6-months from treatment initiation, including: (i) smoking demographics, including self report of smoking abstinence over the follow-up period allowing up to five cigarettes total [30]; (ii) 4-item Alcohol Use Disorders Identification Test (AUDIT-C; [38]); (iii) 15-item Minnesota Nicotine Withdra…”
MethodCook, J. W., Lanza, S. T., Chu, W., Baker, T. B., & Piper, M. E. (2016) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntw247 · Cited by 79
Role of the Glutamatergic System in Nicotine Dependence
Liechti, M. E., & Markou, A. (2008) · CNS Drugs · doi:10.2165/00023210-200822090-00001 · Cited by 79
Clinical significance of tobacco withdrawal
Hughes, J. R. (2006) · Nicotine & Tobacco Research · doi:10.1080/14622200500494856 · Cited by 80
Self-citationMeasurement of the effects of abstinence from tobacco: A qualitative review.
Hughes, J. R. (2007) · Psychology of Addictive Behaviors · doi:10.1037/0893-164x.21.2.127 · Cited by 76
Self-citationPotentially addictive properties of sugar-sweetened beverages among adolescents
Falbe, J., Thompson, H. R., Patel, A. I., & Madsen, K. A. (2018) · Appetite · doi:10.1016/j.appet.2018.10.032 · Cited by 84
“This study was limited to three days of cessation, which overlaps with timing for peak symptoms of withdrawal from caffeine of 20-51 hours (Juliano & Griffiths, 2004) and several symptoms of withdrawal from tobacco and alcohol (Hughes, 2007; Kosten & O'Connor, 2003; Shiffman et al., 2006).”
BackgroundSmoking Cessation, Version 3.2022, NCCN Clinical Practice Guidelines in Oncology
Shields, P. G., Bierut, L. J., Arenberg, D. A., Balis, D. S., Cinciripini, P. M., Davis, J. M., Edmondson, D. M., Feliciano, J., Hitsman, B. L., Hudmon, K. S., et al. (2023) · Journal of the National Comprehensive Cancer Network · doi:10.6004/jnccn.2023.0013 · Cited by 83
Varenicline in the treatment of tobacco dependence
Fagerström, K. O. (2008) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s927 · Cited by 78
“In addition, withdrawal from nicotine results in a combination of psychological and physical symptoms leading to cravings and a continued desire to smoke (West et al 2006; Hughes 2007).”
Kerr, S., Woods, C., Knussen, C., Watson, H. E., & Hunter, R. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-221 · Cited by 76
Tobacco dependence and withdrawal: Science base, challenges and opportunities for pharmacotherapy☆
Henningfield, J. E., Shiffman, S. S., Ferguson, S. G., & Gritz, E. R. (2009) · Pharmacology & Therapeutics · doi:10.1016/j.pharmthera.2009.03.011 · Cited by 77
“…of signs and symptoms that begin to emerge within a few hours of discontinuation of nicotine intake, with prominent symptoms including dysphoric mood, anxiety, anger, difficulty concentrating, sleep disturbance, and weight gain (WHO, 1992; American Psychiatric Association, 2000; Hughes, 2007a).”
BackgroundInfluentialWu, A. D., Gao, M., Aveyard, P., & Taylor, G. M. J. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.16111 · Cited by 68
Metadata
- Authors
- Hughes, J.
- Affiliations
- University of Vermont (US)
- Corresponding author
- Hughes, John
- Venue
- Nicotine & Tobacco Research
- Publisher
- Oxford University Press (OUP)
- Published
- 2007-03
- Volume
- 9
- Issue
- 3
- Pages
- 315-327
- ISSN
- 1462-2203 (ISSN-L)
- OpenAlex
- W2054388960
- Cited by
- 801
- References
- 177
- Citations by year
- 2026: 27 · 2025: 32 · 2024: 39 · 2023: 29 · 2022: 36 · 2021: 26 · 2020: 61 · 2019: 30 · 2018: 49 · 2017: 43 · 2016: 43 · 2015: 62 · 2014: 55 · 2013: 59 · 2012: 46
- FWCI
- 6.43
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Nicotine & Tobacco Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Drug Abuse (DA000490)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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, nicotine withdrawal symptoms, anger, anxiety, depression, insomnia, restlessness, constipation, cough, dizziness, oral ulcers
- MeSH terms
- Mental Disorders, Female, Humans, Male, Nicotine, Psychomotor Agitation, Substance Withdrawal Syndrome, Tobacco Use Disorder, Meta-Analysis as Topic, Smoking Cessation
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