Anxiety diagnoses in smokers seeking cessation treatment: relations with tobacco dependence, withdrawal, outcome and response to treatment
Open accessAbstract
AIMS: To understand the relations among anxiety disorders and tobacco dependence, withdrawal symptoms, response to smoking cessation pharmacotherapy and ability to quit smoking. DESIGN: Randomized placebo-controlled clinical trial. Participants received six 10-minute individual counseling sessions and either: placebo, bupropion SR, nicotine patch, nicotine lozenge, bupropion SR + nicotine lozenge or nicotine patch + nicotine lozenge. SETTING: Two urban research sites. PARTICIPANTS: Data were collected from 1504 daily smokers (>9 cigarettes per day) who were motivated to quit smoking and did not report current diagnoses of schizophrenia or psychosis or bupropion use. MEASUREMENTS: Participants completed baseline assessments, the Composite International Diagnostic Interview and ecological momentary assessments for 2 weeks. FINDINGS: A structured clinical interview identified participants who ever met criteria for a panic attack (n = 455), social anxiety (n = 199) or generalized anxiety disorder (n = 99), and those who qualified for no anxiety diagnosis (n = 891). Smokers with anxiety disorders reported higher levels of nicotine dependence and pre-quit withdrawal symptoms. Those ever meeting criteria for panic attacks or social anxiety disorder showed greater quit-day negative affect. Smokers ever meeting criteria for anxiety disorders were less likely to be abstinent at 8 weeks and 6 months post-quit and showed no benefit from single-agent or combination-agent pharmacotherapies. CONCLUSIONS: Anxiety diagnoses were common among treatment-seeking smokers and were related to increased motivation to smoke, elevated withdrawal, lack of response to pharmacotherapy and impaired ability to quit smoking. These findings could guide treatment assignment algorithms and treatment development for smokers with anxiety diagnoses.
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Depression and anxiety place smokers at increased risk for cessation failure, though some studies suggest the evidence is inconclusive.
“Considerable research has assessed the impact of depression and anxiety on cessation outcomes, with a number of studies reporting that depression and anxiety place smokers at increased risk for cessation failure [9-14], with other studies suggesting that the evidence is inconclusive [6,15-18].”
From Acceptance and Commitment Therapy Wellness Program for Latine Adults Who Smoke and Have Psychological Distress: Protocol for a Feasibility Study (2023) · cites this paper as [12]
The Introduction (page unavailable) says some research links anxiety disorders to reduced quitting success, while the evidence is mixed. The paper’s Conclusions also report impaired quitting among smokers with anxiety diagnoses. It does not establish the claimed increased risk of cessation failure for smokers with depression. (LLM, conf=0.86)
Experimental — accuracy not yet measuredNegative affective symptoms of withdrawal act as negative reinforcers that sustain addiction.
“The emergence of negative affective symptoms, such as dysphoria, anxiety and irritability and, to a lesser extent, the somatic manifestations of withdrawal, serve as negative reinforcers that sustain the vicious cycle of addiction [23, 121, 132–134].”
From Mechanistic insights into nicotine withdrawal (2011) · cites this paper as [133]
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Self-citation
- Authors
- Piper, M. E., Cook, J. W., Schlam, T. R., Jorenby, D. E., & Baker, T. B.
- Affiliations
- University of Wisconsin System (US)
- University of Wisconsin–Madison (US)
- Corresponding author
- Piper, Megan E.
- Venue
- Addiction
- Publisher
- Wiley
- Published
- 2010-10-25
- Volume
- 106
- Issue
- 2
- Pages
- 418-427
- ISSN
- 0965-2140 (ISSN-L)
- 1360-0443
- PMC
- PMC3017215
- OpenAlex
- W1835789943
- Cited by
- 189
- References
- 53
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 8 · 2023: 20 · 2022: 5 · 2021: 9 · 2020: 9 · 2019: 14 · 2018: 13 · 2017: 15 · 2016: 17 · 2015: 17 · 2014: 25 · 2013: 17 · 2012: 8
- FWCI
- 6.93
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Addiction (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5k05ca139871-05)
- National Institute on Drug Abuse (K08DA021311, P50DA019706)
- National Cancer Institute (K05 CA-139871, 1K05CA139871)
- National Center for Research Resources (M01RR003186, KL2RR025012, M01 RR-03186)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- anxiety disorders, smoking cessation, tobacco dependence, nicotine withdrawal, bupropion, nicotine replacement therapy, panic disorder, social anxiety disorder, generalized anxiety disorder, treatment response, smoking abstinence, negative affect
- MeSH terms
- Adolescent, Anxiety Disorders, Counseling, Drug Therapy, Combination, Female, Humans, Interview, Psychological, Male, Nicotine, Recurrence, Smoking, Substance Withdrawal Syndrome, Tobacco Use Disorder, Logistic Models, Smoking Cessation, Bupropion, Treatment Outcome, Nicotinic Agonists, Dopamine Uptake Inhibitors
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