Effects of abstinence from tobacco: Valid symptoms and time course

“Negative affect, which is considered a hallmark of nicotine withdrawal (American Psychiatric Association, 1994), refers to mood states marked by feeling angry, frustrated, irritable, sad, depressed, distressed, and so forth (Hughes, 2007; Welsch et al., 1999).”

“Hughes (2007) reviews research on the effects of abstinence from tobacco and concludes (p. 315) that: “Anger, anxiety, depression, difficulty concentrating, impatience, insomnia, and restlessness are valid withdrawal symptoms that peak within the first week and last 2–4 weeks.””

“Nicotine withdrawal symptoms usually begin 3–12 h after smoking cessation, reaching to the maximum intensity in 1–3 days, and they may last up to 3 or more weeks [55].”

“During nicotine withdrawal, depression is accompanied by cognitive deficits and anxiety (Hughes 2007; Stolerman and Shoaib 1991).”

“…in humans is represented by a variety of signs such as somatic signs that include gastrointestinal disturbances, weight gain, decreased heart rate (American Psychiatric Association 2000), sweating, dizziness (Hughes and Hatsukami 1986), fatigue, nausea, constipation, and diarrhea (Shiffman, 1979).”

“Daily diaries for the first 14 days following the target quit date were used to obtain the average composite withdrawal score and average craving score for each individual (Hughes, 2007b).”

“Why is it so difficult to remain abstinent immediately after quitting? Severe dysphoria, at levels comparable with those found in psychiatric outpatients (59), accompanies the early days of cessation, with irritability and anxiety as the predominant symptoms (60).”

“Longer term effects on concentration may peak a few days after abstinence and last for several weeks (Hughes 2007).”

“While the aversiveness of tobacco withdrawal plays a role in relapse (Hughes, 2007), individual differences in ability to tolerate or cope with the withdrawal and other stressors from abstinence are also likely to affect success of a smoking quit attempt since some smokers seem better able to…”

“Thus, AS and its facets have been especially tied to NA reduction smoking motives and expectancies as well as problems commonly associated with tobacco withdrawal (of which NA is a core component[40,41,59]), consistent with the notion that high-AS individuals are primarily motivated to smoke for the NA alleviating eff…”

“BSC Usual care BSC Usual care A&E (admitted) 6 (13) 1 (2) 6 1 A&E (not admitted) 9 (20) 7 (14) 12 8 Hospital admission 4 (9) 2 (4) 7 2 Outpatient appointment 23 (50) 20 (39) 116 53 Day case/procedure 6 (13) 6 (12) 8 12 Emergency ambulance 7 (15) 4 (8) 9 6 Patient Transport Service 4 (9) 2 (4) 111 22 GP home visit 5 (1…”

“Despite the availability of treatments for tobacco dependence, only 6% of the more than 1 billion smokers each year are successful in doing so for more than a month (Hughes, 2007; Siu & Tyndale, 2007).”

“2 Median (range) 39 (20–74) 39 (18–70) 32 (18–63) Gender, N (%) Male 13 (33) 22 (55) 18 (46) Female 26 (67) 18 (45) 21 (54) Race, N (%) White, non-Hispanic 38 (97) 37 (92) 34 (87) Other 1 (3) 3 (8) 5 (13) Marital status, N (%) Never married 13 (33) 13 (32) 14 (36) Separated/divorced 9 (23) 12 (30) 11 (28) Widowed 1 (3…”

“The withdrawal syndrome typically begins within the first two days after smoking cessation, peaks in the first week, and lasts 2–4 weeks, although the individual symptoms differ in their time course, and there are marked interindividual differences (Hughes, 2007).”

“[13,18] Surprisingly though, ASI Physical Concerns was not related to tobacco withdrawal symptom severity or negative reinforcement smoking expectancies incrementally to other ASI subscales, which may reflect that tobacco-related negative reinforcement and withdrawal symptoms are primarily tied to negative affective (…”

“While the course of most symptoms of nicotine withdrawal is presumed to be short and transient (American Psychiatric Association, 1994; Hughes, 2007b; Shiffman et al., 2006), even within this time frame for many individuals nicotine abstinence evokes a level of dysphoria commonly associated with clinical impairment (H…”

“This may be particularly true during the initial hours after quitting when withdrawal-related decrements in cognition are at their peak (Piasecki et al. 2003a,b; Hughes 2007; Allen et al. 2008).”

