Physiologic and subjective changes from smokeless tobacco withdrawal

Abstract

This study prospectively examined withdrawal symptoms in persons using Copenhagen smokeless tobacco and in persons smoking cigarettes. Smokeless tobacco chewers (N = 16) and cigarette smokers (N = 11) were examined during a 6-day period, during which time a number of measures were administered. Subjects used smokeless tobacco or smoked cigarettes on an ad libitum basis for a 3-day baseline period and then underwent tobacco deprivation. The significant changes that occurred relative to baseline after smokeless tobacco deprivation included decreased heart rate and orthostatic pulse change and increased craving for tobacco, confusion, eating, number of awakenings, and total scores on a withdrawal symptoms checklist for both self-rated and observer-rated measures. There were more changes and changes of greater severity among cigarette smokers.

Differentiating withdrawal patterns between smokers and smokeless tobacco users.

“…Consistent with previous research (Hatsukami et al, 1987;Hughes & Hatsukami, 1986;Hughes et al, 1990;Keenan, Hatsukami, & Anton, 1989), it was predicted that smokeless users and cigarette smokers would show signifi cant increases in withdrawal and craving at 24-hr and 48-hr deprivation compared to a 0-hr (prequit) baseline. Furthermore, it was expected that smokeless users and cigarette smokers would endorse substantially higher withdrawal and craving symptoms during the deprivation condition compared to the nondeprivation condition.…”

“…Second, repeated measures may bias deprivation effects by using only baseline comparisons. Although previous research utilized 3 nondeprivation days before deprivation (Hatsukami et al, 1987), our study is the fi rst to systematically examine the importance of stabilization.…”

Effect of non-nicotinic moist snuff replacement and lobeline on withdrawal symptoms during 48-h smokeless tobacco deprivation

“…Nicotine withdrawal severity as it pertains to implications for future smokeless tobacco treatment is an area that is not well understood. Cigarette smokers and smokeless users show similar signs and symptoms of nicotine withdrawal (Hatsukami, Gust, & Keenan, 1987;McChargue & Collins, 1998) and report comparable withdrawal severity ratings within the first 48 h of nicotine abstinence (McChargue & Collins, 1998). As such, it may be reasonable to suggest that severe nicotine withdrawal symptoms may also place smokeless tobacco users at a heightened risk for relapse.…”

“…The Minnesota Nicotine Withdrawal Scale (MNWS) assesses nicotine withdrawal symptoms from cigarettes (e.g., Hughes & Hatsukami, 1986) and smokeless tobacco (Hatsukami et al, 1987;. The MNWS has good construct validity and high reliability (Patten & Martin, 1996).…”

The Etiology and Treatment of Nicotine Dependence: A Biopsychosocial Perspective

“…On the other hand, nicotine levels in the brain from spit tobacco tend to increase gradually, reaching their peak about 30 minutes after administration, and decline slowly over 2 hours or more (Benowitz, Porchet, & Jacob, 1990). Despite the differing rates of nicotine absorption and depletion observed across these two modes of administration, spit tobacco users consistently report similar experiences of withdrawal, both in terms of the types of symptoms experienced (Hatsukami, Gust, & Keenan, 1987;McChargue & Collins, 1998;McChargue, Collins, & Cohen, 2002) and in terms of the level of severity (McChargue & Collins, 1998). Thus, the severity of withdrawal symptoms may be dictated by a variety of individual differences, including tobacco use patterns (Killen, Fortmann, Newman, & Varady, 1991), psychiatric comorbidities (Pomerleau, Marks, & Pomerleau, 2000), and personality factors (Gilbert & Gilbert, 1995;Madden et al, 1997).…”