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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BackgroundAsfar, T., Lee, D. J., Alcaide, M. L., Jones, D. L., Zvolensky, M. J., Oluwole, O. J., Pan, Y., Brewer, J. A., & Carrico, A. W. (2025) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntaf077 · Cited by 3
Zhang, Q., Tian, Y., He, B., Zhang, W., Liu, X., & Hao, J. (2025) · IBRO Neuroscience Reports · doi:10.1016/j.ibneur.2025.06.011 · Cited by 2
Marinas-Lacasta, A.-F., Fearon, I. M., Stevenson, M., Abusalem, T., Chapman, F., Sticken, E. T., Wieczorek, R., Pour, S. J., Dethloff, O., Komini, O., et al. (2025) · Frontiers in Toxicology · doi:10.3389/ftox.2025.1589480 · Cited by 2
“…HHS, among adult smokers, its continued use, and the prevention of relapse back to cigarette smoking (Fearon, 2022; Goldenson et al., 2021; Hajek et al., 2020; Phillips-Waller et al., 2021a; Phillips-Waller et al., 2021b; Hughes, 2007; Lechner et al., 2018; Shiffman and Kirchner, 2009; West, 2017).”
Nicotine and neurocognition in HIV: Translational challenges and therapeutic potential
Jha, N. A., Ayoub, S. M., Brody, A. L., & Young, J. W. (2025) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2025.106348 · Cited by 2
Wing, V. C., Cagniard, B., Murphy, N. P., & Shoaib, M. C. (2009) · Biochemical Pharmacology · doi:10.1016/j.bcp.2009.06.017 · Cited by 2
Case Report: Nicotine Replacement Therapy (NRT) in Hospitalized Surgical Patient
Sisler, L., Trout, S., Ripley‐Moffitt, C., et al. (2015) · The Journal of Smoking Cessation · doi:10.1017/jsc.2015.5 · Cited by 2
Green, H. J., O’Shea, O. K., Cotter, J., Philpott, H. L., & Newland, N. (2024) · Harm Reduction Journal · doi:10.1186/s12954-024-00993-0 · Cited by 2
“Post-cessation of smoking and nicotine consumption, absence of such functional effects (including reported temporary deficits in cognitive function) [12] have been cited as reasons for resumption of smoking [13].”
BackgroundPark, H., Han, B., Kim, B., Han, K., Kim, S., Kim, H., Youn, K., Park, H., Roh, Y. K., Choi, Y. S., et al. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.08.211 · Cited by 2
Wu, A. D., Lindson, N., Perera, R., Gao, M., Aveyard, P. N., Begh, R. A., & Hartmann‐Boyce, J. (2025) · BMC Family Practice · doi:10.1186/s12875-025-02843-9 · Cited by 2
“Even though most people who smoke report that they want to quit [23], many continue smoking because they consider smoking a coping mechanism for stress, offering them mental health benefits [24, 25].”
Rome, M., Romo, L., Hennequin, T., Meslot, C., Nègre, F., Illel, K., Zerhouni, O., & Laqueille, X. (2025) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2025.112941 · Cited by 2
Morita, Y., Ohta, M., Jiang, Y., Tanaka, H., & Yamato, H. (2018) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0000000000001466 · Cited by 1
Betts, K. S., Williams, G. M., Najman, J. M., et al. (2014) · Drug and Alcohol Review · doi:10.1111/dar.12169 · Cited by 2
Tobacco Dependence, the Most Important Cardiovascular Risk Factor: Treatment in the Czech Republic
Králíková, E., Kmeťová, A., Pánková, A., Zvolská, K., Felbrová, V., Kulovaná, S., Bortlíček, Z., Blaha, M., & Fraser, K. (2014) · Physiological Research · doi:10.33549/physiolres.932864 · Cited by 2
“Each patient’s level of nicotine dependence is assessed using a series of measures, including the Fagerström Test of Cigarette Dependence (FTCD) (Fagerström et al. 2012), CO in expired air, the number of cigarettes smoked in the past 12 h, Beck Depression Scale II (BDI-II) (Beck et al. 1996), and the Minnesota Withdra…”
MethodRole of clinical pharmacist in smoking cessation: A prospective randomized trial
Rajanandh, M. G., Ramasamy, C., Ethirajan, N., et al. (2012) · Archives of Pharmacy Practice · doi:10.4103/2045-080x.106237 · Cited by 2
Shifting pharmacology of nicotine use and withdrawal: Breaking the cycle of drug abuse
Sesia, T., & Grace, A. A. (2012) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1200179109 · Cited by 2
“Withdrawal is a series of affective and somatic symptoms that emerge a few hours after nicotine abstinence, reflecting neurochemical imbalance (4); however, the precise nature of this imbalance has remained elusive.”