“These symptoms include difficulty concentrating, increased craving, depressed mood, and increased anxiety (Hughes, 1992; 2007).”

“Also, when nicotine levels drop, smokers experience symptoms such as anxiety, irritability and low mood which are then relieved by smoking a cigarette (Hughes 2007).”

“They usually peak within the first week of abstinence and last 2– 4 weeks (Hughes, 2007).”

“Cessation without assistance is very difficult due to the highly addictive nature of cigarettes and unpleasantness of withdrawing from nicotine [1-4].”

“All the nicotine withdrawal symptoms observed in this rat model were somatic behavioral signs, which limited the model's external validity as nicotine withdrawal in humans involves many subjective symptoms (Hughes, 2007; Malin, 2001).”

“Anxiety can contribute to increase smoking, and may be a symptom of nicotine withdrawal (Hughes 2007; Morissette 2007).”

“To control for withdrawal effects at 10-hour abstinence, craving, mood and anxiety, all symptoms of nicotine withdrawal (Hughes, 2007; Baker et al., 2012), were examined using the following measures: cigarette craving was assessed using the Brief Questionnaire of Smoking Urges (QSU-Brief; Cox et…”

“…excessive hunger, and craving cigarettes) with each item rated on a scale from 0–3 (none, mild, moderate, severe) (Etter, Ussher, & Hughes, 2013; Hughes, 2007) and summed to give a total score; 2) the brief Questionnaire for Smoking Urges (QSU-brief) that forms two subscales, Factor 1 and…”

“Although nicotine withdrawal is underrecognized in the hospital, nicotine withdrawal is common, peaks within 1 week of smoking cessation, and includes symptoms of irritability, anxiety, difficulty concentrating, restlessness, and depressed mood.(31) Because these symptoms are largely relieved with NRT, increased use o…”

“Aversive nicotine withdrawal symptoms, including craving, irritability, negative affect, and difficulty concentrating are prominent in the early stages of smoking abstinence (Hughes, 2007a,b; Welsch et al., 1999).”

“Some accounts of relapse (Edwards and Kendler 2011) interpret this to indicate that nicotine withdrawal, which is marked by negative affect and by affective reactivity (Hughes 2007; Hughes and Hatsukami 1986), plays a major role in triggering lapses.”

“These symptoms generally occur in the first 24 h of nicotine deprivation and severe in the first week of abstinence (Hughes, 2007; Soyster et al., 2016).”

“…the participants' personal commitment in the therapy, as reported in literature (Breslau, Kilbey, & Andreski, 1992; Gritz, Carr, & Marcus, 1991; Hughes, 2007; Leischow et al., 1997), seems to support our findings, since participants who attended from 1 to 3 sessions were significantly more…”

“The withdrawal syndrome is characterized by both affective (psychological) and somatic (physical) components, including craving, irritability, trouble in sleeping, anxiety, body tremors, headaches, weight gain, and depression (Hughes, 2007a; Kenny and Markou, 2001).”

“For instance, a review [7] concluded that quitters typically experience withdrawal symptoms for just 2 to 4 weeks after the quit day.”

“Additional measures administered at baseline and other points throughout the protocol included the Minnesota Nicotine Withdrawal Scale—Revised (Hughes 1992, 2007), an 11-item measure of Diagnostic and Statistical Manual of Mental Disorders—IVedition nicotine withdrawal symptoms that yielded an…”

“In Table 4 we propose, according to our experience, some indications for hospitalized patients. signs and symptoms of nicotine withdrawal syndrome According to the review by Hughes [48], nicotine withdrawal symptoms usually start within 24 h from the last cigarette or reduction, last acutely for almost 3–4 days, and u…”

“These symptoms generally emerge within the fi rst 24 h of nicotine deprivation and are typically most severe during the fi rst week of abstinence (Hughes, 2007).”

“These high relapse rates are partially explained by a debilitating nicotine withdrawal syndrome primarily characterized by anger, anxiety, craving, depression, difficulty concentrating, impatience, insomnia, and restlessness (Hughes, 2007).”

“Withdrawal abates within 4 weeks but cravings elicited by smoking reminders can continue months and even years after cessation (Hughes, 2007).”

“These incongruous findings do not appear to be related to the scale used to assess mood symptoms, level of nicotine dependence, or treatment setting (Hughes, 2007a).”

