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Effects of abstinence from tobacco: Etiology, animal models, epidemiology, and significance: A subjective review
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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“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 [19]
In the citing paper
“Of these, depressed mood early on in the quit attempt appears to be the one most strongly associated with relapse (19)”
From The Multiple Facets of Cigarette Addiction and What They Mean for Encouraging and Helping Smokers to Stop (2009) · cites this paper as [19]
In the citing paper
“It has also been found that chronic financial stress (26) and depression (19), which deplete mental energy are associated with greater risk of relapse.”
From The Multiple Facets of Cigarette Addiction and What They Mean for Encouraging and Helping Smokers to Stop (2009) · cites this paper as [19]
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Self-citationImpact of Combined Weight-Control and Smoking-Cessation Interventions on Body Weight
Varner, L. M. (1999) · Journal of the American Dietetic Association · doi:10.1016/s0002-8223(99)00312-0 · Cited by 7
Tate, J. C., Stanton, A. L., Green, S. B., & Schmitz, J. M. (1996) · Experimental and Clinical Psychopharmacology · doi:10.1037/1064-1297.4.3.330 · Cited by 6
Nicotine metabolism in cigarette smokers and nonsmokers
Kyerematen, G. A., Morgan, M. L., Chattopadhyay, B., deBethizy, J. D., & Vesell, E. S. (1994) · Clinical Pharmacology & Therapeutics · doi:10.1038/clpt.1994.14 · Cited by 6
Nicotine withdrawal and road accidents
Knowles, J. (1999) · Nature · doi:10.1038/22037 · Cited by 4
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Effects of abstinence from tobacco: Valid symptoms and time course
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Self-citationThe co‐occurring use and misuse of cannabis and tobacco: a review
Arpana Agrawal, A., Budney, A. J., & Lynskey, M. T. (2012) · Addiction · doi:10.1111/j.1360-0443.2012.03837.x · Cited by 534
Weight gain in smokers after quitting cigarettes: meta-analysis
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Cigarette smoking and depression comorbidity: systematic review and proposed theoretical model
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Smoking and suicide: A brief overview
Hughes, J. R. (2008) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2008.06.003 · Cited by 236
Self-citation
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
- 329-339
- ISSN
- 1462-2203 (ISSN-L)
- OpenAlex
- W2100829515
- Semantic Scholar
- b62e71eeaaa699df395760582dbbf7df27b7e55e
- Cited by
- 173
- References
- 116
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 3 · 2023: 5 · 2022: 3 · 2021: 6 · 2020: 36 · 2019: 6 · 2018: 4 · 2017: 6 · 2016: 7 · 2015: 10 · 2014: 12 · 2013: 10 · 2012: 7
- FWCI
- 8.01
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Nicotine & Tobacco Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Drug Abuse (DA00490)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Nicotinic Acetylcholine Receptors Study
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Keywords
- smoking abstinence, nicotine withdrawal, smoking cessation, withdrawal symptoms, depression, relapse, dopaminergic activity, nicotinic acetylcholine receptors, intracranial self-stimulation
- MeSH terms
- Animals, Mental Disorders, Disease Models, Animal, Humans, Nicotine, Research Design, Substance Withdrawal Syndrome, Tobacco Use Disorder, Randomized Controlled Trials as Topic, Smoking Cessation
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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