Tobacco Withdrawal Symptoms Before and After Nicotine Deprivation in Veteran Smokers with Posttraumatic Stress Disorder and with Major Depressive Disorder
- PMID: 33245346
- PMCID: PMC8186424
- DOI: 10.1093/ntr/ntaa242
Tobacco Withdrawal Symptoms Before and After Nicotine Deprivation in Veteran Smokers with Posttraumatic Stress Disorder and with Major Depressive Disorder
Abstract
Introduction: The high smoking prevalence amongst individuals with psychiatric disorders constitutes a major public health disparity. Negative reinforcement models of addiction posit that severe tobacco withdrawal symptoms, related to the affective vulnerabilities of these smokers, may thwart their quitting smoking successfully. However, relatively few studies have prospectively examined the effects of nicotine deprivation on withdrawal symptoms in these groups.
Methods: This study compared the level of withdrawal symptoms both before and after nicotine deprivation in those diagnosed with posttraumatic stress disorder (PTSD) or major depressive disorder (MDD) and in those without psychiatric diagnoses. Participants were US veterans who smoked (≥10 cigarettes/day) and met diagnostic criteria for PTSD (n = 38), MDD (n = 43), or no psychiatric diagnosis ("controls" n = 44). Participants attended study visits before and during 48-hour nicotine deprivation to report tobacco withdrawal symptoms. Analyses evaluated withdrawal symptom levels (baseline and during nicotine deprivation) and the change in symptoms related to nicotine deprivation and compared (1) participants with a psychiatric diagnosis versus controls, and (2) participants with PTSD versus MDD.
Results: Contrary to hypotheses, nicotine deprivation produced greater increases in most withdrawal symptoms amongst controls than in those with psychiatric diagnoses. Compared with controls, those with PTSD or MDD reported elevated symptom levels both before and after tobacco deprivation for most withdrawal symptoms.
Conclusions: These findings suggest that chronically high levels of distress and craving, rather than acute increases in withdrawal symptoms because of nicotine deprivation, may account for the quitting difficulties of those with comorbid conditions such as PTSD and MDD.
Implications: Severe tobacco withdrawal may account for the higher quitting difficulties of smokers with either posttraumatic stress disorder (PTSD) or major depressive disorder (MDD). Paradoxically, this study showed that individuals with no psychiatric diagnosis had greater increases in tobacco withdrawal severity because of nicotine deprivation than did those with either PTSD or MDD. Those with either PTSD or MDD showed high stable levels of withdrawal symptom severity both before and during two days of abstinence, suggesting that their quitting difficulties may be related to their chronically high levels of distress rather than nicotine deprivation per se.
Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco 2020.
Figures
Similar articles
-
Motives for Smoking in Those With PTSD, Depression, and No Psychiatric Disorder.J Dual Diagn. 2020 Jul-Sep;16(3):285-291. doi: 10.1080/15504263.2020.1759846. Epub 2020 May 12. J Dual Diagn. 2020. PMID: 32393117 Free PMC article.
-
Smoking-induced affect modulation in nonwithdrawn smokers with posttraumatic stress disorder, depression, and in those with no psychiatric disorder.J Abnorm Psychol. 2017 Feb;126(2):184-198. doi: 10.1037/abn0000247. Epub 2016 Dec 22. J Abnorm Psychol. 2017. PMID: 28004948 Free PMC article.
-
A Randomized Clinical Trial of Nicotine Preloading for Smoking Cessation in People with Posttraumatic Stress Disorder.J Dual Diagn. 2018 Jul-Sep;14(3):148-157. doi: 10.1080/15504263.2018.1468947. Epub 2018 Oct 10. J Dual Diagn. 2018. PMID: 29693495 Free PMC article. Clinical Trial.
-
Veteran and Military Mental Health Issues.2021 May 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. 2021 May 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 34283458 Free Books & Documents.
-
Suicidal Ideation.2021 Aug 6. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. 2021 Aug 6. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 33351435 Free Books & Documents.
Cited by 1 article
-
A longitudinal assessment of nicotine dependence, mental health, and attempts to quit Smoking: Evidence from waves 1-4 of the Population Assessment of Tobacco and Health (PATH) study.Addict Behav. 2021 Apr;115:106787. doi: 10.1016/j.addbeh.2020.106787. Epub 2020 Dec 16. Addict Behav. 2021. PMID: 33383566 Free PMC article.
Publication types
MeSH terms
Substances
Grant support
LinkOut - more resources
Full Text Sources
Medical
Miscellaneous