Effects of Acute Tobacco Abstinence in Adolescent Smokers Compared with Nonsmokers

Abstract

Purpose-Abstinence effects such as nicotine withdrawal and mood changes contribute to the maintenance of cigarette smoking in adult smokers and emerging reports on adolescent smokers suggest they may experience similar subjective effects when deprived. This study aimed to prospectively document tobacco abstinence induced changes during the first 48 hours of abstinence in adolescent smokers compared with nonsmokers, to distinguish effects distinct from typical adolescent lability.Methods-57 adolescent smokers and 44 adolescent nonsmokers were assessed during a 48 hour inpatient session. Characteristic nicotine withdrawal symptoms, cravings for cigarettes, and mood symptoms were measured at 13 time points following initiation of abstinence.Results-The only abstinence related effects observed were changes in craving for tobacco and feelings of anger. Tobacco craving increased and peaked quickly following initiation of abstinence and displayed a slight decrease towards the end of the 48 hour abstinence period, while anger symptoms peaked after more prolonged abstinence. Overall, smokers' symptoms and cravings were positively associated with amount of daily smoking but not with reports of dependence or biological measures of extent of use.Conclusions-We observed that among adolescent smokers, the primary effects associated with abstinence from cigarettes are relatively minimal and include a heightened and persistent craving to smoke and increases in anger. Although smokers had greater negative mood symptoms compared with nonsmokers, the presence and severity of most of these symptoms appear to be minimally altered by abstinence and not associated with dependency or biological indicators of amount of tobacco use.Research in adult smokers has shown that experiencing such abstinence effects as nicotine withdrawal and mood changes are important in the maintenance of cigarette smoking [1], and recent evidence indicates that the pattern, duration, and severity of withdrawal symptoms including negative affect, are particularly significant predictors of relapse in adult smokers [2,3,4]. However, the experience of tobacco withdrawal has not been as thoroughly evaluated in adolescent smokers.Retrospective evaluations from adolescent smokers indicate withdrawal experiences similar to those of adults when not smoking; including reported increases in cravings, nervousness, Please address correspondence to Suchitra Krishnan-Sarin, Ph.D., Yale University School of Medicine, Department of Psychiatry, CHMC, S 208, 34 Park Street, New Haven, CT 06519. Address e-mail correspondence to suchitra.krishnan-sarin@yale.edu. . Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could...

Preliminary examination of tobacco withdrawal in adolescent smokers during smoking cessation treatment

“…As has been shown previously (e.g. Killen et al, 2001; Smith et al, under review), symptoms were relatively mild and few in number with craving being the most notable effect.…”

“…In adolescent humans, the nicotine patch may not prevent development of withdrawal symptoms (Killen et al, 2001) and its efficacy has been less conclusively established with adolescent smokers (Hurt et al, 2000; Smith et al, 1996; Hanson et al, 2003; Moolchan et al 2005). Finally, interestingly, although they report withdrawal symptoms, adolescent smokers may in fact only differ from their nonsmoking peers on reports of cravings in response to abstinence (Smith et al, under review; Prokhorov et al 2005). In addition, adolescents’ patterns of tobacco use are likely more highly constrained than those of adults by such factors as school or home rules and regulations (Wiltshire, Amos, Haw, & McNeill, 2005).…”

Nicotine withdrawal produces a decrease in extracellular levels of dopamine in the nucleus accumbens that is lower in adolescent versus adult male rats

“…Furthermore, there is evidence to suggest that nicotine replacement does not prevent the expression of nicotine withdrawal symptoms in adolescent smokers (Killen et al, 2001). Moreover, a recent study directly comparing adolescent smokers to non-smokers found that young smokers only exhibit mild symptoms during withdrawal (anger and craving) that do not appear to be associated with self-reports of dependence or biological markers of cigarette use (Smith et al, 2008a). Another report from this laboratory found that withdrawal symptoms on the quit day were not related to relapse behavior in adolescent smokers (Smith et al, 2008b).…”

Adolescent brain maturation and smoking: What we know and where we’re headed

“…For completeness, however, we briefly review findings relating to adolescent withdrawal. Relative to the adult experience of withdrawal, adolescents experience mild withdrawal symptoms (Smith et al, 2008a). Withdrawal symptoms also seem to be less relevant to promoting relapse during quit attempts in adolescent relative to adult smokers (Smith et al, 2008b).…”