BackgroundPeters, E. N., Cooney, J. L., Liss, T. B., Liss, A., Torello, R., Franco, C. A., Cavallo, D. A., O’Malley, S. S., & Krishnan‐Sarin, S. (2013) · The Journal of Smoking Cessation · doi:10.1017/jsc.2013.13 · Cited by 2
Sridharan, V., Cohen, T., Cobb, N. K., & Myneni, S. (2018) · Lecture notes in computer science · doi:10.1007/978-3-319-93372-6_29 · Cited by 2
The development and validation of a human screening model of tobacco abstinence
Grabski, M., Curran, H. V., Nutt, D., Husbands, S. M., Ferguson, S. G., & Munafo, M. R. (2019) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2019.107720 · Cited by 2
“Lastly, the current study design does not allow for an investigation on whether changes in task performance were due to withdrawal or an ‘offset effect’ (Hughes, 2007) (i.e., sustained changes following drug cessation, rather than the transient effects of withdrawal).”
BackgroundMagnetic resonance imaging for smoking abstinence: symptoms, mechanisms, and interventions
Bi, Y., & Hu, L. (2021) · Brain Science Advances · doi:10.26599/bsa.2021.9050016 · Cited by 2
“2 Tobacco abstinence symptoms Abstinence from chronic tobacco use produces a series of withdrawal symptoms, including affective, cognitive, and physical or somatic components [22].”
BackgroundInfluentialLee, G.-H., Lee, K. M., & Jung, S.-P. (2021) · Daehan imsang geon-gang jeungjin hakoeji/Daehan imsang geon'gang jeungjin haghoeji · doi:10.15384/kjhp.2021.21.3.83 · Cited by 2
Mohamed, A., Shaker, A., Ragab, M., & Ghoneim, A. H. A. (2016) · Egyptian Journal of Chest Diseases and Tuberculosis · doi:10.1016/j.ejcdt.2016.02.010 · Cited by 2
“Usually we start, by one tablet for one week then twice daily for 3 months [6].”
MethodReview: Pharmacotherapy for smoking cessation
Limsuwat, C., Saito, S., & Halvorson, K. M. (2018) · The Southwest Respiratory and Critical Care Chronicles · doi:10.12746/swrccc.v6i25.482 · Cited by 2
“Nicotine withdrawal usually peaks within a few days and lasts for a few weeks.(9) Withdrawal symptoms include increased appetite, weight gain, insomnia, irritability, anxiety, inability to concentrate, and restlessness.”
BackgroundTobacco and Cardiovascular Disease: Achieving Smoking Cessation in Cardiac Patients
Pipe, A. (2009) · doi:10.1002/9781444309768.ch10 · Cited by 4
Allen, A. M. (2012) · University of Minnesota Digital Conservancy (University of Minnesota) · Cited by 2
Varenicline: A Novel Drug for Smoking Cessation
Wardhan, N., Chopra, D., & Rehan, H. S. (2007) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-007-9090-8 · Cited by 2
“Withdrawal symptoms that occur after abrupt cessation/reduction of nicotine use include depressed mood, insomnia, irritability, anxiety, and difficulty in concentrating, restlessness, increased appetite and cravings for tobacco smoking (Hughes 2007).”
BackgroundSmoking Prevention and Cessation
Prokhorov, A. V., & Hudmon, K. S. (2014) · Lung Cancer · doi:10.1002/9781118468791.ch1 · Cited by 2
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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