“Given that withdrawal symptoms last approximately 2–4 weeks (Hughes, 2007), we expected the influence of withdrawal on cessation fatigue would diminish over the initial 12-weeks of a quit attempt.”

“…of Arousal, which, despite a tendency to decrease during abstinence, has not demonstrated consistent response to abstinence, and is not considered part of the nicotine withdrawal syndrome (American Psychiatric Association [APA], 2013; Hughes, 2007; Hughes et al., 1990; Shiffman et al., 2006).”

“43 In our prior review, we concluded impulsivity should be added as a withdrawal symptom, based on the following criteria: (1) it consistently increased in prospective within-participant comparisons, (2) it showed a true withdrawal time course, and (3) it was due to nicotine deprivation.”

“These symptoms include headaches, coughing, fatigue, anxiety, depression, and irritability [14].”

“are at their greatest during this period, may play a more important role in predicting relapse at this stage (Hughes 2007).”

“The aversiveness of tobacco withdrawal symptoms may be part of the reason for rapid relapse (Hughes, 2007).”

“These withdrawal symptoms peak within the first weeks and last for about 2 to 4 weeks [17].”

“Since craving is not a necessary aspect of withdrawal (Hughes & Hatsukami, 1998; Hughes, 2007), involves both positive-affective and negative reinforcement components (Tiffany & Drobes, 1991), and can persist long after withdrawal has abated, medication effects on craving may be independent of its ability to attenuate…”

“1997; Heishman and Hennigfield 2000), and its withdrawal syndrome is characterized by a constellation of behavioral symptoms, including anxiety, anhedonia, depression, anger, difficulty in concentrating, impatience, insomnia, and restlessness (Hughes 2007), some of which are regulated by DOPrs.”

“5% (3), and adequate smoking cessation support may help patients overcome acute nicotine withdrawal syndrome (4).”

“In addition, there may be a relationship between smoking and depressive symptoms, with the cigarette being used as a resource to mitigate depression.(45) Smoking is implicated in a variety of complications affecting sleep, among many others.”

“Although this study marks a crucial first step in understanding the effect of nicotine deprivation on pain intensity, it remains unclear whether these results reflect a nicotine withdrawal effect or an offset effect of nicotine (e.g., Hughes, 2007).”

“Distinct from other withdrawal symptoms, sleep disturbances often do not diminish in severity within the first 21 days after cessation (Hughes 2007).”

“Our inclusion criteria were (1) a prospective withinparticipant test of PA during smoking versus abstinence conditions, (2) inclusion of only people who smoke cigarettes daily, (3) inclusion of an abstinence condition in which no pharmacological treatment was provided, (4) inclusion of at least overnight (ie, ≥12 h) a…”

“A major impediment for cigarette smokers attempting to quit is the tobacco abstinence syndrome characterized by anxiety, irritability, and difficulty concentrating (Hughes, 2007; Piasecki, 2006).”

“…individuals with depression who smoke have a greater likelihood to experience a major depressive episode upon smoking cessation (Dani and Harris, 2005; Hughes, 2007); and 3) nicotine supplementation ameliorates depressive symptoms, even in nonsmokers (McClernon et al., 2006; Salin-Pascual, 2002).”

“NRT use may be particularly beneficial for these smokers for managing nicotine withdrawal, symptoms of which overlap with global negative affect (7).”

“Such individuals do experience nicotine withdrawal soon after their last cigarette [36].”

“Although the nicotine literature suggests that tolerance does not develop to the performance-enhancing effects of nAChR agonists (White and Levin, 1999; Grottick and Higgins, 2000; Nelsen and Goldstein, 1972, 1973; Hahn and Stolerman, 2002), there are adverse cognitive effects upon withdrawal (Hughes, 2007), and acute…”

“(8, 11, 12) However, increased coughing has been described anecdotally as a cigarette withdrawal symptom,(7) and a recent study also suggests that cough and common cold symptoms may increase transiently after smoking cessation,(13) an effect that could be explained by a reduction in secretory immunoglobulin A.”

“A compromised self-regulatory system in dependent smokers may drive relapse rates to be as high as 50% in the first week and 95% in the first year following cessation, despite a desire to quit by nearly 70% of individuals (CDC, 2011a; Hughes, 2007).”

“Patients report difficulty concentrating and confusion with quantified nicotine withdrawal-induced impairments to working memory, attention , response inhibition, reward processing, and reaction time (Hughes 2007; McClernon et al. 2015; van Enkhuizen and Young 2016).”