Abstinence-related expectancies predict smoking withdrawal effects: implications for possible causal mechanisms

Abstract

Rationale Despite the decades-long emphasis on withdrawal in leading models of addiction, the causal mechanisms driving smoking withdrawal effects are not well known. This gap in the knowledge base has stalled theory and treatment development for smoking dependence. Objectives As cognitive factors have been largely neglected as predictors of withdrawal, the current study sought to examine how smokers’ abstinence-related expectancies relate to withdrawal symptomatology. Methods Adult smokers (N=180; ≥10 cigarettes/day) participated in two counterbalanced experimental sessions involving either 16 h of abstinence or smoking as usual. At baseline, participants completed three withdrawal-related scales of the Smoking Abstinence Questionnaire (Withdrawal, Optimistic Outcomes, and Weight Gain scales), a self-report measure of smokers’ abstinence-related expectancies. During experimental sessions, participants completed a number of instruments that covered the range of smoking withdrawal effects (i.e., negative affect, urge/craving to smoke, diminished positive affect, concentration difficulty, hunger, and physiological symptoms). Results Even after controlling for the influence of demographic characteristics and cigarette dependence, smokers’ abstinence-related expectancies were meaningful predictors of abstinence-induced changes in various withdrawal symptoms (mean adjusted standardized β=0.22). Stronger expectancies for withdrawal and weight gain predicted more severe withdrawal effects, whereas stronger expectancies for optimistic outcomes predicted less severe withdrawal effects. Conclusions These findings are consistent with the notion that expectancies actively shape future experience and are the first to support the suggestion that smokers’ abstinence-related expectancies may be causal agents of withdrawal symptomatology. Future research is required to more conclusively determine whether abstinence-related expectancies mold withdrawal effects.

Hospitalized smokers' expectancies for electronic cigarettes versus tobacco cigarettes

“…The objective of the current study was to address this gap in the literature by assessing smokers’ expectancies for e-cigarettes relative to tobacco cigarettes across the full spectrum of expectancy domains. Results will not only portend potential population trends in e-cigarette use, but will allow for a better understanding of subjective responses to e-cigarettes (inasmuch that expectancies shape future experience; Hendricks & Leventhal, 2013) and inform tobacco use interventions. For example, assuming e-cigarettes represent an asset to the public health (Etter, 2013; Hajek et al, 2013; Wagener et al, 2012), uptake of e-cigarette use could be increased via messages intended to boost positive expectancies found to be lacking in comparison to tobacco cigarettes while minimizing negative expectancies that are discovered to be commensurate with tobacco use.…”

Clinical Significance of Early Smoking Withdrawal Effects and Their Relationships With Nicotine Metabolism: Preliminary Results From a Pilot Study

“…Despite an extensive literature on smoking withdrawal (Ashare, Falcone, & Lerman, 2013;Baker et al, 2012;Bidwell et al, 2013;Etter, Ussher, & Hughes, 2012;Evans et al, 2013;Hendricks & Leventhal, 2013), few studies have evaluated early withdrawal effects-those that emerge during the first minutes and hours after the last cigarette. To the best of our knowledge, only two studies have systematically evaluated the early time course of smoking withdrawal effects (Brown et al, 2013;Hendricks, Ditre, Drobes, & Brandon, 2006).…”

Predictors of nicotine withdrawal symptoms: findings from the first randomized smoking cessation trial in a low-income country setting

“…These include smokers' baseline serum cotinine levels (measure of nicotine levels), number of cigarettes smoked per day, motivation to smoke, and depression (Morrell et al 2008;West and Russell 1985). Despite the extensive literature on evaluating nicotine withdrawal symptoms in populations from high-income countries (Bidwell et al 2013;Gritz et al 1991;Hendricks and Leventhal 2013;Hendricks et al 2014;Morrell et al 2008;Neiro et al 2014;Piasecki et al 2003;West and Russell 1985;West et al 2008), such information in low-income countries lags behind. Findings from the first cessation trial that was conducted in a low-income country setting (Aleppo, Syria) show that having fewer nicotine withdrawal symptoms during smoking cessation treatment was associated with a greater likelihood of smoking abstinence (Ward et al 2013).…”