Cigarette craving and withdrawal symptoms during temporary abstinence and the effect of nicotine gum
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Click here to download the presentation (Powerpoint or viewer needed) | Author(s)
Jamie Brown, Ph.D.1, Peter Hajek, Ph.D.2, Hayden McRobbie, MB, ChB, Ph.D.2, Jo Locker, MSc3, Fiona Gillison, Ph.D4, Andy McEwen, Ph.D.1, 3, Emma Beard, Ph.D. 1, and Robert West Ph.D.1, 3
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Jamie Brown Research Associate, University College London | Abstract Rationale: It is widely believed that nicotine withdrawal symptoms appear within a few hours of stopping smoking but few data exist documenting their emergence in naturalistic settings. In several countries, nicotine replacement products are licensed for relief of withdrawal symptoms during temporary abstinence, but again there are no data supporting this from naturalistic settings.
Objectives: To examine the emergence of cigarette craving and withdrawal symptoms during temporary abstinence in a naturalistic setting while using either nicotine or placebo gum.
Methods: Double-blind, randomized, placebo-controlled study in which 132 dependent smokers abstained for 6 hours with the assistance of either nicotine (2mg,n=42 or 4mg,n=24) or placebo (n=66) gum while travelling on a non-smoking train. Outcome measures were ratings of craving and mood withdrawal symptoms prior to treatment and at regular intervals during abstinence.
Results: In a multivariate analysis of all symptoms, there was no interaction between treatment and time (F(21,110)=1.28, p=0.20, η²p=0.20), nor an effect of treatment (F(7,124)=0.45, p=0.87, η²p=0.03). There was an effect of time (F(21,110)=11.59, p<0.001, η²p=0.69) and univariate analyses revealed that the majority of symptoms increased linearly throughout the period of abstinence with detectable onsets typically between the first 60 and 180 minutes of abstinence.
Conclusions: Smokers who temporarily abstain in naturalistic settings experience craving and withdrawal symptoms that emerge linearly over the first 6 hours of abstinence. Changes in craving and several mood withdrawal symptoms can be detected within the first three hours. Nicotine gum may not have an acute effect on the development of these symptoms.
| Source of funding: Pharmacia both funded the study and manufactured the smoking cessation medication that was investigated. Pharmacia have since merged with Pfizer.
| Declaration of interest: Individuals at Pharmacia provided advice on study design and data collection; however final decisions were taken by the investigators and were unrestricted. RW, AMcE, PH and HM have undertaken research and consultancy for companies that develop and manufacture smoking cessation medications. RW and AMcE have a share of a patent for a novel nicotine delivery device. There are no other relationships or activities that could appear to have influenced the submitted work; in particular the delay between data collection and publication was not a result of a sponsorship clause.
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